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Rapid diagnostics of tuberculosis and drug resistance in the industrialized world: clinical and public health benefits and barriers to implementation

Francis Drobniewski1234*, Vladyslav Nikolayevskyy12, Horst Maxeiner1, Yanina Balabanova2, Nicola Casali2, Irina Kontsevaya5 and Olga Ignatyeva5

Author Affiliations

1 Public Health England National Mycobacterium Reference Laboratory, 2 Newark Street, London E1 2AT, UK

2 Queen Mary University of London, 2 Newark Street, London E1 2AT, UK

3 University College, University of London, Torrington Place, London WC1E 7HB, UK

4 Imperial College, London W12 0NN, UK

5 Samara Oblast TB Service, 154 Novo-Sadovaya Street, Samara, Russian Federation

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BMC Medicine 2013, 11:190  doi:10.1186/1741-7015-11-190

Published: 29 August 2013

Abstract

In this article, we give an overview of new technologies for the diagnosis of tuberculosis (TB) and drug resistance, consider their advantages over existing methodologies, broad issues of cost, cost-effectiveness and programmatic implementation, and their clinical as well as public health impact, focusing on the industrialized world. Molecular nucleic-acid amplification diagnostic systems have high specificity for TB diagnosis (and rifampicin resistance) but sensitivity for TB detection is more variable. Nevertheless, it is possible to diagnose TB and rifampicin resistance within a day and commercial automated systems make this possible with minimal training. Although studies are limited, these systems appear to be cost-effective. Most of these tools are of value clinically and for public health use. For example, whole genome sequencing of Mycobacterium tuberculosis offers a powerful new approach to the identification of drug resistance and to map transmission at a community and population level.

Keywords:
Diagnosis; Drug resistance; Tuberculosis; Public health; Whole genome sequencing