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Historically, scientific research, diagnostic testing, and drug treatment have focused on addressing one of two disease states: latent TB infection or active TB disease. Recent research has clearly demonstrated that human TB infection, from latent infection to active disease, exists within a continuous spectrum of metabolic bacterial activity and antagonistic immunological responses. This revised understanding leads us to propose two additional clinical states: incipient and subclinical TB. The recognition of incipient and subclinical TB, which helps divide latent and active TB along the clinical disease spectrum, provides opportunities for the development of diagnostic and therapeutic interventions to prevent progression to active TB disease and transmission of TB bacilli. In this report, we review the current understanding of the pathogenesis, immunology, clinical epidemiology, diagnosis, treatment, and prevention of both incipient and subclinical TB, two emerging clinical states of an ancient bacterium.<\/jats:p>","DOI":"10.1128\/cmr.00021-18","type":"journal-article","created":{"date-parts":[[2018,7,17]],"date-time":"2018-07-17T07:53:42Z","timestamp":1531814022000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":547,"title":["Incipient and Subclinical Tuberculosis: a Clinical Review of Early Stages and Progression of Infection"],"prefix":"10.1128","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9569-4097","authenticated-orcid":false,"given":"Paul K.","family":"Drain","sequence":"first","affiliation":[{"name":"Department of Global Health, University of Washington, Seattle, Washington, USA"},{"name":"Department of Medicine, University of Washington, Seattle, Washington, USA"},{"name":"Department of Epidemiology, University of Washington, Seattle, Washington, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristina L.","family":"Bajema","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Washington, Seattle, Washington, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Dowdy","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keertan","family":"Dheda","sequence":"additional","affiliation":[{"name":"University of Cape Town, Cape Town, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kogieleum","family":"Naidoo","sequence":"additional","affiliation":[{"name":"Centre for the AIDS Programme of Research in Africa, Durban, South Africa"},{"name":"South African Medical Research Council-CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Durban, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel G.","family":"Schumacher","sequence":"additional","affiliation":[{"name":"Foundation for Innovative New Diagnostics, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuyi","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Global Health, University of Washington, Seattle, Washington, USA"},{"name":"Center for Infectious Disease Research, Seattle, Washington, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin","family":"Meermeier","sequence":"additional","affiliation":[{"name":"Oregon Health and Science University, Portland, Oregon, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David M.","family":"Lewinsohn","sequence":"additional","affiliation":[{"name":"Oregon Health and Science University, Portland, Oregon, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David R.","family":"Sherman","sequence":"additional","affiliation":[{"name":"Department of Global Health, University of Washington, Seattle, Washington, USA"},{"name":"Center for Infectious Disease Research, Seattle, Washington, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"235","reference":[{"key":"e_1_3_1_2_2","volume-title":"Global tuberculosis report","author":"World Health Organization","year":"2016","unstructured":"World Health Organization. 2016. 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