{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T10:28:41Z","timestamp":1792319321599,"version":"4.4.0"},"reference-count":56,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2023,1,10]],"date-time":"2023-01-10T00:00:00Z","timestamp":1673308800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Lung cancer and pulmonary tuberculosis are two significant public health problems that continue to take millions of lives each year. They may have similar symptoms and, in some cases, are diagnosed simultaneously or may have a causal relationship. In tuberculosis disease, the chronic inflammation, different produced molecules, genomic changes, and fibrosis are believed to be important factors that may promote carcinogenesis. As a reverse reaction, the development of carcinogenesis and the treatment may induce the reactivation of latent tuberculosis infection. Moreover, the recently used checkpoint inhibitors are a debatable subject since they help treat lung cancer but may lead to the reactivation of pulmonary tuberculosis and checkpoint-induced pneumonitis. Pulmonary rehabilitation is an effective intervention in post-tuberculosis patients and lung cancer patients and should be recommended to improve outcomes in these pathologies.<\/jats:p>","DOI":"10.3390\/ijerph20021282","type":"journal-article","created":{"date-parts":[[2023,1,11]],"date-time":"2023-01-11T01:33:12Z","timestamp":1673400792000},"page":"1282","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":50,"title":["The Bidirectional Relationship between Pulmonary Tuberculosis and Lung Cancer"],"prefix":"10.3390","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5927-7069","authenticated-orcid":false,"given":"M\u0103d\u0103lina","family":"Preda","sequence":"first","affiliation":[{"name":"Marius Nasta Institute of Pneumology, 050159 Bucharest, Romania"},{"name":"Microbiology, Parasitology and Virology Discipline, Department of Fundamental Sciences, Faculty of Midwives and Nursing, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 020021 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bogdan Cosmin","family":"T\u0103nase","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Institute of Oncology \u201cProf. Dr. Al. 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(2022). The Relationship between Previous Pulmonary Tuberculosis and Risk of Lung Cancer in the Future. Infect Agent Cancer, 17.","DOI":"10.1186\/s13027-022-00434-2"},{"key":"ref_2","unstructured":"(2022, November 06). World Health Organization Cancer. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/cancer."},{"key":"ref_3","unstructured":"(2022, November 03). World Health Organization Cancer Today. Available online: http:\/\/gco.iarc.fr\/today\/home."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"604","DOI":"10.1038\/s42003-020-01318-0","article-title":"Lung Gene Expression Signatures Suggest Pathogenic Links and Molecular Markers for Pulmonary Tuberculosis, Adenocarcinoma and Sarcoidosis","volume":"3","author":"Chai","year":"2020","journal-title":"Commun. Biol."},{"key":"ref_5","unstructured":"World Health Organization (2022). Global Tuberculosis Report 2022, World Health Organization."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"286","DOI":"10.21149\/10090","article-title":"Tuberculosis and Lung Cancer","volume":"61","author":"Arrieta","year":"2019","journal-title":"Salud. Publica. Mex."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Bickett, T.E., and Karam, S.D. (2020). Tuberculosis\u2013Cancer Parallels in Immune Response Regulation. Int. J. Mol. Sci., 21.","DOI":"10.3390\/ijms21176136"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Malik, A.A., Sheikh, J.A., Ehtesham, N.Z., Hira, S., and Hasnain, S.E. (2022). Can Mycobacterium Tuberculosis Infection Lead to Cancer? Call for a Paradigm Shift in Understanding TB and Cancer. Int. J. Med. Microbiol., 312.","DOI":"10.1016\/j.ijmm.2022.151558"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"46","DOI":"10.3816\/CLC.2003.n.021","article-title":"The potential contributions of chronic inflammation to lung carcinogenesis","volume":"5","author":"Ballaz","year":"2003","journal-title":"Clin. Lung Cancer"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Villase\u00f1or, T., Madrid-Paulino, E., Maldonado-Bravo, R., Urb\u00e1n-Arag\u00f3n, A., P\u00e9rez-Mart\u00ednez, L., and Pedraza-Alva, G. (2017). Activation of the Wnt Pathway by Mycobacterium tuberculosis: A Wnt\u2013Wnt Situation. Front. Immunol., 8.","DOI":"10.3389\/fimmu.2017.00050"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1586\/14737140.8.4.605","article-title":"Inflammation in the Development of Lung Cancer: Epidemiological Evidence","volume":"8","author":"Engels","year":"2008","journal-title":"Expert Rev. Anticancer. Ther."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Chen, X., Wang, L., Su, X., Luo, S., Tang, X., and Huang, Y. (2020). Identification of Potential Target Genes and Crucial Pathways in Small Cell Lung Cancer Based on Bioinformatic Strategy and Human Samples. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0242194"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Ahmad, F., Rani, A., Alam, A., Zarin, S., Pandey, S., Singh, H., Hasnain, S.E., and Ehtesham, N.Z. (2022). Macrophage: A Cell With Many Faces and Functions in Tuberculosis. Front. Immunol., 13.","DOI":"10.3389\/fimmu.2022.747799"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Upadhyay, S., Mittal, E., and Philips, J.A. (2018). Tuberculosis and the Art of Macrophage Manipulation. Pathog. Dis., 76.","DOI":"10.1093\/femspd\/fty037"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1016\/j.chom.2012.09.012","article-title":"Mycobacterium Tuberculosis-Driven Targeted Recalibration of Macrophage Lipid Homeostasis Promotes the Foamy Phenotype","volume":"12","author":"Singh","year":"2012","journal-title":"Cell Host Microbe"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Sobecki, M., Mrouj, K., Camasses, A., Parisis, N., Nicolas, E., Ll\u00e8res, D., Gerbe, F., Prieto, S., Krasinska, L., and David, A. (2016). The Cell Proliferation Antigen Ki-67 Organises Heterochromatin. eLife, 5.","DOI":"10.7554\/eLife.13722"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Cic\u0117nas, S., and Vencevi\u010dius, V. (2007). Lung Cancer in Patients with Tuberculosis. World J. Surg. Oncol., 5.","DOI":"10.1186\/1477-7819-5-22"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Wang, J., Ge, P., Qiang, L., Tian, F., Zhao, D., Chai, Q., Zhu, M., Zhou, R., Meng, G., and Iwakura, Y. (2017). The Mycobacterial Phosphatase PtpA Regulates the Expression of Host Genes and Promotes Cell Proliferation. Nat. Commun., 8.","DOI":"10.1038\/s41467-017-00279-z"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2936","DOI":"10.1002\/ijc.24636","article-title":"Facts and Fiction of the Relationship between Preexisting Tuberculosis and Lung Cancer Risk: A Systematic Review","volume":"125","author":"Liang","year":"2009","journal-title":"Int. J. Cancer"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Bhatt, M.L.B., Kant, S., and Bhaskar, R. (2012). Pulmonary Tuberculosis as Differential Diagnosis of Lung Cancer. South Asian J. Cancer, 1.","DOI":"10.4103\/2278-330X.96507"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Mahler, B., de Vries, G., van Hest, R., Gainaru, D., Menezes, D., Popescu, G., Story, A., and Abubakar, I. (2021). Use of Targeted Mobile X-Ray Screening and Computer-Aided Detection Software to Identify Tuberculosis among High-Risk Groups in Romania: Descriptive Results of the E-DETECT TB Active Case-Finding Project. BMJ Open, 11.","DOI":"10.1136\/bmjopen-2020-045289"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Xiang, Y., Huang, C., He, Y., and Zhang, Q. (2021). Cancer or Tuberculosis: A Comprehensive Review of the Clinical and Imaging Features in Diagnosis of the Confusing Mass. Front. Oncol., 11.","DOI":"10.3389\/fonc.2021.644150"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Hong, J.Y., Jang, S.H., Kim, S.Y., Chung, K.S., Song, J.H., Park, M.S., Kim, Y.S., Kim, S.K., Chang, J., and Kang, Y.A. (2016). Elevated Serum CA 19-9 Levels in Patients with Pulmonary Nontuberculous Mycobacterial Disease. Braz. J. Infect. Dis., 20.","DOI":"10.1016\/j.bjid.2015.09.005"},{"key":"ref_24","first-page":"645","article-title":"The Value of Combination Analysis of Tumor Biomarkers for Early Differentiating Diagnosis of Lung Cancer and Pulmonary Tuberculosis","volume":"49","author":"Jia","year":"2019","journal-title":"Ann. Clin. Lab. Sci."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Shu, C.-C., Chang, S.-C., Lai, Y.-C., Chang, C.-Y., Wei, Y.-F., and Chen, C.-Y. (2019). Factors for the Early Revision of Misdiagnosed Tuberculosis to Lung Cancer: A Multicenter Study in A Tuberculosis-Prevalent Area. J. Clin. Med., 8.","DOI":"10.3390\/jcm8050700"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1002\/eji.201646875","article-title":"Immune Checkpoints and Their Inhibition in Cancer and Infectious Diseases","volume":"47","author":"Dyck","year":"2017","journal-title":"Eur. J. Immunol."},{"key":"ref_27","first-page":"6439","article-title":"Correlation between Resistance Profile and Immunosuppression in Heavily Treated HIV-1 Infected Romanian Patients","volume":"16","author":"Manolescu","year":"2011","journal-title":"Rom. Biotechnol. Lett."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"956","DOI":"10.1016\/S1470-2045(16)30066-3","article-title":"Safety and Clinical Activity of Pembrolizumab for Treatment of Recurrent or Metastatic Squamous Cell Carcinoma of the Head and Neck (KEYNOTE-012): An Open-Label, Multicentre, Phase 1b Trial","volume":"17","author":"Seiwert","year":"2016","journal-title":"Lancet Oncol."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Ni\u021b\u0103, I., Ni\u021bipir, C., Toma, \u0218.A., Limb\u0103u, A.M., P\u00eervu, E., B\u0103d\u0103r\u0103u, I.A., Suciu, I., Suciu, G., and Manolescu, L.S.C. (2021). Correlation between Androgen Receptor Expression and Immunohistochemistry Type as Prognostic Factors in a Cohort of Breast Cancer Patients: Result from a Single-Center, Cross Sectional Study. Healthcare, 9.","DOI":"10.3390\/healthcare9030277"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Jayaraman, P., Jacques, M.K., Zhu, C., Steblenko, K.M., Stowell, B.L., Madi, A., Anderson, A.C., Kuchroo, V.K., and Behar, S.M. (2016). TIM3 Mediates T Cell Exhaustion during Mycobacterium Tuberculosis Infection. PLoS Pathogens, 12.","DOI":"10.1371\/journal.ppat.1005490"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1038\/s41419-018-1237-y","article-title":"Mycobacterium Tuberculosis Antigens Repress Th1 Immune Response Suppression and Promotes Lung Cancer Metastasis through PD-1\/PDl-1 Signaling Pathway","volume":"10","author":"Cao","year":"2019","journal-title":"Cell Death Dis."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1038\/nri3862","article-title":"Molecular and Cellular Insights into T cell Exhaustion","volume":"15","author":"Wherry","year":"2015","journal-title":"Nat. Rev. Immunol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"116","DOI":"10.4049\/jimmunol.181.1.116","article-title":"Programmed Death (PD)-1: PD-Ligand 1\/PD-Ligand 2 Pathway Inhibits T Cell Effector Functions during Human Tuberculosis","volume":"181","author":"Jurado","year":"2008","journal-title":"J. Immunol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"13402","DOI":"10.1073\/pnas.1007394107","article-title":"Programmed Death-1 (PD-1)\u2013Deficient Mice are Extraordinarily Sensitive to Tuberculosis","volume":"107","author":"Chen","year":"2010","journal-title":"Proc. Natl. Acad. Sci."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1080\/1040841X.2016.1185603","article-title":"T-Cell Exhaustion in Tuberculosis: Pitfalls and Prospects","volume":"43","author":"Khan","year":"2017","journal-title":"Crit. Rev. Microbiol."},{"key":"ref_36","unstructured":"(2023, January 05). European Union Standards for Tuberculosis Care\u20142017 update. Available online: https:\/\/www.ecdc.europa.eu\/en\/publications-data\/european-union-standards-tuberculosis-care-2017-update."},{"key":"ref_37","unstructured":"Tuberculoza, Marius Nasta."},{"key":"ref_38","unstructured":"Thomas, E.H., and Judith, K.A. (2022). Tuberculosis (TB) Treatment & Management, WebMD LLC."},{"key":"ref_39","unstructured":"(2023, January 06). Global Burden of Bacterial Antimicrobial Resistance in 2019: A Systematic Analysis\u2014PubMed, Available online: https:\/\/pubmed.ncbi.nlm.nih.gov\/35065702\/."},{"key":"ref_40","first-page":"25","article-title":"Resistance Pattern of Multi-Drug Resistant Strains of Mycobacterium Tuberculosis and Characteristics of Patients with Multi-Drug Resistant Tuberculosis","volume":"75","author":"Moisoiu","year":"2016","journal-title":"Roum. Arch. Microbiol. Immunol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"S3392","DOI":"10.21037\/jtd.2018.07.11","article-title":"Identifying Lung Cancer in Patients with Active Pulmonary Tuberculosis","volume":"10","author":"Parker","year":"2018","journal-title":"J. Thorac. Dis."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1016\/j.ijid.2021.09.072","article-title":"Tuberculosis Treatment Incompletion in Patients with Lung Cancer: Occurrence and Predictors","volume":"113","author":"Lee","year":"2021","journal-title":"Int. J. Infect. Dis."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1183","DOI":"10.1183\/09031936.00145813","article-title":"Pulmonologists and Lung Cancer: Pivotal Role in Multidisciplinary Approach","volume":"42","author":"Gaga","year":"2013","journal-title":"Eur. Respir. J."},{"key":"ref_44","unstructured":"EMA Keytruda (2015). Summary of Product Characteristics, Merck Sharp & Dohme B.V."},{"key":"ref_45","unstructured":"EMA Tecentriq (2017). Summary of Product Characteristics, Roche Registration GmbH."},{"key":"ref_46","unstructured":"EMA Opdivo (2015). Summary of Product Characteristics, Bristol-Myers Squibb Pharma EEIG."},{"key":"ref_47","unstructured":"EMA Imfinzi (2018). Summary of Product Characteristics, AstraZeneca AB."},{"key":"ref_48","unstructured":"EMA Libtayo (2019). Summary of Product Characteristics, Regeneron Ireland Designated Activity Company (DAC)."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1111\/1759-7714.14274","article-title":"Immune Checkpoint Inhibitor-Related Adverse Events in Lung Cancer: Real-World Incidence and Management Practices of 1905 Patients in China","volume":"13","author":"Shi","year":"2022","journal-title":"Thorac. Cancer"},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Cameli, P., Faverio, P., Ferrari, K., Bonti, V., Marsili, S., Mazzei, M.A., Mazzoni, F., Bartolucci, M., Scotti, V., and Bertolini, F. (2022). Immune-Checkpoint-Inhibitor-Related Lung Toxicity: A Multicentre Real-Life Retrospective Portrait from Six Italian Centres. Life, 12.","DOI":"10.3390\/life12081149"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1107","DOI":"10.1016\/j.chest.2020.11.027","article-title":"Chest CT Diagnosis and Clinical Management of Drug-Related Pneumonitis in Patients Receiving Molecular Targeting Agents and Immune Checkpoint Inhibitors: A Position Paper from the Fleischner Society","volume":"159","author":"Johkoh","year":"2021","journal-title":"Chest"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1016\/j.anr.2020.08.010","article-title":"The Effects of the Respiratory Rehabilitation Program on Perceived Self-Efficacy and Dyspnea in Patients with Lung Cancer","volume":"14","author":"Saetan","year":"2020","journal-title":"Asian Nurs. Res."},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Singh, S.K., Naaraayan, A., Acharya, P., Menon, B., Bansal, V., and Jesmajian, S. (2018). Pulmonary Rehabilitation in Patients with Chronic Lung Impairment from Pulmonary Tuberculosis. Cureus, 10.","DOI":"10.7759\/cureus.3664"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"107","DOI":"10.2478\/pneum-2019-0024","article-title":"Pulmonary Rehabilitation and Tuberculosis: A New Approach for an Old Disease","volume":"68","author":"Mahler","year":"2019","journal-title":"Pneumologia"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1016\/j.jtho.2021.12.005","article-title":"Quitting Smoking at or around Diagnosis Improves the Overall Survival of Lung Cancer Patients: A Systematic Review and Meta-Analysis","volume":"17","author":"Caini","year":"2022","journal-title":"J. Thorac. Oncol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"9428","DOI":"10.3390\/curroncol29120741","article-title":"Nivolumab Hypersensitivity Reactions a Myth or Reality in Solid Tumors\u2014A Systematic Review of the Literature","volume":"29","author":"Slavu","year":"2022","journal-title":"Curr. 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