Recommended standards for modern tuberculosis laboratory services in Europe

Drobniewski, Francis; Hoffner, Sven; Rüsch-Gerdes, Sabine; Šķenders, Ģirts; Thomsen, Vibeke Østergaard

doi:10.1183/09031936.06.00084906

Cited by 37 publications

(34 citation statements)

References 54 publications

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“…The appropriate standards for laboratory services for tuberculosis control programmes in low-incidence countries have been summarised [188]. On top of the required standards for microscopy, nucleic acid amplification, mycobacterial culture and susceptibility testing, standards for DNA fingerprinting techniques need to be agreed upon.…”

Section: Laboratory Servicesmentioning

confidence: 99%

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Tuberculosis contact investigation in low prevalence countries: a European consensus

Kamphorst²,

et al. 2010

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Contact investigation to identify individuals with tuberculosis and latent infection with Mycobacterium tuberculosis is an important component of tuberculosis control in low tuberculosis incidence countries. This document provides evidence-based and best-practice policy recommendations for contact tracing among high-and medium-priority contacts in a variety of settings. It provides a basis for national guidelines on contact investigation and tuberculosis outbreak management, and should support countries and tuberculosis control managers in evaluating and revising national policies. A review of existing guidelines, a literature search, several meetings and consultation with experts were used to formulate and grade recommendations for action during contact investigation.Available tests to identify individuals with latent infection with M. tuberculosis are designed to identify immune response against mycobacterial antigens and have variable predictive value for the likelihood to develop active tuberculosis in different populations. Contact investigation should therefore be limited to situations with a clear likelihood of transmission or to those with a higher probability of developing active tuberculosis, for instance, young children and immunocompromised persons. A risk assessment-based approach is recommended, where the need to screen contacts is prioritised on the basis of the infectiousness of the index case, intensity of exposure and susceptibility of contacts.

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Section: Laboratory Servicesmentioning

confidence: 99%

“…European standards for laboratory examinations have been published [188]. Any contact who has an abnormal chest radiograph or has symptoms suggestive of tuberculosis should have sputum specimens collected and examined.…”

Section: Sputummentioning

confidence: 99%

Tuberculosis contact investigation in low prevalence countries: a European consensus

Kamphorst²,

et al. 2010

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“…Mycobacterium tuberculosis (MTB) and environmental mycobacteria have a similar microscopic appearance and molecular tests that provide rapid identification are increasingly used in clinical practice 3 4. British guidelines2 5 recommend the use of nucleic acid amplification tests (NAAT) in acid fast bacillus (AFB) smear positive samples if rapid confirmation of TB diagnosis would alter the care of the patient, or before conducting a large contact-tracing initiative.…”

mentioning

confidence: 99%

The clinical impact of nucleic acid amplification tests on the diagnosis and management of tuberculosis in a British hospital

Taegtmeyer

Beeching

Scott

et al. 2008

Thorax

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Results: Mycobacteria were seen or isolated from 282 patients and identified as M tuberculosis in 181 (64%). NAAT were indicated in 87/123 AFB positive samples and performed in 51 (59%). M tuberculosis was confirmed or excluded by this method in 86% of tested samples within 2 weeks, compared with 7% identified using standard methods. The appropriate use of NAAT increased significantly over the study period. The NAAT result had a clinical impact in 20/51 (39%) tested patients. Culture results suggest the potential for a direct clinical impact in 8/36 (22%) patients in which it was indicated but not sent and 5/36 (14%) patients for whom it was not indicated. Patients managed by the multidisciplinary group had a higher rate of HIV testing and appropriate use of NAAT. Conclusions: There were significant clinical benefits from the use of nucleic acid amplification tests in this low prevalence setting. Our data suggest that there would be additional benefit from their use with all AFB smear positive clinical samples.

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“…NAAT also offers the promise of centralizing testing services without the "cold chain" transport systems required for culture. 25 However, further improvements in the sensitivity, cost and robustness of NAAT must be achieved before it can be generally adopted by most laboratories. 26 For example, cross-contamination of cultures can easily lead to false positives.…”

Section: Culture Methods and Drug Sensitivity Testingmentioning

confidence: 99%

roles of laboratories and laboratory systems in effective tuberculosis control

Ridderhof

Deun

Kam³

et al. 2007

Bull World Health Organ

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Laboratories and laboratory networks are a fundamental component of tuberculosis (TB) control, providing testing for diagnosis, surveillance and treatment monitoring at every level of the health-care system. New initiatives and resources to strengthen laboratory capacity and implement rapid and new diagnostic tests for TB will require recognition that laboratories are systems that require quality standards, appropriate human resources, and attention to safety in addition to supplies and equipment. To prepare the laboratory networks for new diagnostics and expanded capacity, we need to focus efforts on strengthening quality management systems (QMS) through additional resources for external quality assessment programmes for microscopy, culture, drug susceptibility testing (DST) and molecular diagnostics. QMS should also promote development of accreditation programmes to ensure adherence to standards to improve both the quality and credibility of the laboratory system within TB programmes. Corresponding attention must be given to addressing human resources at every level of the laboratory, with special consideration being given to new programmes for laboratory management and leadership skills. Strengthening laboratory networks will also involve setting up partnerships between TB programmes and those seeking to control other diseases in order to pool resources and to promote advocacy for quality standards, to develop strategies to integrate laboratories' functions and to extend control programme activities to the private sector. Improving the laboratory system will assure that increased resources, in the form of supplies, equipment and facilities, will be invested in networks that are capable of providing effective testing to meet the goals of the Global Plan to Stop TB.

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Recommended standards for modern tuberculosis laboratory services in Europe

Cited by 37 publications

References 54 publications

Tuberculosis contact investigation in low prevalence countries: a European consensus

Tuberculosis contact investigation in low prevalence countries: a European consensus

The clinical impact of nucleic acid amplification tests on the diagnosis and management of tuberculosis in a British hospital

roles of laboratories and laboratory systems in effective tuberculosis control

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