The purpose of this section is to outline the main methods of laboratory tuberculosis tb confirmation available to clinicians in new south wales nsw. Tuberculosis tb is not as common as it was many years ago in the united states. Information for healthcare professionals 4 introduction this is a brief guide for healthcare staff investigating patients suspected of tuberculosis tb. Despite extensive investigation over the years, there is still a great deal to learn about the. The laboratory plays a decisive role in diagnosing tu. Laboratory diagnosis of tuberculosis gs linkedin slideshare.
Sputum smears and cultures should be done for acidfast bacilli if the patient is producing sputum. As a result, the diagnosis of tb disease may be delayed or even overlooked, and the. A diagnosis made other than by culture may only be classified as probable or presumed. Assessing the effect of decentralization of laboratory diagnosis for drugresistant tuberculosis in kenya aditya sharma1, susan musau2, charles m. Recent advances in the laboratory diagnosis of tuberculosis. The handbook laboratory diagnosis of tuberculosis by sputum. Microscoby microscopy has been a diagnostic tool for tb for over a century, and still currently the most rapid diagnostic method. The handbook laboratory diagnosis of tuberculosis by. Clinical presentation and diagnosis of tuberculosis 10 diagnostic process the first step. Diagnosis during the physical exam, your doctor will check your lymph nodes for swelling and use a stethoscope to listen carefully to the sounds your lungs make while you breathe. The recently published idsa atscdc guidelines on the diagnosis of tuberculosis in adults and children weakly recommends the measurement of adenosine deaminase ada and free interferon.
Challenges in the laboratory diagnosis of tb in highincidence countries, tb control relies on passive case. Assessing the effect of decentralization of laboratory. Recent advances in the laboratory diagnosis of tuberculosis the conventional diagnostic methods but provide preliminary information and improve patient management. Bridging the growing gap between diagnosis and treatment in multidrugresistant tuberculosis mdrtb an unprecedented scaleup in test development and laboratory strengthening has been seen since 2009, when the world health assembly called for universal access to tuberculosis tb drug susceptibility testing dst and treatment of all patients. Clinicians have been advised to obtain culture confirmation of tb whenever possible. The disease is a slow progressive, chronic granulomatous infection caused by mycobacterium tuberculosis, an intracellular. The laboratory plays a decisive role in diagnosing tuberculosis tb and the identification and drug sensitivity testing dst of mycobacterium tuberculosis. Handbook on tuberculosis laboratory diagnostic methods in.
Both the world health organization and the union recognise that smear microscopy remains an important tool for the laboratory diagnosis of tb and in monitoring the patients response to treatment. Apr 02, 2015 laboratory diagnosis of tb relies on direct microscopic examination of sputum specimens. In the uk at the local level, the remit of the district laboratory is to examine clinical specimens for the presence of mycobacteria using microscopy and culture. An antibody detectionbased diagnostic test in a suitable format could potentially replace microscopy and extend tuberculosis diagnosis to lower levels of health services. The study objective was to perform ziehlneelsen zn staining, fluorochrome staining. Mycobacteria tuberculosis non sporing, noncapsulated. Recent advances in the laboratory detection of mycobacterium. As a result, the diagnosis of tb disease may be delayed or even overlooked, and the patient may remain ill. Early diagnosis of tuberculosis and drug resistance improves survival and by identifying infectious cases promotes contact tracing, implementation of institutional crossinfection procedures, and other publichealth actions.
The laboratory is essential laboratory is a critical partner in the diagnosis of tb rapid, reliable results are essential for early detection of mtbc to prevent ongoing transmission drug susceptibility test results identify drug resistance and help guide the clinician in providing appropriate treatment. Diagnosis of tuberculosis in children is challenging. Recent advances in the laboratory diagnosis of tuberculosis ifcc. If everyone with tb had a timely diagnosis and highquality treatment, the case fatality rate would be low in all countries. For a diagnosis negating the possibility of tuberculosis infection, most protocols require that two separate cultures both test negative. Jain inspite of the discovery of the causative agent more than a century back, the bacteriological diagnosis of tuberculosis has been a major hurdle in the treatment and control of the disease. Guidelines on the prevention and control of tuberculosis in ireland 2010 hsehpsc444. In 1986, the british medical research council published data about the influence of initial drug resistance on the response of patients with. Handbook on tb laboratory diagnostic methods in the. At the central drug research institute, lucknow, ranjana srivastavas laboratory has developed a pcr test that targets rv0355 encoding a ppe protein of m. Modern laboratory diagnosis of tuberculosis the lancet.
Clinical diagnosis lacks standardization, and traditional and molecular microbiologic methods lack sensitivity, particularly in children. In this article we will discuss about mycobacteria which causes tuberculosis in man. While healthy adults infected with rculosishave a 5% to 10% chance of developing tb disease within their lifetime, and the majority who do so develop disease within the. Pdf laboratory diagnosis of tuberculosis in resource. Describe three laboratory methods used in the diagnosis and control of tb resulting in a better understanding of laboratory results and improved communication between the clinician, the laboratory, and the patient index of materials pages 1. Laboratory diagnosis camilla rodrigues, md,viralvadwai, doctorate fellow phd, m tech tuberculosis tb, though curable, continues to be an unassailable infectious disease incurring both human and economic losses throughout the world. Such practical individuals who they are trained in a working environment can be very useful for diagnosis of tuberculosis and also expeditious diagnosis of hiv.
Updated guidelines for the use of nucleic acid amplification tests in the diagnosis of tuberculosis. Sputum examination in children is not sensitive in diagnosis. Culture of tb bacteria on liquid or solid media is a more sensitive method for tb diagnosis than smear microscopy and it permits testing for drug resistance. Laboratory diagnosis of mycobacterium tuberculosis. The specimens should be examined and cultured in a laboratory that specializes in. Report of an expert consultation on the uses of nucleic acid amplification tests for the diagnosis of tuberculosis. Infections caused by mycobacterium tuberculosis complex remain one of the most important global public health issues. Challenges in the laboratory diagnosis of tb in highincidence countries, tb control relies on passive case finding among individuals selfpresenting to health care facilities, followed by either diagnosis based on clinical symptoms or laboratory diagnosis using sputum smear microscopy.
Laboratory diagnosis of tuberculosis latest diagnostic tools. The diagnosis of latent tuberculosis and decisionmaking regarding its treatment are difficult because of the lack of specific biomarkers and of relevant data from clinical trials. Tuberculosis tb is a global health concern for both developing and developed countries and has recently become more complex due to persistence in aging populations and the rise of drugresistant strains, even in korea1,2. Paramasivan, alashle abimiku,3 steven spector,4 giorgio roscigno,2 and john nkengasong1. Aug 30, 2012 diagnosis of pulmonary tuberculosis majority of adults suffer with pulmonary tuberculosis. The most commonly used diagnostic tool for tuberculosis is a simple skin test, though blood tests are becoming more commonplace. Microbiological examination of sputum continues to be a gold standard in proving the diagnosis. Laboratory coats laboratory coats usually have long sleeves and fasten in the front.
Laboratory diagnosis of tuberculosis tb moderator dr. Laboratory diagnosis of tuberculosis caused by mycobacterium tuberculosis. Who had endorsed xpert mtbrif technology and released a recommendation and guidance for countries to incorporate this new technology in their programs 5. National plan for reliable tuberculosis laboratory services using a systems approach. The global control of tuberculosis remains a challenge from the standpoint of diagnosis, detection of drug resistance, and treatment. New tests are available by level of laboratory and phase of application. The aim of this handbook is to provide network members and other laboratories involved in the diagnosis of tuberculosis, with an agreed list of key diagnostic methods and their protocols in various areas of tb diagnosis, ranging from microbiological diagnosis of active tb to the diagnosis of latent tb infection. Tb laboratory techniques for diagnosing tuberculosis. Modern laboratory diagnosis of mycobacterial infections. Serial sputum specimens are required one taken on the spot and the second brought in the following. In no event shall the world health organization be liable for damages arising.
Ideally, specimens should arrive in the laboratory on the day of collection. Tuberculosis, laboratory diagnosis, direct and indirect methods introduction tuberculosis tb remains a major global health problem, particularly in many of the developing countries including india1. With pulmonary tb being the most common form of disease, the chest radiograph is useful for diagnosis of tb disease. Tuberculosis is diagnosed by finding mycobacterium tuberculosis bacteria in a clinical specimen taken from the patient. Advances in technology and drug susceptibility testing seema oommen 1, nandita banaji 2 1 department of microbiology, pushpagiri institute of medical sciences and research centre, tiruvalla, kerala, india 2 department of microbiology, indira gandhi medical college and research institute, puducherry, india. It requires simple laboratory facilities, and when performed correctly, has a role in rapidly identifying infectious cases. Always notify the laboratory of a suspicion of tuberculosis so that appropriate safety precautions can be employed. Diagnosis and management of tuberculosis 3 was 98% 4.
Chest abnormalities can suggest pulmonary tb disease figure 4. Laboratory diagnosis of tuberculosis by sputum microscopy in many countries, sputum smear microscopy remains the primary tool for the laboratory diagnosis of tuberculosis. While other investigations may strongly suggest tuberculosis as the diagnosis, they cannot confirm it. Rapid laboratory diagnosis of pulmonary tuberculosis article pdf available in international journal of mycobacteriology 63. Introduction tuberculosis tb is one of the leading infectious diseases in the world and is responsible for more than 2 million deaths and 8 million new cases annually. With the exception of a few developed countries, most national tb programs worldwide do not routinely provide diagnostic services based on culture and dst. Highquality laboratory diagnosis of tb is the basis for both individual patient treatment and surveillance. Serial sputum specimens are required one taken on the spot. Tuberculosis diagnostic tools treatment action group. In 2007, a survey of existing mycobacterial laboratory services and quality control practices throughout the eu. More than 8 million new cases of tuberculosis occur annually leading to 2 million deaths. Laboratory gowns these gowns should be long sleeved with an elasticised cuff at least 30mm long and fasten at the back. In clinical practice, rapid tb diagnosis can be difficult, and early pulmonary tb detection continues to be challenging for clinicians. Michigan department of community health tbmycology lab manager objectives overview of laboratory role in tb diagnosis and control techniques for diagnosing tb additional lab results critical to effective case management relevance of lab results to clinical and.
The laboratory diagnosis of mycobacterial infections, tuberculosis in particular, must be expedited to improve better patient management and to save limited resources within the health care system. Radiological examination of lungs, most commonly prescribed investigation. Aug 16, 2016 laboratory diagnosis of tuberculosis gs 1. A guide to utilization of the microbiology laboratory for. Algorithm for laboratory diagnosis and treatmentmonitoring. Clinical presentation and diagnosis of tuberculosis 18 cdc definition. Clinical presentation and diagnosis of tuberculosis. Classification of mycobacteria laboratory diagnosis biochemical reactions.
Therefore, building capacity and enhancing universal access to rapid and. Understanding tuberculosis tb diagnosis is critical to. Multidrugresistant tb is of particular concern to both clinicians and national tb programmes. Tuberculosis, pulmonary diagnosis tuberculosis, multidrugresistant diagnosis clinical laboratory techniques diagnostic techniques and procedures europe isbn 978 92 890 5237 5 address requests about publications of the who regional office for europe to. Laboratory diagnosis, treatment and prevention of tuberculosis. However, in some individuals, tuberculosis infection progresses to tuberculosis disease.
It aims to describe the more important methods of the laboratory diagnosis of tuberculosis and to consider some of the more significant procedures and principles involved in the experimental study of the infection. Laboratory diagnosis of mycobacterium tuberculosis infection and. Laboratory diagnosis of tuberculosis in resourcepoor countries. Laboratory diagnosis of tuberculosistb moderator dr. Tuberculosis tb is a major cause of morbidity and mortality in europe. Laboratory diagnosis of tuberculosis in resourcepoor. Classification of mycobacteria laboratory diagnosis biochemical reactions identification treatment. Laboratory diagnosis of mycobacterium tuberculosis infection. This devastating impact of tuberculosis on vulnerable populations is also driven by its deadly synergy with hiv. Guidelines on the prevention and control of tuberculosis. Mortality is particularly high in those coinfected with hiv and where the bacteria are multipledrugresistant strainsie, strains resistant to at. Eighty percent of all cases worldwide occur in 22 highburden, mainly resourcepoor settings.
Sah medical microbiology lecture cmlt, 2 nd year tuberculosis or tb short for tubercle bacillus. Laboratory diagnosis rapid diagnosis of mycobacterium tuberculosis mtb with the determination of an accurate drugsusceptibility pattern would facilitate initiation. Diagnosis of pulmonary tuberculosis majority of adults suffer with pulmonary tuberculosis. However, the technique, although specific, has low and variable sensitivity and cannot identify drugresistant strains. There have been many advances in methodology for tuberculosis diagnosis. Early diagnosis of mycobacterium tuberculosis in clinical samples becomes important in the control of tb both for the treatment of patients and for curbing of disease transmission to the others in the community. Tb disease often known as active tb, and usually associated with symptoms may be diagnosed in a number of ways.
A guide to utilization of the microbiology laboratory for diagnosis of infectious diseases. Dozens of commercial serological tests for tuberculosis. Onethird of the global population is believed to be infected with bacteria of the mycobacterium tuberculosis complex, the causative agent of tuberculosis. During 2008, there were an estimated 440,000 cases of multidrugresistant tb mdrtb, or 3. Improved laboratory diagnosis of tuberculosis the indian. Two tests are available to determine if an individual is infected with m.
Sep 15, 2001 the laboratory diagnosis of mycobacterial infections, tuberculosis in particular, must be expedited to improve better patient management and to save limited resources within the health care system. In nsw all mycobacteria recovered from clinical samples are forwarded to the nsw mycobacterium reference laboratory mrl at. Because treatment can only be initiated when infection is detected and is based on the results of antimicrobial susceptibility testing, there recently has been a marked increase in the development and testing of novel assays designed to detect. Laboratory diagnosis of tb relies on direct microscopic examination of sputum specimens. Immunodiagnostic tests may improve sensitivity, but. Handbook on tb laboratory diagnostic methods in the european. New laboratory diagnostic tools for tuberculosis control. Tb laboratory techniques for diagnosing tuberculosis dale e. Cain7 1epidemic intelligence service, centers for disease control and prevention, atlanta, usa. The functions of the mycobacteriology laboratory vary depending on the population served, the incidence of m tuberculosis and ntm disease, and whether the laboratory has a reference role. For every stages of diagnosis, there are new approaches. In the industrialized world, the time has gone when laboratories needed weeks to months to diagnose tuberculosis from clinical specimens. Laboratory diagnosis and experimental methods in tuberculosis.
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