Shleider Carnero Canales Christian, Marquez Cazorla Jessica, Furtado Torres André Henrique, Monteiro Filardi Eloise T, Di Filippo Leonardo Delello, Costa Paulo Inácio, Roque-Borda Cesar Augusto, Pavan Fernando Rogério
Facultad de Ciencias Farmacéuticas Bioquímicas y Biotecnológicas, Vicerrectorado de Investigación, Universidad Católica de Santa María, Arequipa 04000, Peru.
Institute of Chemistry, São Paulo State University (UNESP), Araraquara 14801-970, SP, Brazil.
Pharmaceutics. 2023 Sep 30;15(10):2409. doi: 10.3390/pharmaceutics15102409.
Latent tuberculosis infection (LTBI) represents a subclinical, asymptomatic mycobacterial state affecting approximately 25% of the global population. The substantial prevalence of LTBI, combined with the risk of progressing to active tuberculosis, underscores its central role in the increasing incidence of tuberculosis (TB). Accurate identification and timely treatment are vital to contain and reduce the spread of the disease, forming a critical component of the global strategy known as "End TB." This review aims to examine and highlight the most recent scientific evidence related to new diagnostic approaches and emerging therapeutic treatments for LTBI. While prevalent diagnostic methods include the tuberculin skin test (TST) and interferon gamma release assay (IGRA), WHO's approval of two specific IGRAs for (MTB) marked a significant advancement. However, the need for a specific test with global application viability has propelled research into diagnostic tests based on molecular diagnostics, pulmonary immunity, epigenetics, metabolomics, and a current focus on next-generation MTB antigen-based skin test (TBST). It is within these emerging methods that the potential for accurate distinction between LTBI and active TB has been demonstrated. Therapeutically, in addition to traditional first-line therapies, anti-LTBI drugs, anti-resistant TB drugs, and innovative candidates in preclinical and clinical stages are being explored. Although the advancements are promising, it is crucial to recognize that further research and clinical evidence are needed to solidify the effectiveness and safety of these new approaches, in addition to ensuring access to new drugs and diagnostic methods across all health centers. The fight against TB is evolving with the development of more precise diagnostic tools that differentiate the various stages of the infection and with more effective and targeted treatments. Once consolidated, current advancements have the potential to transform the prevention and treatment landscape of TB, reinforcing the global mission to eradicate this disease.
潜伏性结核感染（LTBI）是一种亚临床、无症状的分枝杆菌状态，影响着全球约25%的人口。LTBI的高流行率，加上进展为活动性结核病的风险，凸显了其在结核病（TB）发病率上升中所起的核心作用。准确识别和及时治疗对于控制和减少疾病传播至关重要，是被称为“终止结核病”的全球战略的关键组成部分。本综述旨在研究和突出与LTBI新诊断方法和新兴治疗方法相关的最新科学证据。虽然普遍使用的诊断方法包括结核菌素皮肤试验（TST）和干扰素γ释放试验（IGRA），但世界卫生组织批准两种特定的IGRA用于（MTB）标志着一项重大进展。然而，对具有全球应用可行性的特定检测的需求推动了基于分子诊断、肺部免疫、表观遗传学、代谢组学以及当前对下一代基于MTB抗原的皮肤试验（TBST）的诊断检测研究。正是在这些新兴方法中，已证明有准确区分LTBI和活动性结核病的潜力。在治疗方面，除了传统的一线疗法外，还在探索抗LTBI药物、抗耐药结核病药物以及处于临床前和临床阶段的创新候选药物。尽管取得的进展很有希望，但必须认识到，除了确保所有医疗中心都能获得新药和诊断方法外，还需要进一步的研究和临床证据来巩固这些新方法的有效性和安全性。随着更精确的诊断工具的发展，能够区分感染的不同阶段，以及更有效和有针对性的治疗方法的出现，抗击结核病的斗争正在不断演变。一旦得到巩固，当前的进展有可能改变结核病的预防和治疗格局，加强根除这种疾病的全球使命。
