Department of Medical and Surgical Sciences, "Magna Graecia" University, Catanzaro, Italy.
Infectious and Tropical Disease Unit, "Renato Dulbecco" Teaching Hospital, Catanzaro, Italy.
Infection. 2024 Aug;52(4):1215-1222. doi: 10.1007/s15010-024-02239-4. Epub 2024 Apr 8.
In the context of the evolving global health landscape shaped by the COVID-19 pandemic, tuberculosis (TB) is gaining renewed attention as a reemerging threat even in low-endemic countries. Immunological tests such as the tuberculin skin test (TST) and interferon-gamma release assay (IGRA) are pivotal in identifying tuberculosis infection (TBI). However, their inability to distinguish between past and ongoing infection poses a diagnostic challenge, possibly leading to the unnecessary treatment of a significant portion of the population with potential side effects. This review delves into the concept of incipient tuberculosis (ITB), a dynamic, presymptomatic stage characterized by heightened Mycobacterium tuberculosis complex (MTC) metabolic activity and replication that result in minimal radiological changes, signifying a transitional state between TBI and TB. Key focus areas include epidemiological factors, underlying pathogenesis, imaging findings, and the ongoing challenges in the identification of individuals with ITB through the development of new biomarkers and the use of whole-genome sequencing-based analyses to implement early treatment strategies.
在 COVID-19 大流行塑造的不断变化的全球卫生格局背景下，结核病（TB）作为一种重新出现的威胁，即使在低流行国家也引起了新的关注。结核菌素皮肤试验（TST）和干扰素-γ释放试验（IGRA）等免疫学检测在确定结核感染（TBI）方面具有重要作用。然而，它们无法区分过去和现有的感染，这给诊断带来了挑战，可能导致相当一部分人群因潜在的副作用而进行不必要的治疗。本综述深入探讨了初期结核病（ITB）的概念，这是一个动态的、前驱期的阶段，其特点是结核分枝杆菌复合群（MTC）代谢活性和复制增加，导致放射学变化最小，标志着 TBI 和 TB 之间的过渡状态。重点关注的领域包括流行病学因素、潜在发病机制、影像学发现，以及通过开发新的生物标志物和使用全基因组测序分析来确定 ITB 个体，并实施早期治疗策略所面临的持续挑战。
