Diagnostic Challenge of Tuberculosis Heterogeneity

Abstract

For the ICU physician, the failure to consider, diagnose, and treat tuberculosis (TB) results in increased morbidity and mortality, and poses risks to both patients and health care providers. At present, the diagnosis of TB depends on the detection of either mycobacteria or mycobacterial products from clinical specimens. Given the risks posed to both the patient and health care providers by undiagnosed and/or untreated TB, the ability to diagnose TB rapidly in the ICU cannot be understated. In this regard, nucleic acid amplification tests provide relatively quick information about the presence of (Mtb) DNA. If available, a blood-based test that would accurately identify persons with TB would be of use in the ICU. Currently available tests such as the T-Spot.TB or QuantiFERON-TB Gold In-Tube can discern infection with Mtb, but are not recommended for the ICU as they cannot rule out TB. In this review, we will discuss the increasing literature that would suggest that a blood-based diagnostic that reflects the host response to TB could be used to diagnose TB in the ICU.

Determination of variable region sequences from hybridoma immunoglobulins that target Mycobacterium tuberculosis virulence factors

“…Ideally, a uniform and robust immune response to infection would lead to a preventive vaccine against TB, but this currently appears unattainable [11,[71][72][73]. The heterogeneity of host immune responses to Mtb infection manifests in diverse clinical presentations, posing challenges for rapid diagnosis and treatment of TB [74,75]. The development of antibody-based therapeutic approaches targeted to immunodominant antigens or virulence factors is an important strategy for combating infection.…”

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“…Ideally, a uniform and robust immune response to infection would lead to a preventive vaccine against TB, but this currently appears unattainable [11,[71][72][73]. The heterogeneity of host immune responses to Mtb infection manifests in diverse clinical presentations, posing challenges for rapid diagnosis and treatment of TB [74,75]. The development of antibody-based therapeutic approaches targeted to immunodominant antigens or virulence factors is an important strategy for combating infection.…”

Untitled

“…Ideally, a uniform and robust immune response to infection would lead to a preventive vaccine against TB, but this currently appears unattainable [11,[71][72][73]. The heterogeneity of host immune responses to Mtb infection manifests in diverse clinical presentations, posing challenges for rapid diagnosis and treatment of TB [74,75]. The development of antibody-based therapeutic approaches targeted to immunodominant antigens or virulence factors is an important strategy for combating infection.…”