Performance of Lipoarabinomannan Assay using Cerebrospinal fluid for the diagnosis of Tuberculous meningitis among HIV patients

Wellcome Open Research

article

Richard Kwizera¹  Fiona V. Cresswell¹  Gerald Mugumya⁴  Micheal Okirwoth¹  Enock Kagimu¹  Ananta S. Bangdiwala⁵  Darlisha A. Williams¹  Joshua Rhein¹  David R. Boulware⁵  David B. Meya¹ 

[1] Infectious Diseases Institute, College of Health Sciences, Makerere University;Clinical Research Department, London School of Hygiene and Tropical Medicine;MRC-UVRI and LSHTM Uganda Research Unit;Department of Medicine, School of Medicine, College of Health Sciences, Makerere University;Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota

关键词: Tuberculous meningitis;    extra-pulmonary TB;    lipoarabinomannan;    TB-LAM;    Xpert MTB/Rif Ultra;    HIV;    Diagnostics;    cerebrospinal fluid;   

DOI  :  10.12688/wellcomeopenres.15389.2

学科分类：内科医学

来源: Wellcome

【 摘 要 】

Background: The diagnostic utility of theMycobacteria tuberculosis lipoarabinomannan (TB-LAM) antigen lateral flow assay on cerebrospinal fluid (CSF) for the diagnosis of tuberculous meningitis (TBM) has not been extensively studied and the few published studies have conflicting results.Methods: Lumbar CSF from 59 HIV-positive patients with suspected TBM was tested with TB-LAM and Xpert MTB/Rif Ultra. The diagnostic performance of CSF TB-LAM was compared to positive CSF Xpert MTB/Rif Ultra (definite TBM) and a composite reference of probable or definite TBM according to the uniform case definition. Results: Of 59 subjects, 12 (20%) had definite TBM and five (9%) had probable TBM. With reference to definite TBM, CSF TB-LAM assay had a diagnostic sensitivity of 33% and specificity of 96%. When compared to a composite reference of definite or probable TBM, the sensitivity was 24% and specificity was 95%. There were two false positive tests with TB-LAM (3+ grade). In-hospital mortality in CSF TB-LAM positive patients was 17% compared to 0% in those with definite TBM by Xpert MTB/Rif Ultra but negative LAM.Conclusions: Lumbar CSF TB-LAM has a poor performance in diagnosing TBM. Both urine TB-LAM and Xpert Ultra should be further investigated in the diagnosis of TBM.

【 授权许可】

CC BY