title: Diagnosis of pulmonary tuberculosis.
abstract: OBJECTIVE
  This review summarizes the recent literature on the developments in diagnostics for pulmonary tuberculosis (TB).
  
  
  RESULTS
  A growing body of literature regarding the Xpert MTB/RIF assay confirms the high diagnostic accuracy in a range of clinical settings, including amongst inpatients, those with HIV coinfection and in children with culture-positive disease. Early experiences with operational implementation are now being reported from South Africa. Initial small-scale evaluations suggest that newer versions of line-probe assays have diagnostic accuracy similar to that of the Xpert MTB/RIF assay. Next-generation fully automated molecular assays that use isothermal amplification may in the future be more readily implemented at the point of care. The first low-cost, lateral-flow (strip-test) assay for lipoarabinomannan in urine shows promise as a rapid point-of-care test for TB amongst HIV-infected patients who have advanced immunodeficiency. A range of other diagnostic tools are also at various stages of development.
  
  
  CONCLUSIONS
  There is continued momentum and optimism regarding the developments in TB diagnostics. However, studies of clinical and programmatic impact and operational research are needed to guide implementation and scale-up of new assays in resource-limited settings. Further concerted efforts are needed to develop point-of-care assays which are desperately needed to accelerate progress in TB control.
authors.affiliation: Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK. stephen.lawn@lshtm.ac.uk
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Lawn
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis*; D000942:Antigens, Bacterial / Q000652:urine*; D006801:Humans; D009169:Mycobacterium tuberculosis / Q000235:genetics / Q000302:isolation & purification*; D021141:Nucleic Acid Amplification Techniques / Q000191:economics / Q000379:methods*; D060888:Real-Time Polymerase Chain Reaction / Q000379:methods; D012680:Sensitivity and Specificity; D013019:South Africa; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000209:etiology
chemical_list: D000942:Antigens, Bacterial