Article information
Abstract
Rapid diagnosis of tuberculosis (TB) and multidrug-resistant (resistance to at least rifampin and isoniazid) Mycobacterium tuberculosis (MDR-TB) is one of the cornerstones for global TB control as it allows early epidemiological and therapeutic interventions. The slow growth of the tubercle bacillus is the greatest obstacle to rapid diagnosis of the disease. However, considerable progress has recently been made in developing novel diagnostic tools, especially molecular methods (commercial and ‘in-house’), for direct detection in clinical specimens. These methods, based on nucleic acid amplification (NAA) of different targets, aim to identify the M. tuberculosis complex and detect the specific chromosome mutations that are most frequently associated with phenotypic resistance to multiple drugs. In general, commercial methods are recommended since they have a better level of standardization, reproducibility and automation. Although some aspects such as cost-efficiency and the appropriate setting for the implementation of these techniques are not yet well established, organizations such as the WHO are strongly supporting the implementation and universal use of these new molecular methods. This chapter summarizes current knowledge and the available molecular methods for rapid diagnosis of TB and anti-tuberculous drug resistance in clinical microbiology laboratories.
Keywords:
Tuberculosis
Molecular diagnosis
Rapid detection of drug resistance
Resumen
El diagnóstico rápido de la enfermedad tuberculosa y la resistencia múltiple a los fármacos antituberculosos (al menos isoniazida y rifampicina) en Mycobacterium tuberculosis complex (MDR-TB) es una de las piedras angulares en el control de esta enfermedad, ya que permite una acción epidemiológica y terapéutica precoz. El crecimiento lento del bacilo tuberculoso es uno de los mayores impedimentos para un diagnóstico rápido. En los últimos años ha existido un importante avance en el desarrollo de nuevas herramientas diagnósticas, sobre todo moleculares (comerciales y caseras), para el diagnóstico directo de muestra clínica. Estos métodos se basan en la amplificación de diversas dianas de ácidos nucleicos (AAN), para la identificación de M. tuberculosis complex y la detección de las mutaciones cromosómicas más frecuentemente relacionadas con la resistencia fenotípica a diversos fármacos. En general, entre las múltiples técnicas existentes, se recomiendan los métodos comerciales por su mayor estandarización, reproducibilidad y automatización. A pesar de que aspectos como el coste-efectividad y las indicaciones para la adecuada implementación de estas técnicas no están del todo bien establecidos, organizaciones como la OMS están apoyando de forma firme la aplicación y utilización universal de estos nuevos métodos moleculares. Este capítulo resume el conocimiento actual y los métodos moleculares disponibles para el diagnóstico rápido de la TB y la resistencia a los fármacos en los laboratorios de microbiología clínica.
Palabras clave:
Tuberculosis
Diagnóstico molecular
Detección rápida de la resistencia
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