Cargando…

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

Background: The diagnostic utility of the Mycobacteria 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: L...

Descripción completa

Detalles Bibliográficos
Autores principales: Kwizera, Richard, Cresswell, Fiona V., Mugumya, Gerald, Okirwoth, Micheal, Kagimu, Enock, Bangdiwala, Ananta S., Williams, Darlisha A., Rhein, Joshua, Boulware, David R., Meya, David B.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: F1000 Research Limited 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6749932/
https://www.ncbi.nlm.nih.gov/pubmed/31544160
http://dx.doi.org/10.12688/wellcomeopenres.15389.2
_version_ 1783452377047629824
author Kwizera, Richard
Cresswell, Fiona V.
Mugumya, Gerald
Okirwoth, Micheal
Kagimu, Enock
Bangdiwala, Ananta S.
Williams, Darlisha A.
Rhein, Joshua
Boulware, David R.
Meya, David B.
author_facet Kwizera, Richard
Cresswell, Fiona V.
Mugumya, Gerald
Okirwoth, Micheal
Kagimu, Enock
Bangdiwala, Ananta S.
Williams, Darlisha A.
Rhein, Joshua
Boulware, David R.
Meya, David B.
author_sort Kwizera, Richard
collection PubMed
description Background: The diagnostic utility of the Mycobacteria 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.
format Online
Article
Text
id pubmed-6749932
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher F1000 Research Limited
record_format MEDLINE/PubMed
spelling pubmed-67499322019-09-20 Performance of Lipoarabinomannan Assay using Cerebrospinal fluid for the diagnosis of Tuberculous meningitis among HIV patients Kwizera, Richard Cresswell, Fiona V. Mugumya, Gerald Okirwoth, Micheal Kagimu, Enock Bangdiwala, Ananta S. Williams, Darlisha A. Rhein, Joshua Boulware, David R. Meya, David B. Wellcome Open Res Research Note Background: The diagnostic utility of the Mycobacteria 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. F1000 Research Limited 2019-09-30 /pmc/articles/PMC6749932/ /pubmed/31544160 http://dx.doi.org/10.12688/wellcomeopenres.15389.2 Text en Copyright: © 2019 Kwizera R et al. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Note
Kwizera, Richard
Cresswell, Fiona V.
Mugumya, Gerald
Okirwoth, Micheal
Kagimu, Enock
Bangdiwala, Ananta S.
Williams, Darlisha A.
Rhein, Joshua
Boulware, David R.
Meya, David B.
Performance of Lipoarabinomannan Assay using Cerebrospinal fluid for the diagnosis of Tuberculous meningitis among HIV patients
title Performance of Lipoarabinomannan Assay using Cerebrospinal fluid for the diagnosis of Tuberculous meningitis among HIV patients
title_full Performance of Lipoarabinomannan Assay using Cerebrospinal fluid for the diagnosis of Tuberculous meningitis among HIV patients
title_fullStr Performance of Lipoarabinomannan Assay using Cerebrospinal fluid for the diagnosis of Tuberculous meningitis among HIV patients
title_full_unstemmed Performance of Lipoarabinomannan Assay using Cerebrospinal fluid for the diagnosis of Tuberculous meningitis among HIV patients
title_short Performance of Lipoarabinomannan Assay using Cerebrospinal fluid for the diagnosis of Tuberculous meningitis among HIV patients
title_sort performance of lipoarabinomannan assay using cerebrospinal fluid for the diagnosis of tuberculous meningitis among hiv patients
topic Research Note
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6749932/
https://www.ncbi.nlm.nih.gov/pubmed/31544160
http://dx.doi.org/10.12688/wellcomeopenres.15389.2
work_keys_str_mv AT kwizerarichard performanceoflipoarabinomannanassayusingcerebrospinalfluidforthediagnosisoftuberculousmeningitisamonghivpatients
AT cresswellfionav performanceoflipoarabinomannanassayusingcerebrospinalfluidforthediagnosisoftuberculousmeningitisamonghivpatients
AT mugumyagerald performanceoflipoarabinomannanassayusingcerebrospinalfluidforthediagnosisoftuberculousmeningitisamonghivpatients
AT okirwothmicheal performanceoflipoarabinomannanassayusingcerebrospinalfluidforthediagnosisoftuberculousmeningitisamonghivpatients
AT kagimuenock performanceoflipoarabinomannanassayusingcerebrospinalfluidforthediagnosisoftuberculousmeningitisamonghivpatients
AT bangdiwalaanantas performanceoflipoarabinomannanassayusingcerebrospinalfluidforthediagnosisoftuberculousmeningitisamonghivpatients
AT williamsdarlishaa performanceoflipoarabinomannanassayusingcerebrospinalfluidforthediagnosisoftuberculousmeningitisamonghivpatients
AT rheinjoshua performanceoflipoarabinomannanassayusingcerebrospinalfluidforthediagnosisoftuberculousmeningitisamonghivpatients
AT boulwaredavidr performanceoflipoarabinomannanassayusingcerebrospinalfluidforthediagnosisoftuberculousmeningitisamonghivpatients
AT meyadavidb performanceoflipoarabinomannanassayusingcerebrospinalfluidforthediagnosisoftuberculousmeningitisamonghivpatients