Performance of urine lipoarabinomannan assays for paediatric tuberculosis in Tanzania

Kroidl, Inge, Clowes, Petra, Reither, Klaus, Mtafya, Bariki, Rojas-Ponce, Gabriel, Ntinginya, Elias N., Kalomo, Mariam, Minja, Lilian T., Kowuor, Dickens, Saathoff, Elmar, Kroidl, Arne, Heinrich, Norbert, Maboko, Leonard, Bates, Matthew, O'Grady, Justin, Zumla, Alimuddin, Hoelscher, Michael and Rachow, Andrea (2015) Performance of urine lipoarabinomannan assays for paediatric tuberculosis in Tanzania. European Respiratory Journal, 46 (3). pp. 761-770. ISSN 0903-1936

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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.

Item Type: Article
Additional Information: Date of acceptance: 09/04/2015
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
Depositing User: Pure Connector
Date Deposited: 15 Feb 2016 13:04
Last Modified: 22 Apr 2020 00:46
URI: https://ueaeprints.uea.ac.uk/id/eprint/57081
DOI: 10.1183/09031936.00003315

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