ReviewSpecific immune-based diagnosis of tuberculosis
Section snippets
Tuberculosis and diagnosis
Fast and accurate diagnosis of tuberculosis is a very important element of global health measures to control the disease. The gold standard in diagnosis remains clinical examination, combined with direct microscopic examination of sputum and culture of bacteria. Culture of M tuberculosis can take up to 8 weeks, and in 10–20% of cases the bacillus is not successfully cultured.5, 6 Diagnosis in these patients should be based on clinical findings and radiographic examination. This process
Current use of tuberculin
The TST measures the induction of cutaneous induration as a result of delayed-type-hypersensitivity reactions after intradermal injection of PPD. PPD is prepared by precipitation of proteins from heat-killed cultures of M tuberculosis, resulting in a mixture of complex antigens that is poorly defined and contains many individual proteins in varying stages of denaturation. The TST, when combined with direct smear examination, allows an immediate diagnosis of TB infection; however, interpretation
Specific antigens of M tuberculosis
The need for antigens specific to M tuberculosis for diagnosis of tuberculosis as well as for epidemiological analyses has been recognised for many years.32, 33 Initial attempts to extract antigens specific to the tuberculosis complex by adsorption with crossreacting antibodies were able to increase specificity somewhat.17 However, this approach did not produce truly specific antigens because of the difficulty in completely removing the large number of potentially cross-reactive antigens and
New initiatives in tuberculosis diagnosis
Sputum microscopy is the only immediate test for diagnosis of tuberculosis. However, the sensitivity of microscopy varies from 22% to 65%64 and in western countries generally only around 40–50% of cases have smear-positive samples.6, 65 Culture on BACTEC or Lowenstein-Jensen media takes 4–8 weeks and increases this proportion to around 80%.5, 6 Nonetheless, this addition still leaves a substantial percentage of cases dependent on clinical findings for diagnosis (a notoriously difficult problem
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