Gong Wenping, Wu Xueqiong
Tuberculosis Prevention and Control Key Laboratory/Beijing Key Laboratory of New Techniques of Tuberculosis Diagnosis and Treatment, Senior Department of Tuberculosis, The 8th Medical Center of PLA General Hospital, Beijing, China.
Front Microbiol. 2021 Oct 22;12:745592. doi: 10.3389/fmicb.2021.745592. eCollection 2021.
As an ancient infectious disease, tuberculosis (TB) is still the leading cause of death from a single infectious agent worldwide. Latent TB infection (LTBI) has been recognized as the largest source of new TB cases and is one of the biggest obstacles to achieving the aim of the End TB Strategy. The latest data indicate that a considerable percentage of the population with LTBI and the lack of differential diagnosis between LTBI and active TB (aTB) may be potential reasons for the high TB morbidity and mortality in countries with high TB burdens. The tuberculin skin test (TST) has been used to diagnose TB for > 100 years, but it fails to distinguish patients with LTBI from those with aTB and people who have received Bacillus Calmette-Guérin vaccination. To overcome the limitations of TST, several new skin tests and interferon-gamma release assays have been developed, such as the Diaskintest, C-Tb skin test, EC-Test, and T-cell spot of the TB assay, QuantiFERON-TB Gold In-Tube, QuantiFERON-TB Gold-Plus, LIAISON QuantiFERON-TB Gold Plus test, and LIOFeron TB/LTBI. However, these methods cannot distinguish LTBI from aTB. To investigate the reasons why all these methods cannot distinguish LTBI from aTB, we have explained the concept and definition of LTBI and expounded on the immunological mechanism of LTBI in this review. In addition, we have outlined the research status, future directions, and challenges of LTBI differential diagnosis, including novel biomarkers derived from and hosts, new models and algorithms, omics technologies, and microbiota.
作为一种古老的传染病，结核病（TB）仍是全球单一感染源导致死亡的主要原因。潜伏性结核感染（LTBI）已被认为是新结核病病例的最大来源，也是实现终结结核病战略目标的最大障碍之一。最新数据表明，相当比例的LTBI人群以及LTBI与活动性结核病（aTB）之间缺乏鉴别诊断，可能是结核病高负担国家结核病发病率和死亡率居高不下的潜在原因。结核菌素皮肤试验（TST）用于诊断结核病已有100多年历史，但它无法区分LTBI患者与aTB患者以及接种过卡介苗的人群。为克服TST的局限性，已开发出几种新的皮肤试验和干扰素-γ释放试验，如迪阿金试验、C-Tb皮肤试验、EC试验、结核T细胞斑点试验、管内式结核菌素金标试验、增强型结核菌素金标试验、LIAISON增强型结核菌素金标试验以及LIOFeron TB/LTBI。然而，这些方法无法区分LTBI与aTB。为探究所有这些方法均无法区分LTBI与aTB的原因，我们在本综述中阐释了LTBI的概念和定义，并阐述了LTBI的免疫机制。此外，我们概述了LTBI鉴别诊断的研究现状、未来方向及挑战，包括源自病原体和宿主的新型生物标志物、新模型和算法、组学技术以及微生物群。
