Tuberculosis in the developing world: recent advances in diagnosis with special consideration of extensively drug-resistant tuberculosis.
Tuberculosis in the developing world: recent advances in diagnosis with special consideration of extensively drug-resistant tuberculosis.
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DOI：
10.1097/qco.0b013e32830ce783
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发表时间：
2008-10
影响因子：
3.9
通讯作者：
Moore DA
中科院分区：
文献类型：
--
作者：
Grandjean L;Moore DA
全球结核病主要通过痰涂片镜检诊断，一半病例无法检出，也无法识别耐药性。仅通过 DOTS 策略进行的全球结核病控制不足，加上 MDR 和 XDRTB 日益增长的威胁，推动了新的商业和非商业测试的最新发展，这些测试在资源有限、高负担的环境中是最迫切需要的。本次审查概述了当前可用的选项范围，特别强调了那些最有潜力解决日益严重的 MDR 和 XDR 灾难的最新进展，因为它影响到了技术和经济上最无力控制灾难的社区。分子诊断技术的简化、快速液体培养和比色指示剂的使用提高了结核病和耐多药结核病检测的灵敏度、速度和可靠性，同时降低了成本并使诊断更接近（尽管距离）护理点。 2008 年的全球结核病控制需要使用新工具来更灵敏、更快速地检测活动性疾病和耐药性。参考实验室可以使用改进的技术，但对于资源和技术能力有限的环境，几乎没有准备好进行现场实施。该管道前景广阔，但在此期间应推广液体培养和手动或比色药敏试验的更广泛使用。
Globally tuberculosis is mainly diagnosed by sputum smear microscopy, which fails to detect half of all cases and fails to identify drug resistance. Inadequate global TB control through the DOTS strategy alone plus the growing threat of MDR and XDRTB has driven recent development of new commercial and non-commercial tests, which are most desperately needed in resource-limited, high-burden settings. This review outlines the range of options currently available, highlighting particularly those recent developments with greatest potential for addressing the growing MDR and XDR disaster as it affects those communities least technically and financially capable of controlling it. Simplification of molecular diagnostic techniques, rapid liquid culture and the use of colorimetric indicators have improved the sensitivity, speed and reliability of TB and MDRTB detection, while decreasing cost and bringing diagnosis closer towards (though still some way from) the point-of-care. Global TB control in 2008 demands the use of new tools for more sensitive and rapid detection of active disease and of drug resistance. Improved technologies are available for reference laboratories but for settings where resources and technical capacity are limited there is little ready for field implementation. The pipeline is promising, but in the interim wider use of liquid culture and manual or colorimetric DST should be promoted.