Asad Zaidi: ICE-TB - a new classification for improved TB care and prevention

Asad Zaidi presents a new framework, published in The Lancet Respiratory Medicine, seeks to replace the approach of the last half century of defining TB as either active (i.e.causing illness and potentially infectious to others) or latent (being infected with the bacterium that causes TB [M tuberculosis] but feeling well and not infectious to others) - an approach researchers say is limiting progress in eradicating the disease. For example, large surveys conducted in over 20 countries have recently shown than many people with infectious TB feel well.
Under the new classification, there are four disease states, and one of infection without disease:
clinical (i.e. with symptoms)
- infectious
- non-infectious
subclinical (without symptoms)
- infectious
- non-infectious
- M. tuberculosis infection that has not progressed to disease - that is, M. tuberculosis may be present in the body and alive, but there are no signs of the disease that are visible to the naked eye, for example with imaging.
The researchers noted that the disease process is non-linear - that people may fluctuate between infectious and non-infectious states, and between the presence and absence of symptoms or signs.
They also said that better diagnostic tools were needed to identify many of the TB states. For instance, there is currently no test to detect a viable M. tuberculosis infection (i.e., one where the bacteria are physiologically active), as opposed to a non-viable infection or recent infection that has cleared.
The researchers say they hope the International Consensus for Early TB (ICE-TB) framework, developed by a diverse group of 64 experts, will help lead to better diagnosis and treatment of the early stages of TB which have historically been overlooked in research.
The international team was led by researchers at UCL, London School of Hygiene & Tropical Medicine, The Walter and Eliza Hall Institute (WEHI), University of Cape Town, Imperial College London and the South African Medical Research Council.
Read the news item on the MRC-CTU website: www.mrcctu.ucl...
The full paper:
Classification of early tuberculosis states to guide research for improved care and prevention: an international Delphi consensus exercise. (2024) Coussens, A. K., Zaidi, S. M. A., Allwood, B. W., Dewan, P. K., Gray, G., Kohli, M., Kredo, T., Marais, B. J., Marks, G. B., Martinez, L., Ruhwald, M., Scriba, T. J., Seddon, J. A., Tisile, P., Warner, D. F., Wilkinson, R. J., Esmail, H., Houben, R., and International Consensus for Early, T. B. g. Lancet Respir Med doi.org/10.101....