Tuberculosis (TB) is one of the world’s leading infectious causes of death, second only to HIV.

Ninety-five per cent of TB sufferers live in low- or middle-income countries such as China, India, Brazil or Indonesia. In 2009, TB deaths orphaned 10 million children worldwide.

Despite major gains in TB control in the Northern Territory (NT) in recent years, TB remains an important problem both here and in our near neighbours. Nine million new TB cases occur yearly, most of them in Southeast Asia. At our field research site in Malaysian Borneo (Sabah), TB is a leading health problem in children and adults.  

Our research focus:
  • To improve the diagnosis of TB in children and adults in Sabah, Malaysia, by optimising locally-available methods and introducing novel testing strategies to ensure early, appropriate treatment and better outcomes and survival rates.
  • To determine the rates of drug-resistant TB and HIV-TB co-infection in Sabah to ensure correct treatment for affected people.
  • To gain a better understanding of TB immunology and pathophysiology to help in the development of TB biomarkers and adjunctive treatments (medicines, which when used in conjunction with the standard antibiotics, lead to improved outcomes).
Our research impact:
  • Following Menzies’ finding that low nitric oxide is linked with worse outcomes in TB patients, future studies will investigate whether improving the lung’s nitric oxide production can help fight TB.
  • During our work in Papua, Indonesia, we developed a method to score chest TB x-rays, which is now being used by researchers internationally, including Malaysia, Africa and India.
  • We have provided important insights into TB outcomes, including TB-HIV co-infection, in Papua, Indonesia, which have led to changes in the local delivery of HIV care.


From left to right: Dr Trisasi Lestari, Professor Nick Anstey, Dr Rini Poespodrodjo, Dr Rina Triasih and Professor Anna Ralph

Key staff:

Menzies:

Students:

  • Dr Trisasi Lestari - PhD, Charles Darwin University
  • Dr Michelle Goroh - DrPH, University of Malaysia Sabah (UMS)

Regional Research Champions:

  • Dr Rina Triasih – Universitas Gadjah Mada (UGM), Indonesia
  • Dr Wong Ke Juin – Likas Hospital, Malaysia  
Collaborators:

Australia:

  • Professor Steve Graham - University of Melbourne and Burnet Institute
  • Professor Ross Bailie - University of Sydney
  • Dr Suman Majumdar – Burnet Institute

Indonesia:

  • Dr Rini Poespodrodjo - Rumah Sakit Umum Daerah (RSUD) and Yayasan Pengembangan Kesehatan dan Masyarakat Papua (YPKMP)
  • Dr Enny Kenangalem - Rumah Sakit Umum Daerah (RSUD) and Yayasan Pengembangan Kesehatan dan Masyarakat Papua (YPKMP)
  • Dr Yodi Mahendradhata - Universitas Gadjah Mada (UGM)

Malaysia:

  • Dr Timothy William - Jessleton Medical centre and Infectious Disease Society Kota Kinabalu (IDSKK)
  • Dr Giri Rajahram - Queen Elizabeth Hospital (QEH) and Infectious Disease Society Kota Kinabalu (IDSKK)
  • Dr Fong Siew M - Likas Hospital
  • Dr Richard Avoi - TB/Leprosy Control Unit, Sabah State Health Department
  • Dr Mohammed Yusof Bin Ibrahim - University of Malaysia Sabah (UMS)
  • Dr Kunji Kanan - Queen Elizabeth Hospital (QEH)
  • Dr Lee Wai Khew - Luyang Clinic
  • Dr Muhammed Nazri - Menggatal Clinic

  1. Ralph, A.P., Rashid Ali, M.R.S., William, T., Piera, K., Parameswaran, U., Bird, E., Wilkes, C.S., Lee, W.K., Yeo, T.W., Anstey, N.M. (2017), Vitamin D and activated vitamin D in tuberculosis in equatorial Malaysia: a prospective clinical study, BMC Infect Dis. 17(1):312. doi: 10.1186/s12879-017-2314-z.

  2. Lee, H.G., William, T., Menon, J., Ralph, A.P., Ooi, E.E., Hou, Y., Sessions, O., Yeo, T.W. (2016), Tuberculous meningitis is a major cause of mortality and morbidity in adults with central nervous system infections in Kota Kinabalu, Sabah, Malaysia: an observational study, BMC Infect Dis. 16:296. doi: 10.1186/s12879-016-1640-x.

  3. Pollett, S., Banner, P., O'Sullivan, M.V., Ralph, A.P. (2016), Epidemiology, Diagnosis and Management of Extra-Pulmonary Tuberculosis in a Low-Prevalence Country: A Four Year Retrospective Study in an Australian Tertiary Infectious Diseases Unit, PLoS One. 11(3):e0149372. doi: 10.1371/journal.pone.0149372. eCollection 2016.

  4. Muhammad Redzwan, S.R., Ralph, A.P., Sivaraman Kannan, K.K., William, T. (2015), Individualised second line anti-tuberculous therapy for an extensively resistant pulmonary tuberculosis (XDR PTB) in East Malaysia.,Med J Malaysia. 70(3):200-4.

  5. Rashid Ali, M.R., Parameswaran, U., William, T., Bird, E., Wilkes, C.S., Lee, W.K., Yeo, T.W., Anstey, N.M., Ralph, A.P. (2015) A prospective study of mycobacterial viability in refrigerated, unpreserved sputum batched for up to 8 weeks, Int J Tuberc Lung Dis. 19(5):620-1. doi: 10.5588/ijtld.14.0938. 

  6. Rashid Ali, M.R., Parameswaran, U., William, T., Bird, E., Wilkes, C.S., Lee, W.K., Yeo, T.W., Anstey, N.M., Ralph, A.P. (2015), A prospective study of tuberculosis drug susceptibility in sabah, malaysia, and an algorithm for management of isoniazid resistance, J Trop Med. 2015:261925. doi: 10.1155/2015/261925. Epub 2015 Mar 9.

  7. William, T., Parameswaran, U., Lee, W.K., Yeo, T.W., Anstey, N.M., Ralph, A.P. (2015), Pulmonary tuberculosis in outpatients in Sabah, Malaysia: advanced disease but low incidence of HIV co-infection, BMC Infect Dis. 15:32. doi: 10.1186/s12879-015-0758-6.

  8. Ralph, A.P., Kenangalem, E., Waramori, G., Pontororing, G.J., Sandjaja, Tjitra, E., Maguire, G.P., Kelly, P.M., Anstey, N.M. (2013) High morbidity during treatment and residual pulmonary disability in pulmonary tuberculosis: under-recognised phenomena, PLoS One. 8(11):e80302. doi: 10.1371/journal.pone.0080302. eCollection 2013.

  9. Ralph, A.P., Lucas, R.M. (2013), Vitamin D and tuberculosis: hope or hype?, Med J Aust. 199(10):648-9.

  10. Kenangalem, E., Waramori, G., Pontororing, G.J., Sandjaja, Tjitra, E., Maguire, G., Kelly, P.M., Anstey, N.M., Ralph, A.P., (2013), Tuberculosis outcomes in Papua, Indonesia: the relationship with different body mass index characteristics between papuan and non-Papuan ethnic groups, PLoS One. 8(9):e76077. doi: 10.1371/journal.pone.0076077. eCollection 2013.

Click here to view more tuberculosis publications in PubMed.
  1. Tuberculosis rates fall in the Top End

    Tuberculosis rates fall in the Top End

    Date

    The rate of tuberculosis (TB) in the Northern Territory (NT) is decreasing. However it is still the highest in Australia, according to a collaborative study between the Northern Territory Centre for Disease Control, Menzies School of Health Research and the Doherty Institute.

  2. History of tuberculosis control in Australia

    History of tuberculosis control in Australia

    Date

    This case study focuses on the role played by NHMRC and Australian governments in the virtual eradication of tuberculosis in Australia during the 20th century.

  3. Management of Tuberculosis: a guide for clinicians

    Management of Tuberculosis: a guide for clinicians

    Date

    The TB Forum has published "Management of Tuberculosis", edited and composed by many of the TB-CRE's key investigators. Including Menzies Associate Professor Anna Ralph

  4. How we can end TB by 2030

    How we can end TB by 2030

    Date

    A regional research collaboration with the Menzies School of Health Research has been highly productive in building capacity in PNG and Indonesia,.

  5. Tuberculosis services in PNG in the journal Public Health Action.

    Tuberculosis services in PNG in the journal Public Health Action.

    Date

    A major output from the Tropical Disease Research Regional Collaborative Initiative between Menzies School of Health Research and the Burnet Institute was launched last week at the Papua New Guinea (PNG) Annual Medical Symposium in Port Moresby. A series of papers have been published by PNG health workers who provide tuberculosis services in PNG in a special supplement in the journal Public Health Action.

  6. Supporting TB health systems

    Supporting TB health systems

    Date

    This research was conducted as part of several initiatives led by a Menzies-Burnet regional consortium in partnership with institutions in Indonesia and PNG.

  7. PNG-Aust researchers to combine under new grant program

    PNG-Aust researchers to combine under new grant program

    Date

    Australian and Papua New Guinean research groups will work in partnership to address malaria, tuberculosis and other health security threats, under a new grants program funded by the Australian government.

  8. Australian support for eliminating malaria and health research in the Indo-Pacific

    Australian support for eliminating malaria and health research in the Indo-Pacific

    Date

    Australia is playing a leading role in supporting malaria elimination efforts, particularly in the Indo-Pacific. The Government's Stronger Systems for Health Security program is supporting practical, relevant research into fundamental health security challenges.

  9. Tuberculosis elimination course for Indonesian health workers

    Tuberculosis elimination course for Indonesian health workers

    Date

    Menzies is collaborating with the Burnet Institute to deliver training in the prevention and eradication of tuberculosis (TB) to 25 visiting Indonesian health professionals.

  10. Tuberculosis, Why haven’t we eliminated TB already?

    Tuberculosis, Why haven’t we eliminated TB already?

    Date

    Tuberculosis - Medical Republic Why haven’t we eliminated TB already?

  11. $2m grant to combat drug resistant malaria and tuberculosis

    $2m grant to combat drug resistant malaria and tuberculosis

    Date

    A $2m research grant to work towards the prevention, control and elimination of malaria and tuberculosis (TB) in Southeast Asia and the Pacific has been awarded to a consortium led by Menzies School of Health Research, in collaboration with Burnet Institute, the Department of Foreign Affairs and Trade announced today.

  12. Tuberculosis remains a worry in Australia despite low disease rates, experts warn

    Tuberculosis remains a worry in Australia despite low disease rates, experts warn

    Date

    Health experts have urged people most at risk of tuberculosis to be tested, in order to help keep the killer disease at bay in Australia.

  13. The Conversation: Lung gas holds clue for future tuberculosis treatment

    The Conversation: Lung gas holds clue for future tuberculosis treatment

    Date

    Australian researchers have uncovered a link between low levels of the gas nitric oxide in the lungs of tuberculosis patients and the body’s ability to fight the deadly disease, opening the door to potential new treatments.

  14. Journal of Infectious Diseases: Impaired Pulmonary Nitric Oxide Bioavailability in Pulmonary Tuberculosis

    Journal of Infectious Diseases: Impaired Pulmonary Nitric Oxide Bioavailability in Pulmonary Tuberculosis

    Date

    Impaired Pulmonary Nitric Oxide Bioavailability in Pulmonary Tuberculosis: Association with Disease Severity and Delayed Mycobacterial Clearance with Treatment.

  15. Disease of the month: tuberculosis

    Disease of the month: tuberculosis

    Date

    With a history as long as mankind’s, TB lies dormant in one third of our global population.