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首页> 外文期刊>Journal of Clinical Microbiology >Role of the Clinical Mycobacteriology Laboratory in Diagnosis and Management of Tuberculosis in Low-Prevalence Settings
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Role of the Clinical Mycobacteriology Laboratory in Diagnosis and Management of Tuberculosis in Low-Prevalence Settings

机译：临床分枝杆菌实验室在低流行环境下在结核病诊断和管理中的作用

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Tuberculosis (TB) remains a global epidemic, despite a significant decline in reported cases in the United States between 2008 and 2009. While the exact nature of this decline is unclear, one thing remains certain: TB, including multidrug-resistant (MDR) and extensively drug-resistant (XDR) TB, is no longer restricted to developing regions of the globe. It is of vital importance that both public and private mycobacteriology laboratories maintain the ability to detect and identify Mycobacterium tuberculosis from patient specimens, as well as correctly determine the presence of antibiotic resistance. To do this effectively requires careful attention to preanalytical, analytical, and postanalytical aspects of testing. Respiratory specimens require digestion and concentration followed by fluorescence microscopy. The Centers for Disease Control and Prevention (CDC) recommends the performance of a direct nucleic acid amplification method, regardless of smear results, on specimens from patients in whom the suspicion of tuberculosis is high. Liquid-based technologies are more rapid and sensitive for the detection of M. tuberculosis in culture and nucleic acid probes, but biochemicals are preferred for identification once growth is detected. Susceptibility testing is most often done using either the agar proportion method or a commercial broth system. New genotypic and phenotypic methods of susceptibility testing include first- and second-line agents and are promising, though not yet widely available. Finally, gamma interferon release assays are preferred to the tuberculin skin test for screening certain at-risk populations, and new CDC guidelines are available that assist clinicians in their use.
机译：尽管在2008年至2009年期间美国报告的病例显着下降，但结核病（TB）仍然是全球流行病。虽然这种下降的确切性质尚不清楚，但仍有一件事是确定的：结核病，包括耐多药（MDR）和广泛耐药性（XDR）结核病不再局限于全球发展中地区。至关重要的是，公共和私人分枝杆菌实验室都必须保持从患者标本中检测和鉴定结核分枝杆菌的能力，并正确确定是否存在抗生素耐药性。要有效地做到这一点，需要仔细注意测试的分析前，分析和分析后方面。呼吸道标本需要消化和浓缩，然后再进行荧光显微镜检查。疾病控制与预防中心（CDC）建议在怀疑肺结核患者的标本上使用直接核酸扩增方法，而不管涂片结果如何。基于液体的技术对培养物中的结核分枝杆菌和核酸探针的检测更加快速和灵敏，但是一旦检测到生长，则优选使用生化试剂进行鉴定。药敏试验通常使用琼脂比例法或商业肉汤系统进行。药敏试验的新基因型和表型方法包括一线和二线药物，尽管尚未广泛使用，但仍很有希望。最后，对于某些高危人群，γ干扰素释放试验优于结核菌素皮肤试验，并且有新的CDC指南可协助临床医生使用。

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