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Tuberculosis: Clinical and Laboratory Updates and Perspectives
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Tuberculosis: Clinical and Laboratory Updates and Perspectives

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Infectious Diseases".

Deadline for manuscript submissions: closed (20 February 2023) | Viewed by 14283

Special Issue Editor

Dr. Feng Wang

E-Mail Website
Guest Editor
Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
Interests: infectious diseases; tuberculosis; host immunity; antigen-specific immune response; opportunistic infection; immunocompromised condition

Special Issue Information

Dear Colleagues,

The diagnosis of tuberculosis (TB) still faces challenges in clinical practice. Specially, the sensitivity of methods based on the detection of Mycobacterium tuberculosis (Mtb) is unsatisfactory, especially for the diagnosis of extrapulmonary TB; the methods based on the detection of Mtb-specific immune responses cannot differentiate active disease from latent infection; and the serological markers cannot differentiate TB from other inflammatory diseases due to a lack of specificity. Nevertheless, with the development of new technologies such as mass spectrometry, high-throughput sequencing, and artificial intelligence, some new tools show the potential to solve the dilemma. The aim of this Special Issue is to provide updates on and perspectives of laboratory diagnosis and management of TB, with particular interest in the use of innovative techniques or optimized traditional technologies for accurate diagnosis and effective management of the disease. Therefore, researchers in the field of laboratory medicine and translational medicine are encouraged to submit their findings as original articles or reviews to this Special Issue.

Dr. Feng Wang
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • tuberculosis
  • extrapulmonary tuberculosis
  • active tuberculosis
  • latent tuberculois infection
  • diagnosis
  • prognosis
  • innovative techniques
  • optimized traditional technologies

Published Papers (6 papers)

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Research

Jump to: Review, Other

12 pages, 942 KiB  
Article
Analysis of a Combined HBHA and ESAT-6-Interferon-γ-Release Assay for the Diagnosis of Tuberculous Lymphadenopathies
by Françoise Mascart, Maya Hites, Emmanuelle Watelet, Gil Verschelden, Christelle Meuris, Jean-Luc Doyen, Anne Van Praet, Audrey Godefroid, Emmanuelle Petit, Mahavir Singh, Camille Locht and Véronique Corbière
J. Clin. Med. 2023, 12(6), 2127; https://doi.org/10.3390/jcm12062127 - 8 Mar 2023
Cited by 1 | Viewed by 1034
Abstract
Background and Objectives: The incidence of tuberculosis lymphadenopathy (TBLA) is increasing, and diagnostic procedures lack sensitivity and are often highly invasive. TBLA may be asymptomatic, and differential diagnosis with other adenopathies (ADPs) is difficult. We evaluated a blood-cell interferon-γ release assay (IGRA) with [...] Read more.
Background and Objectives: The incidence of tuberculosis lymphadenopathy (TBLA) is increasing, and diagnostic procedures lack sensitivity and are often highly invasive. TBLA may be asymptomatic, and differential diagnosis with other adenopathies (ADPs) is difficult. We evaluated a blood-cell interferon-γ release assay (IGRA) with two different stage-specific mycobacterial antigens for the differential diagnosis of ADP suspected of mycobacterial origin. Methods: Twenty-one patients were included and divided into three groups: (1) cervical/axillar ADP (n = 8), (2) mediastinal ADP (n = 10), and (3) disseminated ADP (n = 3). The mycobacterial antigens used for the IGRA were the heparin-binding haemagglutinin (HBHA) and the early-secreted antigenic target-6 (ESAT-6), a latency-associated antigen and a bacterial replication-related antigen, respectively. Diagnosis of TBLA based on microbiological results and/or response to anti-TB treatment was obtained for 15 patients. Results: An IGRA profile highly suggestive of active TB (higher IFN-γ response to ESAT-6 compared to HBHA) was found for 3/6 TBLA patients from group 1, and for all the TBLA patients from groups 2 and 3, whereas this profile was not noticed in patients with a final alternative diagnosis. Conclusion: These results highlight the potential value of this combined HBHA/ESAT-6 IGRA as a triage test for the differential diagnosis of ADP. Full article
(This article belongs to the Special Issue Tuberculosis: Clinical and Laboratory Updates and Perspectives)
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11 pages, 980 KiB  
Article
Clinical Management of Pathogen-Negative Tuberculous Meningitis in Adults: A Series Case Study
by Yuqin He, Yanzhu Huang, Di Wu, Yingying Wu and Minghuan Wang
J. Clin. Med. 2022, 11(21), 6250; https://doi.org/10.3390/jcm11216250 - 23 Oct 2022
Cited by 2 | Viewed by 1518
Abstract
Tuberculosis remains a serious world public health problem. Tuberculous meningitis (TBM) is the one of most severe forms of extrapulmonary tuberculosis. However, the insensitivity and time-consuming requirement of culturing the pathogen Mycobacterium tuberculosis, the traditional “gold standard” diagnostic test for TBM, often [...] Read more.
Tuberculosis remains a serious world public health problem. Tuberculous meningitis (TBM) is the one of most severe forms of extrapulmonary tuberculosis. However, the insensitivity and time-consuming requirement of culturing the pathogen Mycobacterium tuberculosis, the traditional “gold standard” diagnostic test for TBM, often delays timely diagnosis and treatment, resulting in high disability and mortality rates. In our series case study, we present five pathogen-negative TBM cases who received empirical anti-tuberculosis therapy with a good clinical outcome. We describe in detail the clinical symptoms, laboratory test results, and imaging findings of the five patients from symptom onset to dynamic follow-up. We then summarize the similarities of the clinical characteristics of the presented patients, as well as shared features in laboratory and imaging tests, and proceed to analyze the challenges in the timely diagnosis of TBM. Finally, we argue that monitoring of cerebrospinal fluid markers and imaging are critical for the diagnosis and treatment of TBM, and emphasize the importance of differential diagnosis in cases when tuberculous meningitis is highly suspected despite negative findings for that etiology. Full article
(This article belongs to the Special Issue Tuberculosis: Clinical and Laboratory Updates and Perspectives)
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8 pages, 566 KiB  
Article
Comparison of Sputum Treated with Power Ultrasound and Routine NALC-NaOH Methods for Mycobacterial Culture: A Prospective Study
by Junling Wang, Yan Wang, Xiaojie Ling, Zhenjin Zhang, Yunfeng Deng and Peng Tian
J. Clin. Med. 2022, 11(16), 4694; https://doi.org/10.3390/jcm11164694 - 11 Aug 2022
Cited by 3 | Viewed by 1570
Abstract
Mycobacterial culture remains the gold standard for the diagnosis of active tuberculosis. However, an appropriate digestion and decontamination method is essential for the effective recovery of tubercle bacilli in culture. The study was designed to compare the efficacy of sputum treated with power [...] Read more.
Mycobacterial culture remains the gold standard for the diagnosis of active tuberculosis. However, an appropriate digestion and decontamination method is essential for the effective recovery of tubercle bacilli in culture. The study was designed to compare the efficacy of sputum treated with power ultrasound (PU) and routine NALC-NaOH methods for mycobacterial culture from clinically suspected cases of pulmonary tuberculosis. To evaluate the PU and routine NALC-NaOH methods, sputum specimens (n = 597) were studied (culturing on MGIT 960), and the performances were compared. Of the 597 samples, 89 (14.91%) sputum samples treated with the NaOH-NALC method were mycobacterial culture positive, including Mycobacterium tuberculosis (M.TB; n = 77, 12.90%) and nontuberculous mycobacteria (NTM; n = 12, 2.01%). One hundred and ten (18.43%) sputum samples treated with the PU method were culture positive, including M.TB (n = 87, 14.57%) and NTM (n = 23, 3.85%). The PU method detected 10 additional cases of M.TB and 11 additional cases of NTM when compared to the NALC-NaOH method. Statistical analysis showed that a significant difference was found in the culture-positive ratio of M.TB and NTM between the two method groups (p < 0.05). Compared with that of the NALC-NaOH method (8.04%), sputum treated with PU method (4.86%) had a significantly lower contamination rate (p < 0.05). In conclusion, our data indicate that, compared with the NALC-NaOH method, the PU method is a rapid and effective approach for mycobacterial culture when detecting active TB. However, its accurate mechanism has not been well addressed, and further investigation is still required. Full article
(This article belongs to the Special Issue Tuberculosis: Clinical and Laboratory Updates and Perspectives)
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10 pages, 804 KiB  
Article
C-Reactive Protein as a Screening Test for Tuberculosis in People Living with HIV in Southern India: A Cross-Sectional, Observational Study
by Aishwarya Saripalli and John Ramapuram
J. Clin. Med. 2022, 11(13), 3566; https://doi.org/10.3390/jcm11133566 - 21 Jun 2022
Cited by 3 | Viewed by 1569
Abstract
Background: Tuberculosis is the leading cause of mortality in people living with HIV(PLHIV). We assessed the utility of C-reactive protein (CRP) as a screening test for tuberculosis (TB) in PLHIV. Methods: We performed a cross-sectional, observational study on 150 HIV patients visiting the [...] Read more.
Background: Tuberculosis is the leading cause of mortality in people living with HIV(PLHIV). We assessed the utility of C-reactive protein (CRP) as a screening test for tuberculosis (TB) in PLHIV. Methods: We performed a cross-sectional, observational study on 150 HIV patients visiting the Anti-Retroviral Therapy (ART) center for the follow up of their ART treatment. Patients who screened positive on the WHO symptom screen were included in the study. C-reactive protein levels in the blood were measured, and the patients were followed up with for a confirmatory diagnosis of tuberculosis. Results: The ideal cut-off for CRP was found to be 8.25. There was a statistically significant relationship between the CRP value and tuberculosis positivity (p value < 0.001). The CRP value had a sensitivity of 70.13%, a specificity of 69.86%, a positive predictive value of 71.05%, a negative predictive value of 68.92%, and a total diagnostic accuracy of 70% in patients who screened positive on the WHO symptom screen. Conclusion: CRP is a valuable screening tool and should be added to the tuberculosis screening algorithm to improve the diagnostic accuracy of screening for tuberculosis in people living with HIV. Full article
(This article belongs to the Special Issue Tuberculosis: Clinical and Laboratory Updates and Perspectives)
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Review

Jump to: Research, Other

14 pages, 326 KiB  
Review
Review and Updates on the Diagnosis of Tuberculosis
by Yi Huang, Lin Ai, Xiaochen Wang, Ziyong Sun and Feng Wang
J. Clin. Med. 2022, 11(19), 5826; https://doi.org/10.3390/jcm11195826 - 30 Sep 2022
Cited by 16 | Viewed by 5916
Abstract
Diagnosis of tuberculosis, and especially the diagnosis of extrapulmonary tuberculosis, still faces challenges in clinical practice. There are several reasons for this. Methods based on the detection of Mycobacterium tuberculosis (Mtb) are insufficiently sensitive, methods based on the detection of Mtb-specific immune responses [...] Read more.
Diagnosis of tuberculosis, and especially the diagnosis of extrapulmonary tuberculosis, still faces challenges in clinical practice. There are several reasons for this. Methods based on the detection of Mycobacterium tuberculosis (Mtb) are insufficiently sensitive, methods based on the detection of Mtb-specific immune responses cannot always differentiate active disease from latent infection, and some of the serological markers of infection with Mtb are insufficiently specific to differentiate tuberculosis from other inflammatory diseases. New tools based on technologies such as flow cytometry, mass spectrometry, high-throughput sequencing, and artificial intelligence have the potential to solve this dilemma. The aim of this review was to provide an updated overview of current efforts to optimize classical diagnostic methods, as well as new molecular and other methodologies, for accurate diagnosis of patients with Mtb infection. Full article
(This article belongs to the Special Issue Tuberculosis: Clinical and Laboratory Updates and Perspectives)

Other

Jump to: Research, Review

10 pages, 2336 KiB  
Systematic Review
Xpert MTB/RIF Assay for the Diagnosis of Lymph Node Tuberculosis in Children: A Systematic Review and Meta-Analysis
by Hao-Kai Chen, Rui-Si Liu, Yi-Xuan Wang, En-Xiang Quan, Yuan-Hua Liu and Xu-Guang Guo
J. Clin. Med. 2022, 11(15), 4616; https://doi.org/10.3390/jcm11154616 - 8 Aug 2022
Cited by 2 | Viewed by 1616
Abstract
Background: Lymph node tuberculosis (LNTB) is the leading type of extrapulmonary tuberculosis (EPTB) causing death in children. The Xpert MTB/RIF assay is a novel rapid test for the diagnosis of LNTB. Although previous evidence suggests that Xpert is reliably accurate in diagnosing [...] Read more.
Background: Lymph node tuberculosis (LNTB) is the leading type of extrapulmonary tuberculosis (EPTB) causing death in children. The Xpert MTB/RIF assay is a novel rapid test for the diagnosis of LNTB. Although previous evidence suggests that Xpert is reliably accurate in diagnosing EPTB in children, information is lacking for the specific type of LNTB in children. The aim of this study was to systematically assess the accuracy and reliability of Xpert for the diagnosis of LNTB in children. Methods: We systematically searched four databases, Embase, Cochrane Library, PubMed, and Web of Science, which extracted relevant data according to predefined inclusion and exclusion criteria. The data were analyzed by meta-Disc 1.4 and Stata 12.0 software to determine sensitivity, specificity, diagnostic odds ratio (DOR), etc. Results: A total of 646 samples from 8 studies were included in the analysis. The pooled sensitivity, specificity, negative likelihood ratio (NLR), positive likelihood ratio (PLR,) and combined diagnostic odds ratio (DOR) of Xpert for all samples were 0.79 (95% CI 0.70, 0.87), 0.90 (95% CI 0.86, 0.92), 0.29 (95% CI 0.19, 0.43), 7.20 (95% CI 3.32, 15.60), and 37.56 (95% CI 13.04, 108.15), respectively. The area under the curve (AUC) of the summary receiver operating characteristic (sROC) curve was 0.9050. Conclusion: Overall, Xpert showed moderate sensitivity and high specificity compared with culture in the diagnosis of LNTB in children. In addition, after analyzing the combined diagnostic odds ratio and positive LR, our study showed that Xpert has excellent diagnostic accuracy. Full article
(This article belongs to the Special Issue Tuberculosis: Clinical and Laboratory Updates and Perspectives)
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