Tuberculosis (TB), caused by the insidious Mycobacterium tuberculosis bacterium, is a formidable adversary within infectious diseases. Primarily targeting the pulmonary system yet capable of infiltrating vital organs such as the kidneys, spine, and brain, TB presents a dual narrative: latent TB infection (LTBI) and active TB disease. LTBI denotes a state of dormancy with the potential for reactivation, while TB disease manifests in active bacterial replication, posing grave threats to patient health and mortality.
Untreated TB disease exacts a heavy toll, undermining pulmonary and systemic integrity, leading to irreversible organ damage and, often, fatal outcomes. Vigilant surveillance, early diagnosis, and prompt intervention are paramount in mitigating the morbidity and mortality associated with this ancient scourge, underscoring the indispensable role of healthcare practitioners in combating TB's relentless advance.
Tuberculosis transmission occurs through the dissemination of infectious droplets when an afflicted individual coughs, sneezes, or even sings. These droplets, laden with tuberculosis-causing bacteria, linger in the air and can be unwittingly inhaled by others, thus facilitating the entry of the pathogen into their respiratory system.
Environments characterized by dense populations or crowded living conditions provide fertile ground for the facile spread of tuberculosis. Moreover, individuals with compromised immune systems, such as those afflicted with HIV/AIDS, are particularly susceptible to contracting the disease compared to their immunocompetent counterparts. This heightened vulnerability underscores the importance of targeted intervention strategies and heightened vigilance in communities where tuberculosis prevalence is pronounced.
Certain individuals warrant tuberculosis (TB) testing due to their heightened susceptibility to TB bacteria infection. These include:
- Individuals who have had close contact with someone diagnosed with TB disease.
- Individuals hailing from regions where TB disease prevails, notably across Latin America, the Caribbean, Africa, Asia, Eastern Europe, and Russia.
- Those residing or laboring in environments marked by elevated TB transmission risks, such as correctional facilities, long-term care facilities, nursing homes, and homeless shelters.
- Healthcare professionals attend to patients with an escalated risk of TB disease.
- Infants, children, and adolescents exposed to adults with an elevated likelihood of latent tuberculosis infection or TB disease.
While many individuals with latent TB infection never progress to active TB disease, certain groups face an elevated risk of disease development, including:
- Individuals living with HIV infection.
- Individuals recently infected with TB bacteria within the past two years.
- Infants, young children, and elderly individuals.
- Persons engaging in intravenous drug use.
- Individuals afflicted with concurrent illnesses compromising the immune system.
- Individuals with a history of inadequate TB treatment.
It is pertinent to note that TB testing is generally deemed unnecessary for individuals deemed to have a low risk of TB bacterial infection.
A multitude of tuberculosis (TB) tests are available for diagnosing the disease, contingent upon the patient's suspected or confirmed condition. Hence, the selection of the appropriate test hinges upon the physician's evaluation and decision-making.
Typically, the lungs are the first organs suspected of infection. Doctors will have patients undergo common tests with high accuracy such as sputum tests or chest X-rays.
With the advancement of technology, Artificial Intelligence (AI) applications in healthcare are gaining increasing attention. AI applications are developed to enhance the ability to detect disease signs at extremely small scales, helping patients to be diagnosed early and receive timely treatment.
One notable example is DrAid™ for TB Screening - an AI-powered platform for diagnosis and screening of tuberculosis developed by VinBrain, which assists healthcare professionals in early tuberculosis detection through the analysis of chest X-ray images and abnormalities with over 90% accuracy. With its fast screening capability and high accuracy, DrAid™ Tuberculosis Lung has addressed the tuberculosis screening challenge for communities with limited resources and infrastructure.
Currently, for tuberculosis latent infection or individuals infected with tuberculosis bacteria but showing no symptoms, two testing methods are commonly applied in healthcare facilities: Skin testing and blood testing.
Skin testing for diagnosing tuberculosis is commonly known as the Mantoux test or tuberculin skin test (TST). Patients will be injected with a small amount of PPD tuberculin solution into the forearm skin. In the case of latent tuberculosis infection, the skin will react to PPD tuberculin, resulting in a small, raised, swollen area within 48 to 72 hours after the test.
Conversely, if the skin does not react to the Mantoux test, it indicates that the patient has not been exposed to tuberculosis bacteria. However, for individuals who have received the BCG vaccine, a mild skin reaction may occur in the Mantoux test results. Nevertheless, this does not confirm tuberculosis infection.
Previously, skin testing for tuberculosis was more common and was often prioritized for children under 5 years old. However, nowadays, blood testing for tuberculosis latent infection has become more popular, especially for healthcare workers and individuals with weakened immune systems.
The blood testing method for tuberculosis is known as the Interferon-Gamma Release Assay (IGRA), or more commonly referred to as the Quantiferon test. These tests are increasingly being used because they provide additional accuracy and early detection in diagnosing latent tuberculosis infection.
Several tests can be employed to confirm suspected extrapulmonary tuberculosis, including tuberculosis affecting the pleura, pericardium, meninges, bones, joints, abdominal organs, and reproductive organs.
These tests encompass:
These diagnostic measures are pivotal in identifying extrapulmonary tuberculosis, facilitating appropriate treatment decisions, and implementing infection control measures for the patient's family and the wider community.
Currently, the Ministry of Health has not provided a specific figure regarding the cost of tuberculosis testing. Depending on the type of test prescribed and the healthcare facility chosen by the patient, the cost of tuberculosis lung testing will vary.
Below is the price list for tuberculosis testing for patients with health insurance at some frontline hospitals in 2023:
*Please note that the price list provided is for reference only and may not be the latest or final prices that patients have to pay. For healthcare facilities not listed in the price list, patients should contact the respective healthcare facility for more information.
Depending on the types of tests, the costs can range from 60,000 VND to nearly 1,000,000 VND. In reality, the cost of tuberculosis testing at some leading healthcare facilities has been reported to exceed 60 USD (equivalent to over 1.5 million VND), posing a significant financial burden on patients and their families for the examination and treatment of tuberculosis.
In Vietnam, according to statistics from the Ministry of Health, up to 63% of tuberculosis patient households face catastrophic costs (medical expenses exceeding 20% of income). This presents a significant challenge to the healthcare system in its efforts to eliminate tuberculosis entirely from society.
Therefore, the availability of cost-effective Artificial Intelligence (AI) solutions such as VinBrain's DrAid™ for TB Screening not only helps healthcare professionals work more efficiently but also enables patients to easily access screening solutions for early disease detection. With just 1 USD (reduced by up to 60 times), VinBrain's community screening AI solution promises to contribute to accelerating the goal of eliminating tuberculosis in Vietnam by 2023.
Sources:
https://www.cdc.gov/tb/topic/basics/default.htm
https://youmed.vn/tin-tuc/xet-nghiem-lao-bao-nhieu-tien/
https://my.clevelandclinic.org/health/diagnostics/22751-tuberculosis-tb-test
https://www.mayoclinic.org/diseases-conditions/tuberculosis/diagnosis-treatment/drc-20351256
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