Laboratory diagnosis tuberculosis
Recommendation to replace microscopy
In February 2026 the WHO recommended testing sputum using a near point-of-care nucleic acid amplification test (NPOC-NAAT) as the initial diagnostic test for adults and adolescents with symptoms of tuberculosis or screen positive for pulmonary tuberculosis. When sputum cannot be obtained, e.g. from children or those with HIV infection, testing tongue swabs is recommended
A nucleic acid amplification test (NPOC-NAAT) should replace the less sensitive Ziehl-Neelsen widely used microscopy technique.
MiniDock MTB test
A recently developed NPOC-NAAT that has been endorsed by WHO for use in low resource high tuberculosis burden countries is MiniDock MTB* manufactured by Pluslife Biotech (Guangzhou, China).
*MTB: Mycobacterium tuberculosis
MiniDock MTB is an affordable rapid test that can be used to test both sputum and mouth swabs at first level of patient care, including primary health care clinics and mobile units.
Technology: MiniDock MTB uses RNase hybridization-assisted amplification to detect genes associated with the
M. tuberculosis complex. A built-in control checks the amplification process and whether the sample amount has been adequate.
Unlike the high cost of Truenat and GeneXpert (see p. 144 Tropical Medicine Point-of-Care Testing), the cost of MiniDock MTB in 2026 is estimated at USD 3.60 – 4.00 per test. The cost of the Pluslife Thermolyse vortex mixer and the MiniDock unit used to run the test is estimated at USD 330-360.
Power requirements: The MiniDock unit is both battery operated and mains electricity operated. The unit connects to standard mains power to charge its internal battery. Continuous mains electricity is not therefore required. Because the unit requires only minimal power consumption, (DC 5V/3A power supply with output of 10-15W), MiniDock can be operated in the field when mains electricity is unavailable or unreliable. It can be powered from a portable power bank or from a solar panel with built-in voltage regulator. The Pluslife Thermolyse mixer is designed to plug directly into wall AC power outlets. When mains electricity is not available, the mixer can also be operated from a power pack or from a solar panel..
Test method
- Swabs of sputum or tongue are well mixed in a sample tube containing lysis buffer
and beads.
- Sample is vortexed at 3000 rpm at 75 °C for 5 minutes, lyzing bacterial cells to
release M. tuberculosis DNA.
- Sample is squeezed into a nucleic acid MTB test card, ensuring all parts of the
card are filled and the liquid level lies between the two fill lines on the card.
- Test card is capped and the contents mixed.
- Card is placed in the MiniDock unit which detects the card and begins the
isothermal amplification. The test is completed in 12-25 minutes.
Test results are interpreted from the indicator lights on the MiniDock unit.
Red light: Indicates the presence of M. tuberculosis complex in the sputum or tongue swab sample.
Green light: Indicates a negative test. This does not completely rule out tuberculosis.
Power light, red and green lights all lit: Indicate an invalid test which requires repeating.
Test results can be verified through an optional laptop with Pluslife software which can be downloaded or transmitted by Bluetooth.
Users of MiniDock MTB found the test simple to perform. The test requires minimal training.
Note: A Pluslife video of the test method can be found on YouTube entitled MiniDock MTB Platform Workflow.
Specificity of MiniDock MTB: Reported in field assessments as exceeding 97.5% for both sputum and tongue swabs.
Sensitivity of MiniDock MTB: Reported in field assessments as 85.7% for sputum and 79.6% for tongue swabs.
(sensitivity of Ziehl-Neelsen microscopy is 62.4%).
Note: MiniDock MTB sensitivity and specificity are comparable with WHO targets for near-point-of-care TB diagnostics.
Availability of MiniDock MTB test
All the items needed to perform the test are supplied, i.e. sterile collection swabs, tubes containing lysis buffer, MTB test cards, plastic tube and card holders, test caps, and test instructions. MiniDock MTB is available, 10 tests per pack. The test can be stored at room temperature up to 40 °C (test cards contain lyophilized amplification reagents). Pluslife‘s recommended test shelf-life from manufacture is 13 months.
MiniDock MTB is widely available through suppliers to low resource countries including organizations such as The Global Fund to Fight AIDS, Tuberculosis and Malaria and The Stop TB Partnership Global Drug Facility.
Limitations of MiniDock MTB
As with other NPOC-NAATs, tuberculosis may be missed with MiniDock MTB due to paucibacillary disease reducing the sensitivity of the test.
Currently, MiniDock MTB cannot be used for drug resistance testing (e.g. for rifampicin).
Equipment required for MiniDock MTB test
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Pluslife Thermolyse
Vortex mixer used to lyse sample at 75.5 °C, 3000 rpm for 5 minutes.
Measures: 107mm length x 146mm width x 251mm height
Weighs : 3 Kg
Supplied with mains AC wall power unit
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Pluslife Minidock unit
Unit in which the MTB Test card is inserted, amplification occurs and light (red/green) shows test result.
Measures: 101mm length x 916mm width x 65mm height
Weighs : 210 g
Supplied with mains AC/DC wall power unit and USB Type-C cable.
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Update on Neglected Tropical Diseases
Key Progress (WHO)
- Elimination Milestones: By mid-2026, 64 countries have successfully
eliminated at least one neglected tropical disease, moving closer to the
2030 target of 100 countries.
- Treatment and reach: Around 867.1 million people were treated in 2023, with
99% receiving preventive chemotherapy.
- Disease Burden: The overall disease burden dropped to 14.1 million DALYs
Disability Adjusted Life Years) and 119,000 deaths between 2015 and 2021.
- Mental Health Integration: In February 2026, the WHO released an essential care
package to address depression, anxiety, and social stigma experienced by over
1 billion people affected by NTDs.
WHO Global report on neglected tropical diseases 2025
https://www.who.int/publications/i/item/9789240114043
This report presents progress made in 2023-2024 towards the 2030 targets set in Ending the neglect to attain the Sustainable Development Goals: a road map for neglected tropical diseases 2021-2030 including several important analytical updates:
- Progress on all overarching cross-cutting and disease-specific indicators,
milestones and targets.
- Analysis of disease burden in terms of disability-adjusted life years (DALYs),
prevalence and mortality, as well as numbers of people affected by NTDs,
detected, and treated.
- New perspectives on the financial risk associated with NTDs, highlighting their
impoverishing effects on affected populations.
- A detailed review of diagnostics, monitoring and evaluation, access and logistics
and advocacy and funding.
- Analysis of official development assistance for NTDs in a constrained and evolving
financial landscape.
Climate change and NTDs
Summarised from Climate change and NTDs: a perfect storm
The Lancet Global Health editorial Vol 13, Issue 2, E172, February 2025
Climate change is emerging as an important and growing threat to combating NTDs, intensifying the conditions that allow these diseases to persist. Little headway has been made in reducing case incidence and deaths from vector-borne diseases including dengue and chikungunya, transmitted by Aedes spp mosquitoes.
Temperature
Warmer temperatures enable mosquitoes to breed more rapidly, bite more frequently and expand their range outside of tropical and subtropical regions. Cases of dengue have consequently surged in areas that historically reported few or no cases such as Nepal, North America and Europe. Similarly, it is likely that warmer temperatures and other climatic factors that favour insect survival and mobility will drive wider the distribution of the sandflies that transmit leishmaniasis.
Rainfall
Changes in rainfall patterns, including more intense and irregular precipitation, can also fuel the spread of NTDs. Excessive rainfall and flooding lead to stagnant water that acts as a prime breeding ground for vectors including mosquitoes and snails, heightening the risk of diseases like lymphatic filariasis, dengue and schistosomiasis. Exposure to contaminated floodwater also increases the transmission of waterborne diseases, such as leptospirosis and certain skin NTDs. In regions with fragile sanitation infrastructure, these events exacerbate health risks, leaving communities vulnerable to overlapping outbreaks.
Communities most affected
Despite advances in diagnostics, vaccines, post-exposure prophylaxis and preventive chemotherapy, NTDs remain poorly controlled. They disproportionately impact the world’s poorest and most marginalised populations, perpetuating cycles of poverty and inequality.
Indigenous communities face greater risks than their non-indigenous counterparts because many live in remote, NTD-endemic regions where access to health care is limited. Beyond their immediate health impacts, NTDs can lead to chronic illness or disability, blindness and stigma, which impair education and employment opportunities. The dual crisis of climate change and NTDs, further entrench social and economic inequities in vulnerable communities.
Action required
Gaps remain in understanding the impact of climate change on NTDs, underscoring the need for further research. However, research alone will not be enough. Decisive action is needed to integrate evidence-based insights into health policies and initiatives. By combining information from different sectors at the human-animal- environment interface will allow decision makers to anticipate transmission risks and tailor elimination efforts.
To protect the most vulnerable populations and sustain NTD elimination progress, climate resilience must be embedded into every element of global health policy. There must be investment in early warning systems and predictive modelling, scale up of vector control, improvement in sanitation systems, and interventions tailored to at risk communities.
Only a small proportion of multilateral climate funding is directly allocated to health, leaving NTDs at risk of further neglect. Increased advocacy and funding coupled with multi-sectoral climate-conscious strategies are imperative to avoid undoing decades of hard-won gains.
Further reading
Klepac P et al. Climate change, malaria and neglected tropical diseases: a scoping review.
Trans Roy Soc Trop Med & Hyg, Vol 118, Issue 9, Sept 2024, Pages 561-579 https://doi.org/10.1093/trstmh/trae026
Rapid tests used in the elimination of lymphatic filariasis
Lymphatic filariasis is endemic in 72 countries with Wuchereria bancrofti being found in nearly all endemic countries causing 90% of cases, and Brugia species present in limited areas of a few countries in South-east Asia.
NTD Roadmap 2030 targets for the Global Programme to eliminate lymphatic filariasis (GPELF)
- 58 (80%) countries validated for elimination as a Public health problem – defined as:
- infection sustained below transmission assessment survey thresholds for at least 4 years after stopping MDA,
- availability of essential package of care in all areas with known patients.
- All lymphatic filariasis endemic countries implementing post-MDA or post- validation surveillance.
- MDA no longer required.
Rapid tests used in lymphatic filariasis elimination programmes
W. bancrofti antigen
In endemic areas for W. bancrofti lymphatic filariasis, rapid immuno- chromatographic tests are used to detect qualitatively circulating W. bancrofti antigen in blood samples. W. bancrofti antigen takes 12 months or more to appear following infection and persists several years after adult worms no longer reproduce or have died. Antigen tests include the widely used Filariasis Test Strip (FTS) manufactured by Abbott Bioline and the recently developed STANDARD Q Filariasis Ag Test (QFAT) manufactured by SD Biosensor.
In field laboratory comparisons* the QFAT showed comparable diagnostic performance to the FTS. The QFAT was preferred by users because it used a smaller sample volume (20 µl compared to 75 µl for the FTS), the QFAT cassette was easier to handle than the loose FTS strip and tray, and test results were clearer.
* Scott J L. et al. Field laboratory comparison of STANDARD Q Filariasis Antigen Test (QFAT) with Bioline Filariasis Test Strip (FTS) for the detection of lymphatic fiilariasis in Samoa, 2023..
PloS Negl Trop Dis. 2024 Aug 5;18(8):e0012386.doi: 10.1371/journal.pntd.0012386
Brugia species antibodies
In areas endemic for Brugia lymphatic filariasis, the Brugia Rapid cassette immunochromatographic test is used to detect Brugia malayi and Brugia timori IgG4 antibodies qualitatively in serum, plasma or whole blood. The test is
manufactured by Reszon Diagnostics International. Brugia antibodies may indicate an active infection or previous infection. The test shows cross-reactivity with W. bancrofti.
Important: In the elimination of lymphatic filariasis, new diagnostic tests are required for post-elimination surveillance and post-MDA. Target product profiles have been developed to assist test manufacturers *.
*Won K et al. Diagnostics to support elimination of lymphatic filariasis – Development of two target product profiles. PloS Negl Trop Dis.2021 Nov 15;15(11):e0009968.doi 10.1371/journal.pntd.0009968
Further information
WHO Lymphatic filariasis Fact Sheet, November 2024. Access by downloading the title in Google.
Role of the laboratory in onchocerciasis elimination mapping
More than 99% of people with onchocerciasis live in sub-Saharan Africa and Yemen. The remaining 1% live in the border between Brazil and Bolivarian Republic of Venezuela. In 2023 WHO estimated that at least 249.5 million people required preventive treatment against onchocerciasis. Mass drug administration (MDA) with ivermectin is used to eliminate onchocerciasis with a minimum of 80% coverage.
Countries verified as free of onchocerciasis
Countries that have been verified by WHO as free of onchocerciasis following elimination activities are Colombia (2013), Ecuador (2014), Mexico (2015),
Guatemala (2016), and Niger (2025).
Senegal stopped MDA and is now under post-treatment surveillance. WHO reports that MDA has stopped in at least one focus in Uganda, Tanzania, Ethiopia, Equatorial Guinea, Mali, Nigeria, Sudan and Bolivarian Republic of Venezuela.
Mapping areas for onchocerciasis transmission
The WHO Road map for NTDS 2021-2030 has set a target for the elimination of onchocerciasis by 2030. This requires large areas of Africa to be mapped to identify all areas of active onchocerciasis that require ivermectin MDA.
In 2025 WHO published Onchocerciasis elimination mapping: handbook for national elimination programmes to assist countries identify areas of transmission requiring interventions and to provide evidence supporting the classification of non- endemic areas. This comprehensive handbook includes how to carry out, manage and interpret onchocerciasis elimination mapping (OEM) surveys and how to train survey teams.
Laboratory analysis required for OEM
The WHO handbook includes details of the laboratory analysis required for OEM. The Ov16 RDT is recommended and the test method is described. The test detects antibodies specific to Onchocerca volvulus. Standard operating procedures for collecting, packing and shipping dry blood spots (DBS) for use in the Ov16 test are also included. Testing in a central laboratory is recommended. Following the laboratory analysis, data from the epidemiological assessments are reviewed and interpreted to classify areas as either endemic or non-endemic. Results are compiled into summary tables and action maps.
Further information
WHO Onchocerciasis Fact sheet January 2025. Access by downloading the title in Google.
WHO Onchocerciasis Technical Advisory Subgroup Report of the eighth meting, Spain 9-12 Dec 2024. Access by entering title in Google.
Onchocerciasis Elimination Mapping: A Handbook for National Elimination Programmes. Dec 2024. Access by downloading the title in Google.
ISBN 978-92-4-009922-7 (electronic version) ISBN 978-92-4-009923-4 (print version)
Addition of noma to WHO NTDs
Noma, also called cancrum oris or gangrenous stomatitis was designated by WHO a neglected tropical disease (NTD) in December 2023. It is a severe rapidly fatal gangrenous disease of the mouth and face involving polymicrobial organisms that live in the mouth. It is an opportunistic non-contagious disease mainly affecting malnourished children aged 2-6 years with weakened immune systems and mostly found in sub-Saharan Africa but has also been reported from Latin America, Asia and other areas.
Diagnosis and prevention of noma
There is no point-of-care test available to diagnose noma. The disease is diagnosed clinically. WHO classifies noma into 5 clinical stages following simple gum inflammation, Stage 1 – acute necrotizing gingivitis, Stage 2 – oedema, Stage 3 – gangrene, Stage 4 – scarring, Stage 5 – sequelae ( drooling, missing and exposed teeth, problems affecting opening of the jaw, eating, speaking, breathing, vision).
Norma is treatable with antimicrobials, oral hygiene and nutrition supplements but is frequently not diagnosed and reported due to its rapid progression, lack of awareness, associated social stigma and poor health care services.
In adding noma to its list of NTDs, WHO recommends a more integrated approach to preventing and controlling noma by: “… improved awareness of the disease among populations and mental health counselling helping to remove stigma and enhance the reintegration of noma survivors and their families into society “. Integration of noma into existing health surveillance can improve data availability, accessibility and multisectoral collaboration.
WHO course and brochure on noma
To assist in the early awareness of noma, in addition to the WHO noma factsheet, a free of charge WHO course on noma is available in English, French, Hausa, Hindi and Portuguese. A 24-page well illustrated brochure includes information on the prevention, control and complications of noma*. For each clinical stage, the brochure provides main signs and symptoms, information on medication and management by health workers, family and friends.
*Access by entering in Google: WHO information brochure for early detection and management of noma.
Further information
Noma WHO Fact Sheet, 15 December 2023.
MSF What is Noma? Available at https://noma.msf.og
Galli et al. Prevalence, incidence, and reported global distribution of noma: a systematic literature review. Lancet Infectious Diseases, 2022, 15:S1473-3099(21)00698-8
WHO NTD Fact Sheets
Neglected tropical diseases (NTDs) fact sheets are available on the WHO website, providing the key facts and overview of each disease. Depending on NTD, also included are clinical signs and symptoms, transmission, distribution, treatment, diagnosis, prevention and control. Each fact sheet covers the WHO response, including technical support, management of outbreaks, consultations, new tools and diagnostics, publication of guidelines and handbooks, training, record gathering, and progress on NTD elimination programmes and the WHO 2021-2030 Roadmap for the global control of NTDs.
The fact sheets are kept up-to-date. The following are as of October 2026:
2026 Fact Sheets
Chagas disease
Leprosy
Rabies
Schistosomiasis
Snakebite envenoming
Trachoma
2025 Fact Sheets
Dengue
Chikunganya
Dracunculiasis (Guinea-worm disease)
Onchocerciasis
2024 Fact Sheets
Lymphatic filariasis
2023 Fact Sheets
Noma
Chromoblastomycosis
Sporotrichosis
Prodoconiosis (non-filarial lymphoedema)
Scabies and other ectoparasitoses
Human African trypanosomiasis
Tungiasis
Buruli ulcer
Leishmaniasis
Soil-transmitted helminth infections
Yaws
2022 Fact Sheets
Taeniasis and cysticercosis
2021 Fact sheets
Echinococcosis
Foodborne trematode infections
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