The Challenges of TB Detection

July 31, 2020 14:05:40

Mycobacteria tuberculosis complex (“MTBC”) is the pathogenic bacteria causing tuberculosis (“TB”). On the other hand, nontuberculous mycobacteria (“NTM”) is also another bacterium that has the potential to cause disease. Mycobacteria are organisms living in water, animal tissues, soil, and food sources.

The organisms can conquer their hosts without showing any pathogenic signs and can cause serious infections. Infections by MTBC and NTM organisms have continued posing a lot of challenges to microbiologists and physicians globally. Their exclusive cell wall component prevents them from straining by a standard gram strain procedure.

Worldwide TB Epidemic

M.tuberculosis is the most common TB-causing bacterium in human beings. The pathogens are transmitted through droplet infections via air by sneezing, coughing, and speaking. TB is one of the top ten causes of death worldwide above malaria and HIV/AIDS. Every year, 10 million people are infected with TB, and 1.7 billion people have latent TB infection; hence are at higher risk of developing active TB.

Early detection and treatment are crucial in improving TB treatment success, which is currently very low. Drug-resistant TB strains have also hindered treatment efforts. A more specific drug is required to close the gap between the detection and treatment of TB.

Challenges of Mycobacteria Detection

It is important to differentiate between TB and NTM for proper diagnosis and treatment. Besides, the course of action will depend on the type of mycobacteria species present. For accurate testing and detection of TB and NTM, genotypic methods are preferred compared to biochemical and phenotypic resistance testing.

Furthermore, genotypic methods will give the test results in 3 hours compared to traditional methods, which offers results after 2-4 weeks for positive cases and 6-8 weeks for negative situations. Therefore, genetic methods provide more benefit to patients as all the resistant patterns are found earlier for proper treatment. Furthermore, genetic testing can be performed at any laboratory to determine the presence or absence of TB, and advanced tests to identify NTM.

Other rapid diagnostic tests and treatment measures have also been introduced by the World Health Organization (“WHO”). For instance, the line probe assay is used to detect resistance to second-line anti-TB drugs compared to traditional-based methods. Detecting second-line resistance by the SL-LPA implies that MDR-TB patients should not be enlisted on a shorter regimen. It may threaten their treatment and fuel development of XDR-TB. Additionally, patients detected with XDR-TB should not be enrolled on a shorter regimen as they require a correctly designed individual regimen for successful treatment.

Clinical Importance of Molecular Testing

The transmission of TB occurs mostly outside the house, and the drug resistance epidemic is driven by transmission. It mainly occurs in previously treated patients who get reinfected. Molecular testing is widely used in South Africa, where more than 15,000 LPAs are done annually. Molecular testing has tremendously changed the world of TB testing, and it is the most used testing tool. Its benefits speak for themselves, hence the method has been swiftly adopted by physicians.

The Future Direction of Mycobacteria

Optimizing patient treatment through rapid and reliable identification of mycobacteria is greatly improving the health outcomes of TB and NTM infections globally. The future of mycobacteria is rapidly changing, even in undeveloped countries with limited resources. Therefore, molecular testing should be globally adopted, and this will lead to a world free of TB deaths reduction by 95%.

Such challenges posed by the pathogen responsible for triggering TB are behind the tireless work being done by companies so that the medical community can stand a chance of beating these hard-to-treat diseases.

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