Duthie Malcolm S, Reed Steven G
HDT Bio Corp, 1616 Eastlake Ave E, Seattle, WA, 98102, USA.
Appl Microbiol Biotechnol. 2021 Jan;105(2):503-508. doi: 10.1007/s00253-020-11062-4. Epub 2021 Jan 4.
Immunological and molecular advances have modernized diagnostic testing for many diseases. Although interferon gamma-release and polymerase chain reaction assays have been developed to detect Mycobacterium tuberculosis (Mtb) infection, purified protein derivative (PPD)-based tuberculin skin testing (TST) remains the most widely used method. Indeed, the TST is a simple and cost-effective tool that can be easily applied for widespread screening for Mtb infection. However, the lack of specificity has been a limitation of these tests, and, more recently, supply issues have arisen. Building upon the skin tests that historically have been used within TB and leprosy control programs, we discuss recent developments using modern technologies for improving mycobacterial skin testing as well as practical advantages inherent to the technique. Furthermore, we outline how this knowledge could be applied to develop similar tests that could benefit diagnostic strategies for other infections. KEY POINTS: • Skin testing provides a significantly cheaper alternative to most modern technologies. • Skin tests provide a lab-independent diagnostic strategy that can be widely administered. • Diseases for which T cell responses are more robust or durable than antibody responses are accessible for skin testing.
免疫学和分子学的进展使许多疾病的诊断检测实现了现代化。尽管已经开发出干扰素γ释放检测和聚合酶链反应检测来检测结核分枝杆菌（Mtb）感染，但基于纯化蛋白衍生物（PPD）的结核菌素皮肤试验（TST）仍然是使用最广泛的方法。事实上，TST是一种简单且经济高效的工具，可轻松应用于广泛筛查Mtb感染。然而，缺乏特异性一直是这些检测的一个局限，而且最近还出现了供应问题。基于历史上在结核病和麻风病控制项目中使用的皮肤试验，我们讨论了利用现代技术改进分枝杆菌皮肤试验的最新进展以及该技术固有的实际优势。此外，我们概述了如何应用这些知识来开发类似的检测方法，从而使其他感染的诊断策略受益。关键点：• 皮肤试验比大多数现代技术提供了一种成本显著更低的替代方法。• 皮肤试验提供了一种无需实验室的诊断策略，可广泛实施。• 对于T细胞反应比抗体反应更强健或更持久的疾病，可进行皮肤试验。
