Clinical Microbiology: Open Access

Abstract

A Critical Appraisal of the Ban on Serological Tests for Tuberculosis Usefulness of Serological Monitoring of Tuberculosis Antibodies during the Treatment of TB Patients

Roland Maes

In 2011, the WHO banned the use of serological tests for the detection of antibodies against mycobacteria. This ban rests on a meta-analysis that observed a disparity in accuracy and specificity of results reported in various studies using this technique. All the included results were either level II observational studies or level III expert opinions. The immense majority of studies on other aspects of TB, as microscopy and vaccine efficacy, also pertain to these levels and present the same spread of results. The WHO policy statement rests on incorrect and invalid evidence. The experts analysed a pool of published studies of widely divergent quality, using different serological markers, and drew thereupon conclusions on quality of the serological test itself instead of on the quality of the studies analysed. In addition, the authors of the meta-analysis report results that are sometimes incorrect drew conclusions on incomplete data, removed publications from their study using dubious reasons, lumped together results that should have been analysed separately and finally failed to take into consideration the value of the golden diagnostic methods used today. I intend to prove that serology is a very useful complementary tool in the diagnostic and prognostic of mycobacterial infections and that, had the WHO based their analysis on the complete information available, they would have supported the use of some serological tools for the diagnosis of TB instead of banning them.