Correia-Neves Margarida, Fröberg Gabrielle, Korshun Liudmyla, Viegas Sofia, Vaz Paula, Ramanlal Nehaben, Bruchfeld Judith, Hamasur Beston, Brennan Patrick, Källenius Gunilla
Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.
ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal.
ERJ Open Res. 2019 Feb 11;5(1). doi: 10.1183/23120541.00115-2018. eCollection 2019 Feb.
Tuberculosis (TB) is considered the most onerous of infectious diseases according to recent reports from the World Health Organization. Available tests for TB diagnosis present severe limitations, and a reliable point-of-care (POC) diagnostic test does not exist. Neither is there a test to discern between the different stages of TB, and in particular to predict which patients with infection and no clinical signs are more at risk of advancing to overt disease. We here review the usefulness of mycobacterial lipoarabinomannan (LAM) as a diagnostic marker for active and latent TB and, also, aspects of the immune response to LAM relevant to such tests. There is a high potential for urinary LAM-based POC tests for the diagnosis of active TB. Some technical challenges to optimised sensitivity of the test will be detailed. A method to quantify LAM in urine or serum should be further explored as a test of treatment effect. Recent data on the immune response to LAM suggest that markers for host response to LAM should be investigated for a prognostic test to recognise individuals at the greatest risk of disease activation.
根据世界卫生组织最近的报告，结核病（TB）被认为是最严重的传染病。现有的结核病诊断检测存在严重局限性，且不存在可靠的即时检测（POC）诊断方法。也没有检测来区分结核病的不同阶段，特别是预测哪些感染但无临床症状的患者更有可能发展为显性疾病。我们在此综述分枝杆菌脂阿拉伯甘露聚糖（LAM）作为活动性和潜伏性结核病诊断标志物的实用性，以及与此类检测相关的对LAM免疫反应的各个方面。基于尿液LAM的POC检测用于诊断活动性结核病具有很大潜力。将详细介绍为优化检测灵敏度所面临的一些技术挑战。应进一步探索一种定量尿液或血清中LAM的方法作为治疗效果检测。最近关于对LAM免疫反应的数据表明，应研究宿主对LAM反应的标志物，以进行预后检测，识别疾病激活风险最高的个体。
