Slim-Saidi L, Mehiri-Zeghal E, Ghariani A, Tritar F
Laboratoire national de référence des mycobactéries, laboratoire de bactériologie, hôpital A. Mami de pneumologie, 2080 Ariana, Tunisie.
Laboratoire national de référence des mycobactéries, laboratoire de bactériologie, hôpital A. Mami de pneumologie, 2080 Ariana, Tunisie.
Rev Pneumol Clin. 2015 Apr-Jun;71(2-3):110-21. doi: 10.1016/j.pneumo.2015.02.002. Epub 2015 Mar 6.
Bacteriological diagnosis of tuberculosis has benefited in recent years from many technological advances to improve rapidity and sensitivity of the techniques. Thus, new LED fluorescence microscopes are in the process of replacing the optical microscopes and the Ziehl-Neelsen technique, making the examination more precise, faster and easier. The manual and automatic liquid culture has improved Lowenstein-Jensen culture and helped shorten antibiotic sensitivity test, allowing appropriate management of patients. The development and standardization of molecular biology methods led to the rapid detection and identification of mycobacterium directly in clinical samples but also of resistance genes for early diagnosis of MDR-TB and dealing with them quickly. However, the performance of these techniques does not sufficiently cover the diagnosis of smear-negative tuberculosis, extrapulmonary forms, children- and immune-compromised tuberculosis where sensitivity is limited. The diagnosis of latent tuberculosis is reinforced by the in vitro release testing of gamma interferon overcoming the lack of specificity of the tuberculin skin test. Despite considerable progress, more amelioration is still needed to improve these techniques in order to extend them to the paucibacillary tuberculosis and to facilitate their access to low-resource countries.
近年来，结核病的细菌学诊断受益于诸多技术进步，这些进步提高了检测技术的速度和灵敏度。因此，新型LED荧光显微镜正在逐步取代光学显微镜和萋-尼氏染色法，使检查更加精确、快速且简便。手动和自动液体培养改进了罗-琴氏培养基培养法，并有助于缩短抗生素敏感性试验时间，从而实现对患者的合理治疗。分子生物学方法的发展和标准化不仅能直接在临床样本中快速检测和鉴定分枝杆菌，还能检测耐药基因，以实现耐多药结核病的早期诊断并迅速应对。然而，这些技术的性能尚不足以涵盖涂片阴性结核病、肺外结核、儿童结核病以及免疫功能低下者结核病的诊断，因为这些情况下其灵敏度有限。γ干扰素体外释放试验克服了结核菌素皮肤试验缺乏特异性的问题，强化了潜伏性结核病的诊断。尽管取得了显著进展，但仍需进一步改进这些技术，以便将其应用于少菌型结核病，并使其在资源匮乏的国家更易获得。
