Writing in the journal of the
Asian Pacific Society of Respirology Christoph Lange (Germany) and Toru Mori (Japan) note that
One of the basic indicators of quality in diagnosing tuberculosis is the delay in diagnosis (‘doctor’s delay’, or ‘health system’s delay’), that is, the time from the first visit of a patient until the establishment of tuberculosis diagnosis.
Developed countries are the ones dragging the chain
It is remarkable that these delays in the low-prevalence settings are always longer than those in the high-prevalence settings.
With regards to IGRA;
Introduction of IGRA into clinical practice is regarded by many as the most important development in the diagnosis of M. tuberculosis infection over the last decade..
..the specificity of IGRA is consistently high and obviously superior to TST
They conclude
tuberculosis control is not possible, if the diagnosis of active cases is delayed as M. tuberculosis continues to be transmitted from cases to contacts. In addition, false positive diagnosis of LTBI has caused unnecessary burden to individuals and healthcare systems.
The urgent need for innovation in diagnostics is obvious.
However, it is good to see that the changes in diagnostics have started towards the end of the last century, assisted by the progress of biotechnology and the late riser’s alertness to the problem. The balance between developments in the diagnosis and in the treatment of tuberculosis has changed. Recent diagnostic advances overweigh the inefficient progress of new drug development against tuberculosis by far.
