Razi Journal of Medical Sciences

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Despite advances in medical sciences in recent years, tuberculosis remains a worldwide health problem. The World Health Organization (WHO) global tuberculosis report 2016 states that tuberculosis killed 1.4 million individuals (1.2 to 1.6 million) HIV-negative and 0.39 million (0.32 million to 0.46 million) HIV-positive people in 2015. The 30 high-tuberculosis burden countries represented 87% of all assessed incident cases around the world. Of these, China, India and Indonesia alone represented 45% of worldwide cases in 2015. Currently, the annual rate of decline in tuberculosis incidence is around 1–2% while the rate would need to be 4–5% by 2020 and over 10% by 2025 to achieve the goal of ending the epidemic by 2030. Although there are many laboratory methods to accelerate the diagnosis, a delay in the definitive diagnosis of the disease is still a major clinical problem. Due to the slow growth of the causative agent, (Mycobacterium tuberculosis), isolation, identification, and other clinically important mycobacteria can take several weeks or longer. During the past few years, many methods have been provided for direct detection, species identification, and susceptibility testing of tuberculosis agents. Understanding the effectiveness and practical limitations of these methods is important to improve diagnosis. This article describes recent advances in the diagnosis of tuberculosis based on molecular and non-molecular methods. In the current review, we aim to perform a literature review in different library databases and electronic searches (Science Direct, PubMed, and Google Scholar) which were randomly obtained. For each stage of diagnosis, there are new methodologies. New tests are accessible by level of laboratory and period of application. Overall, the innovation for the diagnosis of tuberculosis and antibiotic resistance in pulmonary specimens is all well advanced, with high particularity and progressively high sensitivity. Ongoing advances in molecular science and molecular epidemiology, and a superior comprehension of the molecular basis of drug resistance in tuberculosis, have given new devices to fast diagnosis; however, the high cost of most of these strategies, and their prerequisite for the high cost of most and skilled personnel have blocked their execution on a routine basis, particularly in low-income countries. Improving the process of identifying the spectrum of tuberculosis, including active, drug-resistant strains as well as latent tuberculosis, can have a profound impact on global health. For example, an experiment with and 85% sensitivity and a 97% specificity in identifying people with tuberculosis could prevent 392,000 deaths per year. New methods allow rapid detection of active tuberculosis in patients with negative sputum smear for fast acid bacilli and enable rapid and accurate identification of tuberculosis-resistant strains in respiratory samples. Rapid isolation and diagnosis of M. tuberculosis have improved the early detection of tuberculosis. Molecular methods play an important role in the diagnosis of M. tuberculosis and have many advantages such as reducing the detection time, rapid detection of mutations related to drug resistance and clinical use. Despite the obvious advantages of molecular detection methods, they have some disadvantages and some molecular methods have not yet been approved by the Food and Drug Administration. Molecular methods are mainly useful in cases of positive smear and are recommended in patients with negative smear when there is a high clinical suspicion of tuberculosis. On the other hand, despite the advantages of molecular methods, the genetic basis of drug resistance of any tuberculosis drug is not fully understood, so the results of molecular tests must always be confirmed by phenotypic methods. Tuberculosis control strategies are personally identified with the availability of powerful tests for the determination of active tuberculosis and the identification of inactive tuberculosis infection. Improved tuberculosis diagnostics, along with different interventions, are vital to arriving at the objective of entering the pre-elimination phase by 2035 in countries with a low incidence of the disease. At present that many of these techniques are only economically viable in the developed nations, it is hoped that recent advances will lead to the development of novel diagnostic strategies applicable to use in developing nations, where the burden of tuberculosis is maximum and effective intervention is most urgently required. Thus, more consideration and examination are needed to create effective and cheap methods in various settings to overcome this overall issue and more evidence is needed to survey the operational effect of noncommercial, low-cost, rapid diagnostic techniques in field conditions.

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