Advancement in diagnostic approaches for latent tuberculosis: distinguishing recent from remote infections

Abstract

Tuberculosis (TB) remains as a significant global health threat to date, with latent TB infection (LTBI) serving as a major reservoir for future active disease cases. A practical approach to an effective control and eradication of TB hence, requires an explicit identification of infected patient whom are at high risk of progressing from latent to active TB, particularly in those recently infected individuals. Current diagnostic tools however, including Tuberculin Skin Test and Interferon-Gamma Release Assays, are still lacking for their ability to critically distinguish between recent and remote infections, leading to insufficiency in optimizing targeted preventive treatment strategies. This review examines the limitations of current diagnostic tools and explores novel biomarkers to enhance distinction within the infection timeline in LTBI diagnostics. Advancement in immune profiling, dormancy antigen, along with molecular and transcriptomic approaches holds great promise to develop a diagnostic tools with better accuracy to differentiate recent from remote infections, thereby optimizing targeted interventions to improve TB control strategies. These underscores the need for further research into these emerging diagnostic tools to facilitate an effective public health strategies and contribute to the united efforts in End TB Strategy.

Keywords: IGRA; LTBI; LTBI diagnostics; Recent TB infection; Remote TB infection; TST.

Fig. 1

Overview of current diagnostic tools for LTBI, highlighting existing challenges and future advancements for differentiating recent versus remote infections. Created in BioRender. Ding, Y. (2024) https://BioRender.com/h84i055