It is now fully recognized that tuberculosis has been the most neglected health crisis in the world. Part of the problem is the lack of appreciation on the part of public health officials and practitioners regarding the importance of laboratory services in the control of tuberculosis. The role of the laboratory in the management of tuberculosis patients has been greatly underestimated and is still not fully appreciated in the medical community, even in industrialized countries.

In the United States, the attitude toward all problems related to tuberculosis began to change after the increase of rates since 1985, after the tragic outbreak in the early 1990s, and especially after the official recognition of tuberculosis and other mycobacterial infections as acquired immunodeficiency syndrome (AIDS)–related problems. The new situation stimulated research and development in various areas, particularly new methods for rapid diagnosis of tuberculosis and new systems for cultivation and drug susceptibility testing, with an attempt to achieve the shortest turnaround time for laboratory reports. Progress in molecular biology created new opportunities for development of such methods. Still, there is not always sufficient communication between molecular biologists and clinical microbiologists, and new sophisticated techniques sometimes have been developed without an understanding of their practical applicability in the clinical laboratory. Some physicians and scientists expect new molecular biology–based technology to be a “magic bullet” that will resolve all problems. It has even become unfashionable to express doubts about the need for new technology for any specific use, or even to compare the cost-effectiveness of new and traditional methods. It is tragic that, in some developing countries, substantial funds and efforts have been committed to the development of new molecular biology–based techniques when standard laboratory services and drug susceptibility testing are considered unaffordable. It is premature to define when, how, and which of the new technologies will find their place in clinical laboratories.

Mycobacteriology laboratories can be efficient if they respond properly to the new challenges related to rapid evolution in the epidemiologic situation and development of new technologies and therapies. The following are the most important among these challenges:

This review provides the physician with information regarding the present status of laboratory services and the most likely changes that can be expected in the foreseeable future. The anticipation is that the laboratory report will arrive in the shortest possible turn-around time to provide the practitioner with information answering a variety of questions regarding the bacteriologic diagnosis, drug susceptibility of the isolate, and bacteriologic response to therapy. More details, addressed primarily to laboratory workers, regarding specific methods and operation of the laboratory, can be found in the September 1996 issue of Clinics in Laboratory Medicine, devoted to clinical mycobacteriology.<sup>21 Clinical mycobacteriology Clin Lab Med 1996 ;  16 : 3

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