From the London School of Hygiene and Tropical Medicine: Diagnosis of pulmonary tuberculosis

http://www.ncbi.nlm.nih.gov/pubmed/23528956

Curr Opin Pulm Med. 2013 May;19(3):280-8. doi: 10.1097/MCP.0b013e32835f1b70.

Diagnosis of pulmonary tuberculosis.

Lawn SD.

Source

Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK. stephen.lawn@lshtm.ac.uk

Abstract

PURPOSE OF REVIEW:

This review summarizes the recent literature on the developments in diagnostics for pulmonary tuberculosis (TB).

RECENT FINDINGS:

A growing body of literature regarding the Xpert MTB/RIF assay confirms the high diagnostic accuracy in a range of clinical settings, including amongst inpatients, those with HIV coinfection and in children with culture-positive disease. Early experiences with operational implementation are now being reported from South Africa. Initial small-scale evaluations suggest that newer versions of line-probe assays have diagnostic accuracy similar to that of the Xpert MTB/RIF assay. Next-generation fully automated molecular assays that use isothermal amplification may in the future be more readily implemented at the point of care. The first low-cost, lateral-flow (strip-test) assay for lipoarabinomannan in urine shows promise as a rapid point-of-care test for TB amongst HIV-infected patients who have advanced immunodeficiency. A range of other diagnostic tools are also at various stages of development.

SUMMARY:

There is continued momentum and optimism regarding the developments in TB diagnostics. However, studies of clinical and programmatic impact and operational research are needed to guide implementation and scale-up of new assays in resource-limited settings. Further concerted efforts are needed to develop point-of-care assays which are desperately needed to accelerate progress in TB control.