The utility of point-of-care urinary lipoarabinomannan testing for the diagnosis of tuberculosis in critically ill patients: a prospective observational study

BMC Infectious Diseases

Dhivendra Singh¹  Kim de Vasconcellos¹  Praksha Ramjathan² 

[1] Department of Critical Care, King Edward VIII Hospital, Durban, South Africa;Discipline of Anaesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa;Department of Medical Microbiology, School of Laboratory Medicine and Medical Science, University of KwaZulu-Natal and National Health Laboratory Services, King Edward VIII Hospital, Durban, South Africa;

关键词: Urinary lipoarabinomannan;    Point-of-care, tuberculosis;    Critically ill;   

DOI  :  10.1186/s12879-021-05979-y

来源: Springer

【 摘 要 】

BackgroundTuberculosis is a major global public health concern. Patients with tuberculosis who require critical care have a high mortality and delay in initiating antituberculous therapy is associated with increased mortality. Lipoarabinomannan (LAM) is a lipopolysaccharide found in the cell wall of Mycobacterium tuberculosis. Urinary LAM may be used as a bedside diagnostic test for tuberculosis.MethodsThe study was a single centre, prospective observational study that compared the utility of urinary LAM with conventional tuberculosis diagnostic modalities in patients with suspected tuberculosis who required intensive care admission. Urinary LAM testing was performed using the Alere Determine TB LAM Ag lateral flow assay test strips. A patient was classified as having confirmed tuberculosis if they met the following criteria: a clinical presentation compatible with tuberculosis, with either a positive TB culture, a positive GeneXpert, or a histological diagnosis of tuberculosis.ResultsFifty patients were included in the study, with 12 having confirmed tuberculosis. All patients received mechanical ventilation, and the ICU mortality was 60%. Urinary LAM had a sensitivity of 50.0% (95% CI, 21.1 to 78.9%) and a specificity of 84.2% (95% CI, 68.8 to 94.0%) for confirmed tuberculosis.ConclusionUrinary LAM allows for rapid bedside diagnosis of tuberculosis in critically ill patients. A positive urinary LAM should prompt consideration to initiate antituberculous treatment while the results of further diagnostic testing are awaited.

【 授权许可】

CC BY