Diagnostic accuracy of the rapid urine lipoarabinomannan test for pulmonary tuberculosis among HIV-infected adults in Ghana–findings from the DETECT HIV-TB study
Identifieur interne : 000368 ( Main/Exploration ); précédent : 000367; suivant : 000369Diagnostic accuracy of the rapid urine lipoarabinomannan test for pulmonary tuberculosis among HIV-infected adults in Ghana–findings from the DETECT HIV-TB study
Auteurs : Stephanie Bjerrum [Danemark] ; Ernest Kenu [Ghana] ; Margaret Lartey [Ghana] ; Mercy Jemina Newman [Ghana] ; Kennedy Kwasi Addo [Ghana] ; Aase Bengaard Andersen [Danemark] ; Isik Somuncu Johansen [Danemark]Source :
- BMC Infectious Diseases [ 1471-2334 ] ; 2015.
Descripteurs français
- KwdFr :
- Adulte, Adulte d'âge moyen, Agents antiVIH (usage thérapeutique), Aire sous la courbe, Courbe ROC, Expectoration (microbiologie), Femelle, Ghana, Hospitalisation, Humains, Infections à VIH (), Infections à VIH (traitement médicamenteux), Lipopolysaccharides (urine), Mycobactéries non tuberculeuses (isolement et purification), Mâle, Sensibilité et spécificité, Tuberculose pulmonaire (), Tuberculose pulmonaire (diagnostic), Tuberculose pulmonaire (mortalité), Études prospectives.
- MESH :
- diagnostic : Tuberculose pulmonaire.
- isolement et purification : Mycobactéries non tuberculeuses.
- microbiologie : Expectoration.
- mortalité : Tuberculose pulmonaire.
- traitement médicamenteux : Infections à VIH.
- urine : Lipopolysaccharides.
- usage thérapeutique : Agents antiVIH.
- Adulte, Adulte d'âge moyen, Aire sous la courbe, Courbe ROC, Femelle, Ghana, Hospitalisation, Humains, Infections à VIH, Mâle, Sensibilité et spécificité, Tuberculose pulmonaire, Études prospectives.
- Wicri :
- geographic : Ghana.
English descriptors
- KwdEn :
- Adult, Anti-HIV Agents (therapeutic use), Area Under Curve, Female, Ghana, HIV Infections (complications), HIV Infections (drug therapy), Hospitalization, Humans, Lipopolysaccharides (urine), Male, Middle Aged, Nontuberculous Mycobacteria (isolation & purification), Prospective Studies, ROC Curve, Sensitivity and Specificity, Sputum (microbiology), Tuberculosis, Pulmonary (complications), Tuberculosis, Pulmonary (diagnosis), Tuberculosis, Pulmonary (mortality).
- MESH :
- chemical , therapeutic use : Anti-HIV Agents.
- chemical , urine : Lipopolysaccharides.
- geographic : Ghana.
- complications : HIV Infections, Tuberculosis, Pulmonary.
- diagnosis : Tuberculosis, Pulmonary.
- drug therapy : HIV Infections.
- isolation & purification : Nontuberculous Mycobacteria.
- microbiology : Sputum.
- mortality : Tuberculosis, Pulmonary.
- Adult, Area Under Curve, Female, Hospitalization, Humans, Male, Middle Aged, Prospective Studies, ROC Curve, Sensitivity and Specificity.
Abstract
Rapid diagnostic tests are urgently needed to mitigate HIV-associated tuberculosis (TB) mortality. We evaluated diagnostic accuracy of the rapid urine lipoarabinomannan (LAM) test for pulmonary TB and assessed the effect of a two-sample strategy.
HIV-infected adults eligible for antiretroviral therapy were prospectively enrolled from Korle-Bu Teaching Hospital in Ghana and followed for minimum 6 months. We applied the LAM test on urine collected as a spot and early morning sample. Diagnostic accuracy was analysed for a microbiological TB reference standard based on sputum culture and Gene Xpert MTB/RIF results and for a composite reference standard including clinical follow-up data. Performance of sputum smear microscopy was included for comparison.
Of 469 patients investigated for TB, the LAM test correctly identified 24/55 (44 %) of microbiologically confirmed TB cases. Sensitivity of the LAM test was positively associated with hospitalisation (67 %), Modified Early Warning Score > 4 (57 %) and subsequent death (71 %). LAM test specificity was 95 % increasing to 98 % for the composite reference standard. A two-sample LAM test strategy did not improve test performance. Using concentrated sputum for Ziehl-Neelsen and fluorescence microscopy in combination yielded a sensitivity of 31/55 (56 %) that increased to 35/55 (64 %) when the LAM test was added. Surprisingly, nontuberculous mycobacteria were cultured in 34/469 (7 %) and associated with a positive LAM test (
LAM test sensitivity was highest in patients with poor prognosis and subsequent death and did not increase with a two-sample strategy. A rigorous sputum microscopy strategy had superior sensitivity, but the simplicity of the LAM test holds operational possibilities as a TB screening method among severely sick patients.
The online version of this article (doi:10.1186/s12879-015-1151-1) contains supplementary material, which is available to authorized users.
Url:
DOI: 10.1186/s12879-015-1151-1
PubMed: 26427365
PubMed Central: 4591579
Affiliations:
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of Clinical Research, University of Southern Denmark, Odense</wicri:regionArea><wicri:noRegion>Odense</wicri:noRegion></affiliation></author><author><name sortKey="Kenu, Ernest" sort="Kenu, Ernest" uniqKey="Kenu E" first="Ernest" last="Kenu">Ernest Kenu</name><affiliation wicri:level="3"><nlm:aff id="Aff3">Fevers Unit, Korle-Bu Teaching Hospital, Accra, Ghana</nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>Fevers Unit, Korle-Bu Teaching Hospital, Accra</wicri:regionArea><placeName><settlement type="city">Accra</settlement><region nuts="2">Région du Grand Accra</region></placeName></affiliation></author><author><name sortKey="Lartey, Margaret" sort="Lartey, Margaret" uniqKey="Lartey M" first="Margaret" last="Lartey">Margaret Lartey</name><affiliation wicri:level="3"><nlm:aff id="Aff3">Fevers Unit, Korle-Bu Teaching Hospital, Accra, Ghana</nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>Fevers Unit, Korle-Bu Teaching Hospital, 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Ghana</orgName></affiliation></author><author><name sortKey="Newman, Mercy Jemina" sort="Newman, Mercy Jemina" uniqKey="Newman M" first="Mercy Jemina" last="Newman">Mercy Jemina Newman</name><affiliation wicri:level="4"><nlm:aff id="Aff5">Department of Medical Microbiology, School of Biomedical and Allied Sciences, College of Health Sciences, University of Ghana, Accra, Ghana</nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>Department of Medical Microbiology, School of Biomedical and Allied Sciences, College of Health Sciences, University of Ghana, Accra</wicri:regionArea><placeName><settlement type="city">Accra</settlement><region nuts="2">Région du Grand Accra</region></placeName><orgName type="university">Université du Ghana</orgName></affiliation></author><author><name sortKey="Addo, Kennedy Kwasi" sort="Addo, Kennedy Kwasi" uniqKey="Addo K" first="Kennedy Kwasi" last="Addo">Kennedy Kwasi Addo</name><affiliation wicri:level="4"><nlm:aff id="Aff6">Department of Bacteriology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana</nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>Department of Bacteriology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra</wicri:regionArea><placeName><settlement type="city">Accra</settlement><region nuts="2">Région du Grand Accra</region></placeName><orgName type="university">Université du Ghana</orgName></affiliation></author><author><name sortKey="Andersen, Aase Bengaard" sort="Andersen, Aase Bengaard" uniqKey="Andersen A" first="Aase Bengaard" last="Andersen">Aase Bengaard Andersen</name><affiliation wicri:level="1"><nlm:aff id="Aff1">Department of Infectious Diseases, Odense University Hospital, Odense, Denmark</nlm:aff><country xml:lang="fr">Danemark</country><wicri:regionArea>Department of Infectious Diseases, Odense University Hospital, Odense</wicri:regionArea><wicri:noRegion>Odense</wicri:noRegion></affiliation></author><author><name sortKey="Johansen, Isik Somuncu" sort="Johansen, Isik Somuncu" uniqKey="Johansen I" first="Isik Somuncu" last="Johansen">Isik Somuncu Johansen</name><affiliation wicri:level="1"><nlm:aff id="Aff1">Department of Infectious Diseases, Odense University Hospital, Odense, Denmark</nlm:aff><country xml:lang="fr">Danemark</country><wicri:regionArea>Department of Infectious Diseases, Odense University Hospital, Odense</wicri:regionArea><wicri:noRegion>Odense</wicri:noRegion></affiliation></author></analytic><series><title level="j">BMC Infectious Diseases</title><idno type="eISSN">1471-2334</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult</term><term>Anti-HIV Agents (therapeutic use)</term><term>Area Under Curve</term><term>Female</term><term>Ghana</term><term>HIV Infections (complications)</term><term>HIV Infections (drug therapy)</term><term>Hospitalization</term><term>Humans</term><term>Lipopolysaccharides (urine)</term><term>Male</term><term>Middle Aged</term><term>Nontuberculous Mycobacteria (isolation & purification)</term><term>Prospective Studies</term><term>ROC Curve</term><term>Sensitivity and Specificity</term><term>Sputum (microbiology)</term><term>Tuberculosis, Pulmonary (complications)</term><term>Tuberculosis, Pulmonary (diagnosis)</term><term>Tuberculosis, Pulmonary (mortality)</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Adulte</term><term>Adulte d'âge moyen</term><term>Agents antiVIH (usage thérapeutique)</term><term>Aire sous la courbe</term><term>Courbe ROC</term><term>Expectoration (microbiologie)</term><term>Femelle</term><term>Ghana</term><term>Hospitalisation</term><term>Humains</term><term>Infections à VIH ()</term><term>Infections à VIH (traitement médicamenteux)</term><term>Lipopolysaccharides (urine)</term><term>Mycobactéries non tuberculeuses (isolement et purification)</term><term>Mâle</term><term>Sensibilité et spécificité</term><term>Tuberculose pulmonaire ()</term><term>Tuberculose pulmonaire (diagnostic)</term><term>Tuberculose pulmonaire (mortalité)</term><term>Études prospectives</term></keywords><keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Anti-HIV Agents</term></keywords><keywords scheme="MESH" type="chemical" qualifier="urine" xml:lang="en"><term>Lipopolysaccharides</term></keywords><keywords scheme="MESH" type="geographic" xml:lang="en"><term>Ghana</term></keywords><keywords scheme="MESH" qualifier="complications" xml:lang="en"><term>HIV Infections</term><term>Tuberculosis, Pulmonary</term></keywords><keywords scheme="MESH" qualifier="diagnosis" xml:lang="en"><term>Tuberculosis, Pulmonary</term></keywords><keywords scheme="MESH" qualifier="diagnostic" xml:lang="fr"><term>Tuberculose pulmonaire</term></keywords><keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>HIV Infections</term></keywords><keywords scheme="MESH" qualifier="isolation & purification" xml:lang="en"><term>Nontuberculous Mycobacteria</term></keywords><keywords scheme="MESH" qualifier="isolement et purification" xml:lang="fr"><term>Mycobactéries non tuberculeuses</term></keywords><keywords scheme="MESH" qualifier="microbiologie" xml:lang="fr"><term>Expectoration</term></keywords><keywords scheme="MESH" qualifier="microbiology" xml:lang="en"><term>Sputum</term></keywords><keywords scheme="MESH" qualifier="mortality" xml:lang="en"><term>Tuberculosis, Pulmonary</term></keywords><keywords scheme="MESH" qualifier="mortalité" xml:lang="fr"><term>Tuberculose pulmonaire</term></keywords><keywords scheme="MESH" qualifier="traitement médicamenteux" xml:lang="fr"><term>Infections à VIH</term></keywords><keywords scheme="MESH" qualifier="urine" xml:lang="fr"><term>Lipopolysaccharides</term></keywords><keywords scheme="MESH" qualifier="usage thérapeutique" xml:lang="fr"><term>Agents antiVIH</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adult</term><term>Area Under Curve</term><term>Female</term><term>Hospitalization</term><term>Humans</term><term>Male</term><term>Middle Aged</term><term>Prospective Studies</term><term>ROC Curve</term><term>Sensitivity and Specificity</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Adulte</term><term>Adulte d'âge moyen</term><term>Aire sous la courbe</term><term>Courbe ROC</term><term>Femelle</term><term>Ghana</term><term>Hospitalisation</term><term>Humains</term><term>Infections à VIH</term><term>Mâle</term><term>Sensibilité et spécificité</term><term>Tuberculose pulmonaire</term><term>Études prospectives</term></keywords><keywords scheme="Wicri" type="geographic" xml:lang="fr"><term>Ghana</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Rapid diagnostic tests are urgently needed to mitigate HIV-associated tuberculosis (TB) mortality. We evaluated diagnostic accuracy of the rapid urine lipoarabinomannan (LAM) test for pulmonary TB and assessed the effect of a two-sample strategy.</p></sec><sec><title>Methods</title><p>HIV-infected adults eligible for antiretroviral therapy were prospectively enrolled from Korle-Bu Teaching Hospital in Ghana and followed for minimum 6 months. We applied the LAM test on urine collected as a spot and early morning sample. Diagnostic accuracy was analysed for a microbiological TB reference standard based on sputum culture and Gene Xpert MTB/RIF results and for a composite reference standard including clinical follow-up data. Performance of sputum smear microscopy was included for comparison.</p></sec><sec><title>Results</title><p>Of 469 patients investigated for TB, the LAM test correctly identified 24/55 (44 %) of microbiologically confirmed TB cases. Sensitivity of the LAM test was positively associated with hospitalisation (67 %), Modified Early Warning Score > 4 (57 %) and subsequent death (71 %). LAM test specificity was 95 % increasing to 98 % for the composite reference standard. A two-sample LAM test strategy did not improve test performance. Using concentrated sputum for Ziehl-Neelsen and fluorescence microscopy in combination yielded a sensitivity of 31/55 (56 %) that increased to 35/55 (64 %) when the LAM test was added. Surprisingly, nontuberculous mycobacteria were cultured in 34/469 (7 %) and associated with a positive LAM test (<italic>p</italic> = 0.008).</p></sec><sec><title>Conclusions</title><p>LAM test sensitivity was highest in patients with poor prognosis and subsequent death and did not increase with a two-sample strategy. A rigorous sputum microscopy strategy had superior sensitivity, but the simplicity of the LAM test holds operational possibilities as a TB screening method among severely sick patients.</p></sec><sec><title>Electronic supplementary material</title><p>The online version of this article (doi:10.1186/s12879-015-1151-1) contains supplementary material, which is available to authorized users.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Gupta, A" uniqKey="Gupta A">A Gupta</name></author><author><name sortKey="Nadkarni, G" uniqKey="Nadkarni G">G Nadkarni</name></author><author><name sortKey="Yang, Wt" uniqKey="Yang W">WT Yang</name></author><author><name sortKey="Chandrasekhar, A" uniqKey="Chandrasekhar A">A Chandrasekhar</name></author><author><name sortKey="Gupte, N" uniqKey="Gupte N">N Gupte</name></author><author><name sortKey="Bisson, Gp" uniqKey="Bisson G">GP 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Cole</name></author><author><name sortKey="Hanna, D" uniqKey="Hanna D">D Hanna</name></author><author><name sortKey="Andrade, Bb" uniqKey="Andrade B">BB Andrade</name></author><author><name sortKey="Maeurer, M" uniqKey="Maeurer M">M Maeurer</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cannas, A" uniqKey="Cannas A">A Cannas</name></author><author><name sortKey="Calvo, L" uniqKey="Calvo L">L Calvo</name></author><author><name sortKey="Chiacchio, T" uniqKey="Chiacchio T">T Chiacchio</name></author><author><name sortKey="Cuzzi, G" uniqKey="Cuzzi G">G Cuzzi</name></author><author><name sortKey="Vanini, V" uniqKey="Vanini V">V Vanini</name></author><author><name sortKey="Lauria, Fn" uniqKey="Lauria F">FN Lauria</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Rosen, S" uniqKey="Rosen S">S Rosen</name></author><author><name sortKey="Fox, Mp" uniqKey="Fox M">MP Fox</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Brinkhof, Mw" uniqKey="Brinkhof M">MW Brinkhof</name></author><author><name sortKey="Pujades Rodriguez, M" uniqKey="Pujades Rodriguez M">M Pujades-Rodriguez</name></author><author><name sortKey="Egger, M" uniqKey="Egger M">M Egger</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Honge, Bl" uniqKey="Honge B">BL Honge</name></author><author><name sortKey="Jespersen, S" uniqKey="Jespersen S">S Jespersen</name></author><author><name sortKey="Nordentoft, Pb" uniqKey="Nordentoft P">PB Nordentoft</name></author><author><name sortKey="Medina, C" uniqKey="Medina C">C Medina</name></author><author><name sortKey="Da Silva, D" uniqKey="Da Silva D">D Da Silva</name></author><author><name sortKey="Da Silva, Zj" uniqKey="Da Silva Z">ZJ Da Silva</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Danemark</li><li>Ghana</li></country><region><li>Région du Grand Accra</li></region><settlement><li>Accra</li><li>Legon (Ghana)</li></settlement><orgName><li>Université du Ghana</li></orgName></list><tree><country name="Danemark"><noRegion><name sortKey="Bjerrum, Stephanie" sort="Bjerrum, Stephanie" uniqKey="Bjerrum S" first="Stephanie" last="Bjerrum">Stephanie Bjerrum</name></noRegion><name sortKey="Andersen, Aase Bengaard" sort="Andersen, Aase Bengaard" uniqKey="Andersen A" first="Aase Bengaard" last="Andersen">Aase Bengaard Andersen</name><name sortKey="Bjerrum, Stephanie" sort="Bjerrum, Stephanie" uniqKey="Bjerrum S" first="Stephanie" last="Bjerrum">Stephanie Bjerrum</name><name sortKey="Johansen, Isik Somuncu" sort="Johansen, Isik Somuncu" uniqKey="Johansen I" first="Isik Somuncu" last="Johansen">Isik Somuncu Johansen</name></country><country name="Ghana"><region name="Région du Grand Accra"><name sortKey="Kenu, Ernest" sort="Kenu, Ernest" uniqKey="Kenu E" first="Ernest" last="Kenu">Ernest Kenu</name></region><name sortKey="Addo, Kennedy Kwasi" sort="Addo, Kennedy Kwasi" uniqKey="Addo K" first="Kennedy Kwasi" last="Addo">Kennedy Kwasi Addo</name><name sortKey="Lartey, Margaret" sort="Lartey, Margaret" uniqKey="Lartey M" first="Margaret" last="Lartey">Margaret Lartey</name><name sortKey="Lartey, Margaret" sort="Lartey, Margaret" uniqKey="Lartey M" first="Margaret" last="Lartey">Margaret Lartey</name><name sortKey="Newman, Mercy Jemina" sort="Newman, Mercy Jemina" uniqKey="Newman M" first="Mercy Jemina" last="Newman">Mercy Jemina Newman</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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