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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Test characteristics of urinary lipoarabinomannan and predictors of mortality among hospitalized HIV-infected tuberculosis suspects in Tanzania
PLoS ONE, Volume 7, No. 3, Article e32876, Year 2012
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Description
Background: Tuberculosis is the most common cause of death among patients with HIV infection living in tuberculosis endemic countries, but many cases are not diagnosed pre-mortem. We assessed the test characteristics of urinary lipoarabinomannan (LAM) and predictors of mortality among HIV-associated tuberculosis suspects in Tanzania. Methods: We prospectively enrolled hospitalized HIV-infected patients in Dar es Salaam, with ≥2 weeks of cough or fever, or weight loss. Subjects gave 2 mLs of urine to test for LAM using a commercially available ELISA, ≥2 sputum specimens for concentrated AFB smear and solid media culture, and 40 mLs of blood for culture. Results: Among 212 evaluable subjects, 143 (68%) were female; mean age was 36 years; and the median CD4 count 86 cells/mm 3. 69 subjects (33%) had culture confirmation of tuberculosis and 65 (31%) were LAM positive. For 69 cases of sputum or blood culture-confirmed tuberculosis, LAM sensitivity was 65% and specificity 86% compared to 36% and 98% for sputum smear. LAM test characteristics were not different in patients with bacteremia but showed higher sensitivity and lower specificity with decreasing CD4 cell count. Two month mortality was 64 (53%) of 121 with outcomes available. In multivariate analysis there was significant association of mortality with absence of anti-retroviral therapy (p = 0.004) and a trend toward association with a positive urine LAM (p = 0.16). Among culture-negative patients mortality was 9 (75%) of 12 in LAM positive patients and 27 (38%) of 71 in LAM negative patients (p = 0.02). Conclusions: Urine LAM is more sensitive than sputum smear and has utility for the rapid diagnosis of culture-confirmed tuberculosis in this high-risk population. Mortality data raise the possibility that urine LAM may also be a marker for culture-negative tuberculosis. © 2012 Talbot et al.
Authors & Co-Authors
Talbot, Elizabeth A.S.
United States, Hanover
Geisel School of Medicine at Dartmouth
Switzerland, Geneva
Foundation for Innovative new Diagnostics, Switzerland
Munseri, Patricia Jane
Tanzania, Dar es Salaam
Muhimbili University of Health and Allied Sciences
Sweden, Stockholm
Karolinska Institutet
Teixeira, J. Pedro
United States, Hanover
Geisel School of Medicine at Dartmouth
Matee, Mecky Isaac N.
Tanzania, Dar es Salaam
Muhimbili University of Health and Allied Sciences
Bakari, Muhammad
Tanzania, Dar es Salaam
Muhimbili University of Health and Allied Sciences
Lahey, Timothy P.
United States, Hanover
Geisel School of Medicine at Dartmouth
Von Reyn, Fordham
United States, Hanover
Geisel School of Medicine at Dartmouth
Statistics
Citations: 46
Authors: 7
Affiliations: 4
Identifiers
Doi:
10.1371/journal.pone.0032876
e-ISSN:
19326203
Research Areas
Infectious Diseases
Study Design
Cross Sectional Study
Study Locations
Tanzania
Participants Gender
Female