Diagnostic Challenge of Tuberculosis Heterogeneity

Elisa Nemes; Erin W. Meermeier; Thomas J. Scriba; Gerhard Walzl; Stephanus T. Malherbe; David M. Lewinsohn

doi:10.1055/s-0038-1660471

Seminars in Respiratory and Critical Care Medicine, Table of Contents

Semin Respir Crit Care Med 2018; 39(03): 286-296
DOI: 10.1055/s-0038-1660471

Review Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Diagnostic Challenge of Tuberculosis Heterogeneity

Elisa Nemes

¹South African Tuberculosis Vaccine Initiative (SATVI) and Institute of Infectious Disease and Molecular Medicine, Division of Immunology, Department of Pathology, University of Cape Town, Cape Town, South Africa

,

Erin W. Meermeier

²Department of Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland, Oregon

³VA Portland Health Care System, Portland, Oregon

,

Thomas J. Scriba

¹South African Tuberculosis Vaccine Initiative (SATVI) and Institute of Infectious Disease and Molecular Medicine, Division of Immunology, Department of Pathology, University of Cape Town, Cape Town, South Africa

,

Gerhard Walzl

⁴South African Medical Research Council, Centre for Tuberculosis Research, Department of Science and Technology, National Research Foundation Centre of Excellence for Biomedical Tuberculosis Research, Stellenbosch University, Cape Town, South Africa

⁵Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa

,

Stephanus T. Malherbe

⁴South African Medical Research Council, Centre for Tuberculosis Research, Department of Science and Technology, National Research Foundation Centre of Excellence for Biomedical Tuberculosis Research, Stellenbosch University, Cape Town, South Africa

⁵Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa

,

David M. Lewinsohn

²Department of Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland, Oregon

³VA Portland Health Care System, Portland, Oregon

› Author Affiliations

Abstract

For the ICU physician, the failure to consider, diagnose, and treat tuberculosis (TB) results in increased morbidity and mortality, and poses risks to both patients and health care providers. At present, the diagnosis of TB depends on the detection of either mycobacteria or mycobacterial products from clinical specimens. Given the risks posed to both the patient and health care providers by undiagnosed and/or untreated TB, the ability to diagnose TB rapidly in the ICU cannot be understated. In this regard, nucleic acid amplification tests provide relatively quick information about the presence of Mycobacterium tuberculosis (Mtb) DNA. If available, a blood-based test that would accurately identify persons with TB would be of use in the ICU. Currently available tests such as the T-Spot.TB or QuantiFERON-TB Gold In-Tube can discern infection with Mtb, but are not recommended for the ICU as they cannot rule out TB. In this review, we will discuss the increasing literature that would suggest that a blood-based diagnostic that reflects the host response to TB could be used to diagnose TB in the ICU.

Keywords

tuberculosis - diagnosis - subclinical - host response

Full Text

References

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