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• 25% of global population has an Mtb immune response called TB infection (TBI) • IGRA/TST are approved for TBI diagnosis with low accuracy to identify TB progressor • Developing new diagnostic tests is needed to address the current limitations • mRNA signature detection has a good accuracy for identifying TB progressors • Blood pathogen-based tests are a promising approach to diagnose TBI Tuberculosis (TB) remains the leading cause of death worldwide from a single infectious disease. An estimated quarter of the world's population, about 2 billion people, has an immune response to Mtb without clinical, microbiological, or radiological signs of TB disease. This condition is known as TB infection (TBI) and carries a lifelong risk of reactivation with 5-10% of individuals eventually developing TB disease during their lifetime. IGRA and skin-tests are World Health Organization (WHO)-approved tests for TBI diagnosis and allow to identify those needing TB preventive therapy. The WHO End TB Strategy proposes several approaches to mitigate the global burden of TB. Achieving the goal of TB elimination requires improved early diagnosis of TBI individuals at risk of developing TB disease, provision of preventive therapy, and development of new diagnostic tests to address the current limitations. This review provides an update on the tests currently used for TBI diagnosis and offers an overview of experimental tests based on either host response analysis or pathogen detection. Additionally, we briefly report experimental tests, such as those based on host RNA signatures, which can help identifying TBI individuals at high risk of progressing towards TB disease. Although these experimental tests show promise, further investigation and randomized clinical trials are required to establish reliable proof-of-concept.
Alonzi et al. (Wed,) studied this question.