Tuberculosis remains one of the leading causes of death from infectious disease worldwide. In 2023, it affected approximately 10.8 million people and caused 1.25 million deaths, with most cases concentrated in low- and middle-income countries, particularly in Africa and Asia. Despite notable advances in diagnosis over the past two decades, particularly with the introduction of rapid molecular tests, current strategies are reaching their limits in these settings due to fragile health systems, financial constraints, a lack of skilled human resources, and difficulties in maintaining equipment. This review critically analyzes the limitations of conventional and molecular tuberculosis diagnostic strategies in developing countries and explores emerging innovations, including biomarkers, point-of-care testing, artificial intelligence, assisted imaging, and community based approaches. Drawing on field experience in Africa and recent developments in diagnostic tools, we propose an integrated and sustainable strategy combining technological and organizational innovations, adapted to the realities of low-resource countries, to improve early detection, diagnostic confirmation, and management of tuberculosis patients.
References
[1]
Brosch, R., Marmiesse, M. and Cole, S.T. (2003) La génomique et le développement de nouvelles stratégies thérapeutiques et préventives dans la lutte contre la tuberculose. MédecineetMaladiesInfectieuses, 33, 141-146. https://doi.org/10.1016/s0399-077x(03)00071-4
[2]
Morel, F., Jaffré, J., Sougakoff, W., Aubry, A. and Véziris, N. (2020) Place de la biologie moléculaire dans le diagnostic de la tuberculose. Revue des Maladies Respiratoires, 37, 412-416. https://doi.org/10.1016/j.rmr.2019.09.004
[3]
Astier, H., Briquet, A. and Garnotel, E. (2017) Mycobacterium canettii, une mycobactérie du complexe tuberculosis. RevueFrancophonedesLaboratoires, 2017, 47-59. https://doi.org/10.1016/s1773-035x(17)30375-1
[4]
Gérôme, P., Fabre, M. and Koeck, J. (2003) Les méthodes d’étude de la sensibilité de Mycobacterium tuberculosis aux antibiotiques. Revue Française des Laboratoires, 2003, 65-74. https://doi.org/10.1016/s0338-9898(03)80503-6
[5]
Sougakoff, W., Truffot-Pernot, C., Szpytma, M., Cambau, E., Lemaître, N. and Jarlier, V. (1999) Diagnostic moléculaire de la résistance de Mycobacterium tuberculosis aux antituberculeux. Revue Française des Laboratoires, 1999, 25-28. https://doi.org/10.1016/s0338-9898(99)80174-7
[6]
Maugein, J. and Chemoul, A. (2010) La résistance aux antituberculeux. Revue Francophone des Laboratoires, 2010, 43-50. https://doi.org/10.1016/s1773-035x(10)70509-8
[7]
Dufour, B. and Bénet, J. (2015) L’infection à Mycobacterium bovis en France en 2014: Recrudescence et inquiétudes. Revue Francophone des Laboratoires, 2015, 67-75. https://doi.org/10.1016/s1773-035x(15)30114-3
[8]
Blanc, F. (2023) Tuberculose et infection par le virus de l’immunodéficience humaine: comment réduire la mortalité? Bulletin de l'Académie Nationale de Médecine, 207, 1044-1052. https://doi.org/10.1016/j.banm.2023.07.007
[9]
Lange, C., Bothamley, G., Günther, G., Guglielmetti, L., Kontsevaya, I., Kuksa, L., etal. (2025) A Year in Review on Tuberculosis and Non-Tuberculous Mycobacteria Disease: A 2025 Update for Clinicians and Scientists. PathogensandImmunity, 10, 1-45. https://doi.org/10.20411/pai.v10i2.791
[10]
Dumont, Y., Lounnas, M., Carrière, C., Solassol, J., Bañuls, A. and Godreuil, S. (2018) Tuberculose bovine: Une maladie globalisée à l’interface homme-animal. Revue FrancophonedesLaboratoires, 2018, 58-63. https://doi.org/10.1016/s1773-035x(18)30179-5
[11]
Dorman, S.E., Schumacher, S.G., Alland, D., Nabeta, P., Armstrong, D.T., King, B., etal. (2018) Xpert MTB/RIF Ultra for Detection of Mycobacterium Tuberculosis and Rifampicin Resistance: A Prospective Multicenter Diagnostic Accuracy Study. The Lancet Infectious Diseases, 18, 76-84.
[12]
Lawn, S.D. and Zumla, A.I. (2013) Diagnosis of Extrapulmonary Tuberculosis Using the Xpert®MTB/RIF Assay. ExpertReviewofAnti-InfectiveTherapy, 10, 631-635. https://doi.org/10.1586/eri.12.43
[13]
Boehme, C.C., Nabeta, P., Hillemann, D., Nicol, M.P., Shenai, S., Krapp, F., et al. (2010) Rapid Molecular Detection of Tuberculosis and Rifampin Resistance. New England Journal of Medicine, 363, 1005-1015. https://doi.org/10.1056/nejmoa0907847
[14]
Quentin-Noury, C. (2016) Automatisation de l’antibiogramme au laboratoire de bactériologie. RevueFrancophonedesLaboratoires, 2016, 49-59. https://doi.org/10.1016/s1773-035x(16)30172-1
[15]
Gravet, A. and Camdessoucens-Miehé, G. (2011) Application de la spectrométrie de masse à la microbiologie. RevueFrancophonedesLaboratoires, 2011, 55-64. https://doi.org/10.1016/s1773-035x(11)71212-6
[16]
Jarlier, V. (2003) L’observatoire national de l’épidémiologie de la résistance bactérienne aux antibiotiques (onerba): Méthodologie, résultats concernant les fluoroquinolones. Revue Française des Laboratoires, 2003, 49-52. https://doi.org/10.1016/s0338-9898(03)90022-9
[17]
Georget, M. and Pisan, E. (2023) [Next Generation Sequencing (NGS) for Beginners]. Revue des Maladies Respiratoires, 40, 345-358. https://doi.org/10.1016/j.rmr.2023.01.026
[18]
Leocadie, A. and Segard, S. (2025) La génétique : les techniques et les outils de séquençage en biologie clinique. IRBM News, 46, Article ID: 100576. https://doi.org/10.1016/j.irbmnw.2024.100576
[19]
Kumar, K.R., Cowley, M.J. and Davis, R.L. (2024) Next-Generation Sequencing and Emerging Technologies. SeminarsinThrombosisandHemostasis, 50, 1026-1038. https://doi.org/10.1055/s-0044-1786397
[20]
Brousset, P., Abel, L., Froguel, P., Quintana-Murci, L., Solassol, J., Ardaillou, R., etal. (2024) Apport des techniques de séquençage de l’ADN de nouvelle génération en pratique et en recherche médicale en France. Bulletindel’AcadémieNationaledeMédecine, 208, 1141-1149. https://doi.org/10.1016/j.banm.2024.06.022
[21]
Garinet, S. and Blons, H. (2021) Nouvelles techniques en biologie moléculaire. Revue des Maladies Respiratoires Actualités, 13, 1S46-1S54. https://doi.org/10.1016/s1877-1203(21)00013-6
[22]
Lawn, S.D., Dheda, K., Kerkhoff, A.D., Peter, J.G., Dorman, S., Boehme, C.C., etal. (2013) Determine TB-LAM Lateral Flow Urine Antigen Assay for HIV-Associated Tuberculosis: Recommendations on the Design and Reporting of Clinical Studies. BMCInfectiousDiseases, 13, Article No. 407. https://doi.org/10.1186/1471-2334-13-407
[23]
Pai, M., Denkinger, C.M., Kik, S.V., Rangaka, M.X., Zwerling, A., Oxlade, O., etal. (2014) Gamma Interferon Release Assays for Detection of Mycobacterium Tuberculosis Infection. ClinicalMicrobiologyReviews, 27, 3-20. https://doi.org/10.1128/cmr.00034-13
