The Authors: Keertan Dheda is a Professor of Respiratory Medicine and the Director of the Lung Infection and Immunity Unit within the Division of Pulmonology, Department of Medicine, at the University of Cape Town. His main research interests are the study of the immunopathogenesis, epidemiology and diagnosis of tuberculosis (TB), including drug-resistant TB. Morten Ruhwald, MD, PhD, heads the TB Immunology Group at Clinical Research Centre, Copenhagen University Hospital, Hvidovre. Research interests include studies of adaptive immunity and development of simple and accurate immunodiagnostic tests for latent TB. Grant Theron is a research fellow in the Lung Infection and Immunity Unit at the University of Cape Town. He is funded by the National Research Foundation and the Claude Leon Foundation. His background is in basic science, and his main research interests relate to new and improved diagnostics for TB and drug-resistance, as well as novel approaches for understanding and disrupting TB transmission. Jonathan Peter is a PhD fellow and consultant physician at the Lung Infection and Immunity Unit, Department of Medicine, at the University of Cape Town. His major research interest is the development and validation of field-friendly TB diagnostics, such as urine lipoarabinomannan, suitable for use in resource-limited, high human immunodeficiency virus (HIV)-prevalent settings. Wing Cheong Yam is a Clinical Bacteriologist/Honorary Associate Professor in the Department of Microbiology, The University of Hong Kong. He is in charge of the development and daily running of molecular microbiology service for Queen Mary Hospital, including rapid diagnosis of emerging infections such as TB and drug-resistant HIV-1.
INVITED REVIEW SERIES: TUBERCULOSIS: CURRENT STATE OF KNOWLEDGE
Point-of-care diagnosis of tuberculosis: Past, present and future
Version of Record online: 25 JAN 2013
© 2012 The Authors. Respirology © 2012 Asian Pacific Society of Respirology
Volume 18, Issue 2, pages 217–232, February 2013
How to Cite
DHEDA, K., RUHWALD, M., THERON, G., PETER, J. and YAM, W. C. (2013), Point-of-care diagnosis of tuberculosis: Past, present and future. Respirology, 18: 217–232. doi: 10.1111/resp.12022
SERIES EDITORS: CHI CHIU LEUNG, CHRISTOPH LANGE AND YING ZHANG
- Issue online: 25 JAN 2013
- Version of Record online: 25 JAN 2013
- Accepted manuscript online: 27 NOV 2012 06:32PM EST
- Manuscript Accepted: 13 NOV 2012
- Manuscript Received: 5 OCT 2012
Diagnosis represents only one aspect of tuberculosis (TB) control but is perhaps one of the most challenging. The drawbacks of current tools highlight several unmet needs in TB diagnosis, that is, necessity for accuracy, rapidity of diagnosis, affordability, simplicity and the ability to generate same-day results at point-of-care (POC). When a return visit is required to access test results, time to treatment is prolonged, and default rates are significant. However, a good diagnostic tool is also critically dependent on obtaining an adequate biological sample. Here, we review the accuracy and potential impact of established and newer potential POC diagnostic tests for TB, including smear microscopy, the Xpert MTB/RIF assay (Cepheid) and the Determine TB lipoarabinomannan antigen test (Alere). Novel experimental approaches and detection technologies for POC diagnosis of active TB, including nucleic acid amplification tests, detection of volatile organic compounds or metabolites, mass spectroscopy, microfluidics, surface-enhanced Raman spectroscopy, electrochemical approaches, and aptamers among others, are discussed. We also discuss future applications, including the potential POC diagnosis of drug-resistant TB and presumed latent TB infection. Challenges to the development and roll-out of POC tests for TB are also reviewed.