Tuberculosis is a chronic infectious disease that predominantly affects the lungs. The hallmark of tuberculosis infection is the formation of granulomas in the vicinity of infectious foci. Tuberculous granulomas are highly organized bodies with a complex cell composition and well-orchestrated biochemical pathways. Granuloma development plays a dual role. The process restricts the infection dissemination and forms a battlefield for protective immunity but simultaneously may compromise the lung function, threatening host health. The susceptibility to the infection per se, the degree of lung failure, and disease severity are under genetic control. Tuberculosis genetics is complex and poorly understood, but current knowledge indicates that intracellular infections are controlled by a network of biochemical reactions, many of which were not suspected to be involved until recently.