title: Rapid diagnostics of tuberculosis and drug resistance in the industrialized world: clinical and public health benefits and barriers to implementation.
abstract: In this article, we give an overview of new technologies for the diagnosis of tuberculosis (TB) and drug resistance, consider their advantages over existing methodologies, broad issues of cost, cost-effectiveness and programmatic implementation, and their clinical as well as public health impact, focusing on the industrialized world. Molecular nucleic-acid amplification diagnostic systems have high specificity for TB diagnosis (and rifampicin resistance) but sensitivity for TB detection is more variable. Nevertheless, it is possible to diagnose TB and rifampicin resistance within a day and commercial automated systems make this possible with minimal training. Although studies are limited, these systems appear to be cost-effective. Most of these tools are of value clinically and for public health use. For example, whole genome sequencing of Mycobacterium tuberculosis offers a powerful new approach to the identification of drug resistance and to map transmission at a community and population level.
authors.affiliation: Public Health England National Mycobacterium Reference Laboratory, 2 Newark Street, London E1 2AT, UK. f.drobniewski@qmul.ac.uk.
authors.forename: Francis
authors.initials: F
authors.lastname: Drobniewski
authors.forename: Vladyslav
authors.initials: V
authors.lastname: Nikolayevskyy
authors.forename: Horst
authors.initials: H
authors.lastname: Maxeiner
authors.forename: Yanina
authors.initials: Y
authors.lastname: Balabanova
authors.forename: Nicola
authors.initials: N
authors.lastname: Casali
authors.forename: Irina
authors.initials: I
authors.lastname: Kontsevaya
authors.forename: Olga
authors.initials: O
authors.lastname: Ignatyeva
mesh_terms: D000995:Antitubercular Agents / Q000494:pharmacology*; D024881:Drug Resistance, Bacterial; D016680:Genome, Bacterial; D006801:Humans; D025202:Molecular Diagnostic Techniques / Q000379:methods* / Q000706:statistics & numerical data*; D009169:Mycobacterium tuberculosis / Q000187:drug effects* / Q000302:isolation & purification*; D017422:Sequence Analysis, DNA / Q000379:methods; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis*
chemical_list: D000995:Antitubercular Agents