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Diagnostics 2018, 8(4), 78; https://doi.org/10.3390/diagnostics8040078

Challenges and Progress with Diagnosing Pulmonary Tuberculosis in Low- and Middle-Income Countries

1
International Union Against Tuberculosis and Lung Disease, 68 Boulevard Saint Michel, 75006 Paris, France
2
London School of Hygiene and Tropical Medicine, Keppel Street, Bloomsbury, London WC1E 7HT, UK
3
International Union Against Tuberculosis and Lung Disease, South-East Asia Regional Office, C-6, Qutub Institutional Area, 110016 New Delhi, India
*
Author to whom correspondence should be addressed.
Received: 11 September 2018 / Revised: 19 November 2018 / Accepted: 21 November 2018 / Published: 23 November 2018
(This article belongs to the Special Issue Diagnosis and Treatment of Tuberculosis)
Full-Text   |   PDF [251 KB, uploaded 23 November 2018]

Abstract

Case finding and the diagnosis of tuberculosis (TB) are key activities to reach the World Health Organization’s End TB targets by 2030. This paper focuses on the diagnosis of pulmonary TB (PTB) in low- and middle-income countries. Sputum smear microscopy, despite its many limitations, remains the primary diagnostic tool in peripheral health facilities; however, this is being replaced by molecular diagnostic techniques, particularly Xpert MTB/RIF, which allows a bacteriologically confirmed diagnosis of TB along with information about whether or not the organism is resistant to rifampicin within two hours. Other useful diagnostic tools at peripheral facilities include chest radiography, urine lipoarabinomannan (TB-LAM) in HIV-infected patients with advanced immunodeficiency, and the loop-mediated isothermal amplification (TB-LAMP) test which may be superior to smear microscopy. National Reference Laboratories work at a higher level, largely performing culture and phenotypic drug susceptibility testing which is complemented by genotypic methods such as line probe assays for detecting resistance to isoniazid, rifampicin, and second-line drugs. Tuberculin skin testing, interferon gamma release assays, and commercial serological tests are not recommended for the diagnosis of active TB. Linking diagnosis to treatment and care is often poor, and this aspect of TB management needs far more attention than it currently receives. View Full-Text
Keywords: tuberculosis; World Health Organization; smear microscopy; molecular diagnosis; Xpert MTB/RIF; chest radiography; urine LAM; TB-LAMP; culture and drug susceptibility testing; line probe assays tuberculosis; World Health Organization; smear microscopy; molecular diagnosis; Xpert MTB/RIF; chest radiography; urine LAM; TB-LAMP; culture and drug susceptibility testing; line probe assays
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).
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Harries, A.D.; Kumar, A.M. Challenges and Progress with Diagnosing Pulmonary Tuberculosis in Low- and Middle-Income Countries. Diagnostics 2018, 8, 78.

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