African elephants Loxodonta africana and Asian elephants Elephas maximus are both susceptible to infection by Mycobacterium tuberculosis (Mtb). The Asian elephant has lived in close association with humans in Asian range countries for thousands of years and this close partnership is likely responsible for the exposure of the Asian elephant to this human disease. The confirmation by modern veterinary medicine of the existence of Mtb infection in elephants has only occurred recently after a testing programme was initiated in 1996 in elephant‐holding facilities in the United States. At the time of writing, Mtb is recognized as a disease primarily of Asian elephants in zoos. However, recent identification of tuberculosis in several free‐ranging elephants, both Asian and African, indicates that the disease may be emerging in the threatened wild populations of these species, which may further hinder the survival of wild elephants in some free‐ranging populations. Ante‐mortem diagnosis of the disease in elephants is improving but remains challenging. Protecting both human and elephant health via prevention of Mtb exposure must be part of a preventative‐medicine strategy wherever humans and elephants closely interact. Treatment of Mtb‐infected elephants has been accomplished by many facilities with some promising results. However, many challenges remain, including the side effects of drug therapies and poor compliance to medication administration by the elephant. Inconsistent treatment may potentially result in the bacterium developing resistance to the antibiotics. A brief overview of the diagnosis, treatment and management of Mtb in elephants in human care is provided.