Diagnostic accuracy of the rapid urine lipoarabinomannan test for pulmonary tuberculosis among HIV-infected adults in Ghana–findings from the DETECT HIV-TB study

BMC Infectious Diseases

Research Article

Kennedy Kwasi Addo¹  Isik Somuncu Johansen²  Aase Bengaard Andersen²  Stephanie Bjerrum³  Mercy Jemina Newman⁴  Ernest Kenu⁵  Margaret Lartey⁶ 

[1] Department of Bacteriology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana;Department of Infectious Diseases, Odense University Hospital, Odense, Denmark;Department of Infectious Diseases, Odense University Hospital, Odense, Denmark;Institute of Clinical Research, University of Southern Denmark, Odense, Denmark;Department of Medical Microbiology, School of Biomedical and Allied Sciences, College of Health Sciences, University of Ghana, Accra, Ghana;Fevers Unit, Korle-Bu Teaching Hospital, Accra, Ghana;Fevers Unit, Korle-Bu Teaching Hospital, Accra, Ghana;Department of Medicine, University of Ghana Medical and Dental School, Accra, Ghana;

关键词: Tuberculosis;    HIV;    Lipoarabinomannan;    Urine;    Diagnosis;    Africa;    Ghana;   

DOI  :  10.1186/s12879-015-1151-1

 received in 2015-05-27, accepted in 2015-09-28,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundRapid diagnostic tests are urgently needed to mitigate HIV-associated tuberculosis (TB) mortality. We evaluated diagnostic accuracy of the rapid urine lipoarabinomannan (LAM) test for pulmonary TB and assessed the effect of a two-sample strategy.MethodsHIV-infected adults eligible for antiretroviral therapy were prospectively enrolled from Korle-Bu Teaching Hospital in Ghana and followed for minimum 6 months. We applied the LAM test on urine collected as a spot and early morning sample. Diagnostic accuracy was analysed for a microbiological TB reference standard based on sputum culture and Gene Xpert MTB/RIF results and for a composite reference standard including clinical follow-up data. Performance of sputum smear microscopy was included for comparison.ResultsOf 469 patients investigated for TB, the LAM test correctly identified 24/55 (44 %) of microbiologically confirmed TB cases. Sensitivity of the LAM test was positively associated with hospitalisation (67 %), Modified Early Warning Score > 4 (57 %) and subsequent death (71 %). LAM test specificity was 95 % increasing to 98 % for the composite reference standard. A two-sample LAM test strategy did not improve test performance. Using concentrated sputum for Ziehl-Neelsen and fluorescence microscopy in combination yielded a sensitivity of 31/55 (56 %) that increased to 35/55 (64 %) when the LAM test was added. Surprisingly, nontuberculous mycobacteria were cultured in 34/469 (7 %) and associated with a positive LAM test (p = 0.008).ConclusionsLAM test sensitivity was highest in patients with poor prognosis and subsequent death and did not increase with a two-sample strategy. A rigorous sputum microscopy strategy had superior sensitivity, but the simplicity of the LAM test holds operational possibilities as a TB screening method among severely sick patients.

【 授权许可】

CC BY   
© Bjerrum et al. 2015