...a fraction of TB patients (5% to 10%) still maintain a lifetime risk of developing active disease. ...Mtb has coevolved with humans to achieve an evolutionary trade-off that infrequently compromises host health for survival. By contrast, other studies have shown that helminth infection can be protective during the early stages of Mycobacterium bovis BCG infection 13. ...definitive data that these parasites promote progression from asymptomatic TB to active disease via T-cell immunomodulation are lacking. ...both have evolved mechanisms to modulate host immunity. In this Pearl, we suggest helminth-associated intestinal microbiota modulation as a potential mechanism underlying disease tolerance to Mtb infection or, at the very least, confound studies examining the impact of helminth infection on TB outcomes. ...investigating changes in the composition and/or functional output of the intestinal microbiota, with its far-reaching regulatory capacity (via immune suppression, metabolite processing, and niche competition), is needed to determine the relative contribution of diverse intestinal residents on Mtb infection.