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Semin Respir Crit Care Med 2018; 39(03): 286-296
DOI: 10.1055/s-0038-1660471
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Diagnostic Challenge of Tuberculosis Heterogeneity

Elisa Nemes
1   South African Tuberculosis Vaccine Initiative (SATVI) and Institute of Infectious Disease and Molecular Medicine, Division of Immunology, Department of Pathology, University of Cape Town, Cape Town, South Africa
,
Erin W. Meermeier
2   Department of Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland, Oregon
3   VA Portland Health Care System, Portland, Oregon
,
Thomas J. Scriba
1   South African Tuberculosis Vaccine Initiative (SATVI) and Institute of Infectious Disease and Molecular Medicine, Division of Immunology, Department of Pathology, University of Cape Town, Cape Town, South Africa
,
Gerhard Walzl
4   South African Medical Research Council, Centre for Tuberculosis Research, Department of Science and Technology, National Research Foundation Centre of Excellence for Biomedical Tuberculosis Research, Stellenbosch University, Cape Town, South Africa
5   Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
,
Stephanus T. Malherbe
4   South African Medical Research Council, Centre for Tuberculosis Research, Department of Science and Technology, National Research Foundation Centre of Excellence for Biomedical Tuberculosis Research, Stellenbosch University, Cape Town, South Africa
5   Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
,
David M. Lewinsohn
2   Department of Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland, Oregon
3   VA Portland Health Care System, Portland, Oregon
› Author Affiliations
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Publication History

Publication Date:
02 August 2018 (online)

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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 Mycobacterium tuberculosis (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.

Keywords

tuberculosis - diagnosis - subclinical - host response