Scholarlink

Background <p>Tuberculosis diagnostics have advanced rapidly: in addition to microscopy and culturing nucleic acid amplification tests (NAAT) and molecular drug-resistance assays are now widely available. Several novel methods currently undergoing clinical evaluation promise earlier and more precise diagnostics in the future.</p> Objective <p>Established and emerging tuberculosis diagnostics were assessed regarding sensitivity/specificity, clinical feasibility and the contribution to personalized treatment.</p> Material and methods <p>A narrative update is given with selective evidence synthesis of current guidelines, reviews and primary studies on microscopy, NAAT, culture-based and molecular-based diagnostics, drug resistance testing, stool polymerase chain reaction (PCR) and additional clinically evaluated novel procedures.</p> Results <p>In pulmonary tuberculosis NAAT as the primary test enables a rapid diagnosis. Early molecular resistance testing (rifampicin/isoniazid; add fluoroquinolones in resistance to rifampicin) should be standard. In multidrug-resistant or rifampicin-resistant (MDR/RR) tuberculosis, next-generation sequencing expedites time to an effective treatment regimen. Culturing remains essential for species identification and phenotypic drug susceptibility testing. In children stool PCR increases the detection rate. Oral swabs and face-mask sampling are promising but not yet ready for routine use. Urine lipoarabinomannan (LAM) is particularly useful in people with a HIV infection and low CD4 counts. The molecular bacterial load assay (MBLA) may enable earlier treatment response assessment than DNA-based tests. Transcriptomic signatures show high potential for diagnosis and risk stratification.</p> Conclusion <p>Within the framework of the diagnostics of tuberculosis an integrated strategy combining NAAT, early molecular resistance testing and culturing with phenotypic resistance testing optimizes patient care. After further standardization and availability, LAM, MBLA and transcriptomic assays are poised to enter routine clinical practice.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Update: Diagnostik der Tuberkulose

  • 期刊论文

  • 发表日期：

    2025年12月17日

查看全文
  • Harald Hoffmann,
  • Nika Zielinski,
  • Steffen Pichlo,
  • Julia Gaudlitz,
  • Barbara Kalsdorf,
  • Thomas Theo Brehm

摘要

Background

Tuberculosis diagnostics have advanced rapidly: in addition to microscopy and culturing nucleic acid amplification tests (NAAT) and molecular drug-resistance assays are now widely available. Several novel methods currently undergoing clinical evaluation promise earlier and more precise diagnostics in the future.

Objective

Established and emerging tuberculosis diagnostics were assessed regarding sensitivity/specificity, clinical feasibility and the contribution to personalized treatment.

Material and methods

A narrative update is given with selective evidence synthesis of current guidelines, reviews and primary studies on microscopy, NAAT, culture-based and molecular-based diagnostics, drug resistance testing, stool polymerase chain reaction (PCR) and additional clinically evaluated novel procedures.

Results

In pulmonary tuberculosis NAAT as the primary test enables a rapid diagnosis. Early molecular resistance testing (rifampicin/isoniazid; add fluoroquinolones in resistance to rifampicin) should be standard. In multidrug-resistant or rifampicin-resistant (MDR/RR) tuberculosis, next-generation sequencing expedites time to an effective treatment regimen. Culturing remains essential for species identification and phenotypic drug susceptibility testing. In children stool PCR increases the detection rate. Oral swabs and face-mask sampling are promising but not yet ready for routine use. Urine lipoarabinomannan (LAM) is particularly useful in people with a HIV infection and low CD4 counts. The molecular bacterial load assay (MBLA) may enable earlier treatment response assessment than DNA-based tests. Transcriptomic signatures show high potential for diagnosis and risk stratification.

Conclusion

Within the framework of the diagnostics of tuberculosis an integrated strategy combining NAAT, early molecular resistance testing and culturing with phenotypic resistance testing optimizes patient care. After further standardization and availability, LAM, MBLA and transcriptomic assays are poised to enter routine clinical practice.