{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T19:27:36Z","timestamp":1792006056866,"version":"4.4.0"},"reference-count":118,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2025,3,21]],"date-time":"2025-03-21T00:00:00Z","timestamp":1742515200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University of Medicine and Pharmacy of Craiova, Romania"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Tuberculosis (TB) continues to be a major public health challenge in low- and middle-income countries (LMICs), where high burdens of coinfections exacerbate the disease\u2019s impact. In 2023, an estimated 8.2 million people were newly diagnosed with tuberculosis worldwide, reflecting an increase from 7.5 million in 2022 and 7.1 million in 2019. In LMICs, limited access to healthcare, inadequate nutrition, and poor living conditions contribute to higher coinfection rates among TB patients, leading to delayed diagnosis and treatment, which in turn exacerbates disease severity and facilitates transmission. This narrative review synthesizes the epidemiology, clinical implications, diagnostic challenges, and management strategies related to TB coinfections with viral pathogens including HIV, SARS-CoV-2, and influenza, bacteria such as Streptococcus pneumoniae, Staphylococcus aureus, Klebsiella pneumoniae, and Pseudomonas aeruginosa, fungi such as Aspergillus and Candida species, and parasites. This review highlights that overlapping symptoms, immune system compromise, and socioeconomic barriers in LMICs lead to delayed diagnoses and suboptimal treatment outcomes, while also addressing the challenges of managing drug interactions particularly in HIV\u2013TB coinfections and underscoring the need for integrated diagnostic approaches, improved treatment regimens, and strengthened healthcare systems, thereby consolidating current evidence to inform future research priorities and policy interventions aimed at reducing the overall burden of TB and its coinfections in resource-limited settings.<\/jats:p>","DOI":"10.3390\/jcm14072154","type":"journal-article","created":{"date-parts":[[2025,3,21]],"date-time":"2025-03-21T10:10:08Z","timestamp":1742551808000},"page":"2154","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":44,"title":["Coinfections in Tuberculosis in Low- and Middle-Income Countries: Epidemiology, Clinical Implications, Diagnostic Challenges, and Management Strategies\u2014A Narrative Review"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-6335-1627","authenticated-orcid":false,"given":"Ramona","family":"Cioboata","sequence":"first","affiliation":[{"name":"Pneumology Department, University of Medicine and Pharmacy, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-8409-5904","authenticated-orcid":false,"given":"Mara Amalia","family":"Balteanu","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, Faculty of Medicine, Titu Maiorescu University, 031593 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6967-3789","authenticated-orcid":false,"given":"Andrei","family":"Osman","sequence":"additional","affiliation":[{"name":"Department of Anatomy and Embryology, University of Medicine and Pharmacy, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-3856-7917","authenticated-orcid":false,"given":"Silviu Gabriel","family":"Vlasceanu","sequence":"additional","affiliation":[{"name":"Department of Physiology, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3510-3838","authenticated-orcid":false,"given":"Ovidiu Mircea","family":"Zlatian","sequence":"additional","affiliation":[{"name":"Department of Microbiology, University of Medicine and Pharmacy, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denisa Maria","family":"Mitroi","sequence":"additional","affiliation":[{"name":"Doctoral School, University of Medicine and Pharmacy, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-9976-2256","authenticated-orcid":false,"given":"Oana Maria","family":"Catana","sequence":"additional","affiliation":[{"name":"Doctoral School, University of Medicine and Pharmacy, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6006-8443","authenticated-orcid":false,"given":"Adriana","family":"Socaci","sequence":"additional","affiliation":[{"name":"Department of Biology and Life Science, Vasile Goldis University Arad, 310025 Arad, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eugen-Nicolae","family":"Tieranu","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine-Cardiology, University of Medicine and Pharmacy, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,21]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2023). 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