An alternative way to improve diagnosis of multidrug resistant tuberculosis: a rapid diagnostic test and a clinical score.

The emergence of multi- (MDR) and extremely resistant (XDR) forms of M. tuberculosis (MTB), in other words MTB not sensitive to isoniazid, rifampicin, and respectively also not sensitive to a fluoroquinolone and one of the three injectable second-line tuberculostatics, threaten the control of the TB at the global level. There is a high need for fast, simple, inexpensive and reliable diagnosis techniques for culture and sensitivity determination of MTB, especially in countries with a high TB ​​incidence. The detection of suspicious MDR TB cases is difficult. The diagnosis is often made late or not at all, which gives the Koch bacilli the opportunity to spread further, or -in case of inadequate treatment- to further develop resistance. In order to prevent this, a standard second-line treatment schedule should be started empirically for patients with a strong suspicion of MDR TB. Early diagnosis and treatment of MDR-TB are important milestones in the fight against XDR TB. In this research project we propose two complementary approaches: 1) the evaluation of the thin layer agar as a rapid method for the detection, identification and susceptibility of mycobacteria and 2) the development of a reliable and useful clinical prediction score for the empirical start of MDR TB treatment.