July 18, 2025, 9:04 am | Read time: 6 minutes
In Germany, it is often overlooked that diseases once thought to be defeated, like tuberculosis, still exist and that the number of cases has recently increased. Worldwide, about a quarter of the population is infected with the pathogen, and each year around 1.25 million people die from the world’s most common infectious disease.1 FITBOOK editor Michel Winges informs you about the disease and the tuberculosis situation in Germany.
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Overview
What is Tuberculosis?
Tuberculosis is caused by the bacterium “Mycobacterium tuberculosis.” It most commonly affects the lungs but can potentially attack any organ in the body. Transmission usually occurs through the air, such as when infected individuals cough or sneeze.
Approximately two billion people worldwide carry the pathogen without showing any symptoms. This is because most infections initially proceed “silently” and may only manifest later or not at all.
Tuberculosis in Germany
Tuberculosis has not disappeared in Germany; on the contrary, around 4,500 new cases were reported in 2023, which is about a ten percent increase from the previous year. These are significant numbers considering that Germany is considered a low-incidence country internationally. It is also notable that there was a marked increase among children under 15, with numbers rising by 26 percent compared to the previous year.2
What are the Reasons for the Increase?
A clear cause for the increase in numbers cannot be identified, but there are indications and assumptions. On one hand, immigration from countries with significantly higher tuberculosis cases could play a role, as many of the reported cases involve people who have recently arrived in Germany.
On the other hand, increasingly resistant pathogens make tuberculosis harder to treat and infection chains more difficult to break.
No Cause for Alarm
Despite the increase, tuberculosis numbers in Germany remain low by international standards. For most people in the country, the risk of infection is still very low. Modern diagnostics, good treatment options, and a vigilant health system provide protection. It is still important to monitor developments closely and pay special attention to at-risk groups. However, there is no reason for the general population to be concerned.
Tuberculosis Worldwide
While tuberculosis is rare in Germany, it remains the most common infectious disease worldwide. In 2023, about 10.8 million people were newly diagnosed with tuberculosis. Most of them live in these countries, in descending order: India, Indonesia, China, the Philippines, and Pakistan.3
Despite all progress, more than a million people still die from the disease each year. The main reasons for the persistently high prevalence are poverty, poor health care, and often late diagnosis. As long as these conditions do not fundamentally change, tuberculosis will remain one of the world’s greatest health challenges.
Incubation Period
After contracting tuberculosis, it can take six to eight weeks before an infection can be detected in the body. However, this does not mean that one is already ill, only that the immune system has come into contact with the pathogen. Only about five to ten percent of adolescents and adults actually develop the disease. For young children or people with weakened immune systems, this risk is significantly higher, at about twenty to forty percent.
Often, the body’s defenses manage to neutralize the bacteria or at least keep them in check. The pathogens then remain “dormant” in the body and can become active years or even decades later if the immune defense weakens. In children, tuberculosis often breaks out more frequently and usually within the first year after infection, often without typical symptoms.
What About the Risk of Infection After Contracting?
Those with open pulmonary tuberculosis who expel bacteria when coughing can infect others. However, those who consistently take medication are generally no longer contagious after two to three weeks of treatment.4
How is Tuberculosis Transmitted?
Those with open pulmonary tuberculosis release bacteria when coughing or sneezing. This creates tiny, pathogen-laden droplets (aerosols) that can float in the air and be inhaled by others. However, it is not overly contagious. Whether one becomes infected largely depends on two factors:
- how closely and for how long one has been in contact with the infected person
- how weak one’s immune system is
If tuberculosis affects other organs, such as bones, joints, or lymph nodes, there is usually no risk of infection.
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Symptoms
As mentioned, tuberculosis can rarely affect organs other than the lungs. In such cases, symptoms are often difficult to recognize because they can vary greatly. Generally, tuberculosis—whether in the lungs or other organs—begins insidiously, progresses differently in each person, and symptoms often persist for weeks. If tuberculosis is not treated and the condition worsens, the disease can even be fatal in the worst-case scenario.5
Symptoms When the Lungs Are Affected:
- Persistent cough (often longer than three weeks, sometimes with bloody sputum)
- Unintentional weight loss
- Fever
- Night sweats
- Fatigue and weakness
- Chest pain or shortness of breath
Diagnosis
A thorough examination is usually preceded by a patient interview, where the patient reports symptoms, pre-existing conditions, lifestyle, and regular medication use. This is followed by physical examinations. The following procedures can be used for a definitive diagnosis of tuberculosis:
- Microscopic detection of pathogens: For microscopic detection, a sample of sputum is taken and examined in the lab. Resistance of the bacteria is also tested to ensure the most effective antibiotic treatment.
- X-rays: X-rays provide the doctor with a direct view of whether there is a potentially infectious pulmonary tuberculosis. Regular X-rays during treatment progression can also check how well the treatment is working.
- Skin or blood test: Both blood tests and the so-called tuberculin skin test can indicate an infection with tuberculosis pathogens. They show whether the immune system has already come into contact with the pathogen but do not distinguish between an active disease and a “dormant” infection.
Symptoms that may indicate a mycoplasma infection
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Treatment
The standard therapy initially involves taking four different antibiotics simultaneously for two months. After that, two of these medications are discontinued, and treatment continues for another four months with the remaining two antibiotics. The tablets are taken daily on an empty stomach, usually about 30 minutes before breakfast. After six months, all “Mycobacterium tuberculosis” bacteria should be killed.
Mandatory Reporting
Doctors are required to report a confirmed tuberculosis infection to the health department. Subsequently, possible contacts are also examined to contain the spread as effectively as possible.