Reimagining the status quo: How close are we to rapid sputum-free tuberculosis diagnostics for all?

Reimagining the status quo: How close are we to rapid sputum-free tuberculosis diagnostics for all?
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DOI:
10.1016/j.ebiom.2022.103939
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发表时间:
2022-04
期刊:
影响因子:
11.1
通讯作者:
Theron, Grant
Theron, Grant
中科院分区:
医学1区
文献类型:
--
作者:
Nathavitharana, Ruvandhi R.;Garcia-Basteiro, Alberto L.;Ruhwald, Morten;Cobelens, Frank;Theron, Grant

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迫切需要快速,准确,无结核病的结核病(TB)分诊和确认测试,以缩小不断扩大的诊断差距。我们总结了关键技术,并审查了可能影响诊断效果的程序、系统和资源问题。基于人工智能的自动化数字胸部X射线摄影和毛细血管血液即时检测等中早期技术特别有前途。诊断流程中的缺陷包括缺乏基于社区的工具。我们概述了这些技术如何在结核病护理级联的背景下相互补充,帮助推翻当前的模式(例如,减少症状分诊依赖,允许亚临床结核病被诊断),并扩大肺外结核的选择。我们回顾了检测少杆菌结核的困难和当前参考标准的局限性等挑战,并讨论了研究人员和开发人员如何更好地设计和评估检测方法,以优化程序化摄取。最后,我们概述了如何利用适用于COVID-19的紧迫性和创新对于提高结核病患者的诊断护理质量至关重要。
Rapid, accurate, sputum-free tests for tuberculosis (TB) triage and confirmation are urgently needed to close the widening diagnostic gap. We summarise key technologies and review programmatic, systems, and resource issues that could affect the impact of diagnostics. Mid-to-early-stage technologies like artificial intelligence-based automated digital chest X-radiography and capillary blood point-of-care assays are particularly promising. Pitfalls in the diagnostic pipeline, included a lack of community-based tools. We outline how these technologies may complement one another within the context of the TB care cascade, help overturn current paradigms (eg, reducing syndromic triage reliance, permitting subclinical TB to be diagnosed), and expand options for extra-pulmonary TB. We review challenges such as the difficulty of detecting paucibacillary TB and the limitations of current reference standards, and discuss how researchers and developers can better design and evaluate assays to optimise programmatic uptake. Finally, we outline how leveraging the urgency and innovation applied to COVID-19 is critical to improving TB patients’ diagnostic quality-of-care.
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