¿Qué aporta la biología molecular al diagnóstico de la tuberculosis?

DNA Detection Reveals Mycobacterium tuberculosis Complex Shedding Routes in Its Wildlife Reservoir the Eurasian Wild Boar

Since the intensity and frequency of pathogen shedding by hosts determine the probability of infection through direct and indirect contact, the shedding characterization of Mycobacterium tuberculosis complex (MTC) in the key host reservoir in Iberia, the Eurasian wild boar (Sus scrofa), is crucial. We aimed (i) to describe the natural shedding routes of MTC in free-ranging wild boar by a new semi-automated PCR method and (ii) to determine the association of MTC shedding pattern with tuberculosis (TB) progression and individual factors. MTC shedding (by any of the possible routes) was detected in a total of 30.8% (±7.5) out of the sampled individuals with valid or interpretable test results (n = 39). The proportion of TB-positive shedders according to the route was 13.6% (±7.5) for oral swabs, 4.5% (±4.5) for nasal swabs, 4.5% (±4.4) for faecal swabs and 13.6% (±7.5) for individuals being positive to all swabs concomitantly. The probability of shedding mycobacteria (by any route) statistically associated with TB generalization, and the TB score was significantly higher in individuals testing positive to at least one route compared to negatives. Overall, a diversity of shedding routes in wild boar is possible, and it is remarkable that for the first time, the faecal shedding is confirmed for naturally infected wild boar. Our results are consistent with the role wild boar plays for TB maintenance in host communities and environments in Iberia and confirm that it is an important source of mycobacteria infection by different routes. Finally, we evidenced the use of a new PCR technique to detect MTC DNA in excretions can be practical and defined the target routes for sampling wild boar shedding in future studies, such as interventions to control TB in wild boar that can be measured in terms of impact on mycobacteria excretion and transmission (i.e. vaccination).

Advances in rapid diagnosis of tuberculosis disease and anti-tuberculous drug resistance

Rapid diagnosis of tuberculosis (TB) and multidrug-resistant (resistance to at least rifampin and isoniazid) Mycobacterium tuberculosis (MDR-TB) is one of the cornerstones for global TB control as it allows early epidemiological and therapeutic interventions. The slow growth of the tubercle bacillus is the greatest obstacle to rapid diagnosis of the disease. However, considerable progress has recently been made in developing novel diagnostic tools, especially molecular methods (commercial and 'in-house'), for direct detection in clinical specimens. These methods, based on nucleic acid amplification (NAA) of different targets, aim to identify the M. tuberculosis complex and detect the specific chromosome mutations that are most frequently associated with phenotypic resistance to multiple drugs. In general, commercial methods are recommended since they have a better level of standardization, reproducibility and automation. Although some aspects such as cost-efficiency and the appropriate setting for the implementation of these techniques are not yet well established, organizations such as the WHO are strongly supporting the implementation and universal use of these new molecular methods. This chapter summarizes current knowledge and the available molecular methods for rapid diagnosis of TB and anti-tuberculous drug resistance in clinical microbiology laboratories.