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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Diagnostic accuracy of a urine lipoarabinomannan strip-test for TB detection in HIV-infected hospitalised patients
European Respiratory Journal, Volume 40, No. 5, Year 2012
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Description
Lack of point-of-care tests for tuberculosis (TB) result in diagnostic delay, and increased mortality and healthcare-related costs. The urine DetermineTM TB-LAM point-of-care strip-test was evaluated in 335 prospectivelyrecruited hospitalised patients with suspected TB-HIV co-infection (group 1) and from 88 HIVinfected hospitalised patients with non-TB diagnoses (group 2). Cut-off point-specific analyses were performed using: 1) a microbiological reference standard (culture positive versus negative); and 2) a composite reference standard (exclusion of patients with clinical-TB from the culturenegative group). Using the microbiological reference and the manufacturer-recommended grade-1 cut-off point, LAM sensitivity and specificity was 66% (95% CI 57-74%). By contrast, using the composite reference sensitivity was 60% (95% CI 53-67%) and specificity improved to 96% (95% CI 89-100%) (p50.001). The same pattern was seen when the grade-2 cut-off point was used (specificity 75% versus 96%; p=0.01). In group two patients specificity was poor using the grade-1 cut-off point, but improved significantly when the grade-2 cut-off point was used (90% versus 99%; p=0.009). The grade-2 cut-off point also offered superior inter-reader reliability (p=0.002). Sensitivity was highest in those with a CD4 <200 cells per mL. LAM combined with smear-microscopy was able to rule-in TB in 71% of Mycobacterium tuberculosis culture-positive patients. This preliminary study indicates that the LAM strip-test may be a potentially useful rapid rule-in test for TB in hospitalised patients with advanced immunosuppression. The grade 2, but not the manufacturer-recommended grade 1 cut-off point, offered superior rule-in utility and inter-reader reliability. Larger studies to evaluate cut-off points and diagnostic accuracy are urgently required. Copyright © 2012 ERS.
Authors & Co-Authors
Peter, Jonathan Grant
South Africa, Cape Town
University of Cape Town
Theron, Grant
South Africa, Cape Town
University of Cape Town
van Zyl-Smit, Richard N.
South Africa, Cape Town
University of Cape Town
Haripersad, Asheen
South Africa, Cape Town
University of Cape Town
Mottay, Lynelle
South Africa, Cape Town
University of Cape Town
Kraus, Sarah M.
South Africa, Cape Town
University of Cape Town
Binder, Anke B.
South Africa, Cape Town
University of Cape Town
Meldau, Richard
South Africa, Cape Town
University of Cape Town
Hardy, Anneli
South Africa, Cape Town
University of Cape Town
Dheda, Keertan U.J.
South Africa, Cape Town
University of Cape Town
United Kingdom, London
Ucl Medical School
Statistics
Citations: 124
Authors: 10
Affiliations: 2
Identifiers
Doi:
10.1183/09031936.00201711
ISSN:
09031936
e-ISSN:
13993003
Research Areas
Health System And Policy
Infectious Diseases