Abstract
We evaluated the diagnostic performance of two tests based on the release of lipoarabinomannan (LAM) into the urine, the MTB-LAM-ELISA assay and the Determine TB-LAM-strip assay, in children with suspected tuberculosis (TB) in a high TB/HIV-prevalence setting.
In a prospective study, 132 children with suspected active TB were assigned to diagnostic subgroups. Urine samples were subjected to testing by both assays to ascertain sensitivity and specificity. Host factors associated with positive LAM results were investigated and LAM excretion monitored after antituberculous treatment initiation.
18 (13.6%) children had culture-confirmed pulmonary TB. The assays' sensitivity was higher in HIV-positive versus HIV-negative children: 70% (95% confidence interval 35–93%) versus 13% (0–53%) for MTB-LAM-ELISA and 50% (19–81%) versus 0% (0–37%) for Determine TB-LAM. In 35 (27%) children with excluded active TB, both assays showed a specificity of 97.1% (85–100%). Proteinuria and low body mass index were independently associated with LAM positivity. In most patients, LAM excretion declined to zero during or at conclusion of antituberculous treatment.
HIV/TB co-infected children might benefit from LAM-based tests to aid early TB diagnosis and subsequent positive impact on morbidity and mortality. Using LAM as a rule-in and treatment-monitoring tool may also show further potential.
Abstract
Urine lipoarabinomannan assays show reasonable sensitivity in HIV+ but not HIV− TB-infected children http://ow.ly/N56aG
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Support statement: This study was supported by Bundesministerium für Bildung und Forschung and the European Commission as part of EuropAid. Funding information for this article has been deposited with FundRef.
Conflict of interest: None declared.
- Received January 9, 2015.
- Accepted April 9, 2015.
- Copyright ©ERS 2015