Current tuberculosis progress and molecular methods for identifying Mycobacterium tuberculosis

Tuberculosis (TB) is a major health burden, the leading cause of death among people living with HIV, and one of the main causes of death linked to antimicrobial resistance. The World Health Organization (WHO) launched in 2015 the End TB Initiative that aims to reduce TB cases and deaths by 2035. However, despite some progress, significant gaps persist in TB detection, treatment, prevention, and funding. Diagnosis is most often by sputum smear and culture and, when available, by nucleic acid amplification tests (NAATs), which revolutionizes TB diagnosis and monitoring, improving early detection, resistance surveillance, and treatment response evaluation. In this review, we report on the implication of various Real-Time PCR (RT-PCR) laboratory diagnostic tests and compare their performance in detecting MTB. We show that the Xpert MTB/RIF test is currently the most effective and widely validated molecular tool for diagnosing pulmonary TB, though its accuracy in extrapulmonary TB remains inconsistent. These findings suggest that combining molecular tests with other methods-such as radiology, microbiology, biomarkers, and immunological approaches-could provide a more reliable diagnostic strategy. Scaling up molecular tools worldwide, especially in high-burden regions, is essential to achieving the WHO End TB Strategy and ultimately eliminating TB.