New diagnostics for the spectrum of asymptomatic TB: from infection to subclinical disease

Abstract

TB remains a leading cause of morbidity and mortality worldwide. However, most infected immunocompetent individuals are asymptomatic and only 5–10% of these will eventually develop active TB during their lifetime (typically within 2 years after exposure). Therefore, rapid diagnosis and efficient management of asymptomatic infected individuals who are at the highest risk of progression and transmission remain major clinical and public health challenges. In recent years, there has been important scientific progress in our understanding of the spectrum of asymptomatic Mycobacterium tuberculosis (Mtb) infections that not only includes the dynamic state of latent TB infection (LTBI), but also the preclinical state of incipient and subclinical TB. The latter is possibly as prevalent as symptomatically active TB and potentially contributes to global Mtb transmission in various settings. We summarize the latest developments and current challenges of the existing testing tools for LTBI and describe promising biomarkers and diagnostics for the spectrum of asymptomatic TB. Following the negative results of a recent clinical trial for a biomarker-guided preventive therapy approach, we also suggest some treatment options for incipient TB.

Beyond latent and active tuberculosis: a scoping review of conceptual frameworks

“… 56 2023 Management of Tuberculosis Infection: Current Situation, Recent Developments and Operational Challenges Review of recent developments in management of LTBI and operational challenges Review Escalante et al. 57 2023 New diagnostics for the spectrum of asymptomatic TB: from infection to subclinical disease Review of developments and challenges in diagnostics for LTBI and the spectrum of asymptomatic TB Review Kim et al. 58 2023 Host Blood Transcriptional Signatures as Candidate Biomarkers for Predicting Progression to Active Tuberculosis Review of progress and challenges in predictive blood transcriptional signatures Review …”