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The role of rapid diagnostic tests in managing adults with pneumonia in low-resource settings

机译：快速诊断测试在资源贫乏地区控制成人肺炎的作用

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In well-resourced settings the systematic use of rapid diagnostics tests (e.g. pneumococcal urinary antigen test) that define the causal pathogen to direct therapy has not resulted in significantly improved outcomes in adults withpneumonia. The management of pneumonia in many low-resource settings is complicated by a substantial burden of tuberculosis and HIV-associated opportunistic infections, in addition to the usual spectrum of pathogens seenin well-resourced settings. Clinical features alone do not reliably distinguish between these different aetiologiesand physicians often have to treat empirically. Given the limitations in diagnostic laboratory capability present inmost low-resource settings, rapid and point-of-care diagnostic tests could become valuable tools to guide treatment decisions. Pneumococcal and Legionella urinary antigen tests are specific and moderately sensitive, but their utilityin low-resource settings is uncertain. The Xpert MTB/RIF (Cepheid, USA) platform and rapid assays for urinary lipoarabinomannan can substantially speed up tuberculosis diagnosis; the current challenge is to translate this intoearlier treatment and hopefully improve patient outcome. In HIV-infected patients, 1-3-β-D-glucan is a serum marker of Pneumocystis jirovecii infection with excellent sensitivity. Further studies are needed to assess the clinical utilityand cost-effectiveness of these rapid diagnostic assays when they are incorporated into treatment algorithms.
机译：在资源丰富的环境中，系统地使用快速诊断测试（例如肺炎球菌尿液抗原测试）来确定直接治疗的病原体并不能显着改善成人肺炎的预后。在许多资源贫乏地区，除了在资源丰富地区常见的病原体之外，结核病和艾滋病毒相关的机会性感染的负担也很重，这使肺炎的管理变得复杂。仅仅临床特征不能可靠地区分这些不同的病因，医师通常必须凭经验进行治疗。鉴于目前大多数资源匮乏的环境中诊断实验室能力的局限性，快速的即时诊断测试可能会成为指导治疗决策的有价值的工具。肺炎球菌和军团菌尿液抗原检测是特异性和中等敏感性的，但它们在低资源环境中的效用尚不确定。 Xpert MTB / RIF（美国，Cepheid）平台和尿脂阿拉伯糖甘露聚糖的快速检测可大大加快结核病的诊断;当前的挑战是将其转化为更早的治疗方法，并有望改善患者的预后。在HIV感染的患者中，1-3-β-D-葡聚糖是吉氏肺孢子虫感染的血清标志物，具有出色的敏感性。当将这些快速诊断测定法纳入治疗算法时，需要进行进一步的研究以评估其临床实用性和成本效益。

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