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J Korean Med Assoc > Volume 62(1); 2019 > Article
Jhun, Huh, and Koh: Diagnosis of pulmonary tuberculosis

Abstract

The incidence and prevalence of pulmonary tuberculosis (TB) in South Korea remain high despite the fact that South Korea is a high-income country, and pulmonary TB is an important public health issue in terms of both morbidity and mortality. Thus, rapid diagnosis and management of active pulmonary TB are crucial for effective TB control, which can help to prevent the transmission of TB and the occurrence of new TB cases. However, because the clinical and radiological presentations of pulmonary TB may occasionally be nonspecific, identification of causative microorganisms using laboratory tests is the most important diagnostic method. Recently-developed microbiological and molecular techniques are commonly employed in current clinical practice. In particular, advances in liquid culture system, line probe assays, and Xpert MTB/RIF assay have reduced the identification time and facilitate the identification of drug-resistance TB. However, as various tests have both advantages and limitations, physicians should be aware of the principles underpinning the tests when interpreting the results. Thus, the clinical and radiological characteristics of pulmonary TB and several diagnostic laboratory tests that we describe below will aid physicians in diagnosing pulmonary TB efficiently.

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Table 1

Interpretation of Xpert MTB/RIF assay results

jkma-62-18-i001-l.jpg

TB-PCR, Mycobacterium tuberculosis complex-polymerase chain reaction; TB, tuberculosis; RR-TB, rifampin-resistant tuberculosis; MDR-TB, multidrug-resistant tuberculosis; INH-R TB, isoniazid-resistant tuberculosis.

a)Rifampin-resistant TB should be regarded and treated as MDR-TB.

Table 2

Interpretation of rapid drug-susceptibility test for isoniazid and rifampin test results

jkma-62-18-i002-l.jpg

MDR-TB, multidrug-resistant tuberculosis; RR-TB, rifampin-resistant tuberculosis; INH-R TB, isoniazid-resistant tuberculosis.

a)Rifampin-resistant TB should be regarded and treated as MDR-TB.



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