Servicio de Microbiología, IDIBELL-Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
Enferm Infecc Microbiol Clin. 2011 Mar;29 Suppl 1:34-40. doi: 10.1016/S0213-005X(11)70016-7.
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.
快速诊断结核病（TB）和耐多药（至少对利福平及异烟肼耐药）结核分枝杆菌（MDR-TB）是全球结核病控制的基石之一，因为它可以实现早期的流行病学和治疗干预。结核分枝杆菌的缓慢生长是快速诊断该疾病的最大障碍。然而，最近在开发新型诊断工具方面取得了相当大的进展，特别是针对临床标本的直接检测的分子方法（商业和“内部”）。这些方法基于不同靶标的核酸扩增（NAA），旨在鉴定结核分枝杆菌复合群，并检测与多种药物表型耐药最相关的特定染色体突变。通常，推荐使用商业方法，因为它们具有更好的标准化、可重复性和自动化水平。尽管成本效益和在这些技术的实施中的适当设置等方面尚未得到很好的确定，但世卫组织等组织正在大力支持这些新的分子方法的实施和普遍使用。本章总结了临床微生物学实验室中快速诊断结核病和抗结核药物耐药性的最新知识和现有分子方法。
