Kim de Vasconcellos1,2, Praksha Ramjathan3, Dhivendra Singh4,5. 1. Department of Critical Care, King Edward VIII Hospital, Durban, South Africa. kimdevasconcellos@gmail.com. 2. Discipline of Anaesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa. kimdevasconcellos@gmail.com. 3. Department of Medical Microbiology, School of Laboratory Medicine and Medical Science, University of KwaZulu-Natal and National Health Laboratory Services, King Edward VIII Hospital, Durban, South Africa. 4. Department of Critical Care, King Edward VIII Hospital, Durban, South Africa. 5. Discipline of Anaesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa.
Abstract
BACKGROUND: Tuberculosis is a major global public health concern. Patients with tuberculosis who require critical care have a high mortality and delay in initiating antituberculous therapy is associated with increased mortality. Lipoarabinomannan (LAM) is a lipopolysaccharide found in the cell wall of Mycobacterium tuberculosis. Urinary LAM may be used as a bedside diagnostic test for tuberculosis. METHODS: The study was a single centre, prospective observational study that compared the utility of urinary LAM with conventional tuberculosis diagnostic modalities in patients with suspected tuberculosis who required intensive care admission. Urinary LAM testing was performed using the Alere Determine TB LAM Ag lateral flow assay test strips. A patient was classified as having confirmed tuberculosis if they met the following criteria: a clinical presentation compatible with tuberculosis, with either a positive TB culture, a positive GeneXpert, or a histological diagnosis of tuberculosis. RESULTS: Fifty patients were included in the study, with 12 having confirmed tuberculosis. All patients received mechanical ventilation, and the ICU mortality was 60%. Urinary LAM had a sensitivity of 50.0% (95% CI, 21.1 to 78.9%) and a specificity of 84.2% (95% CI, 68.8 to 94.0%) for confirmed tuberculosis. CONCLUSION: Urinary LAM allows for rapid bedside diagnosis of tuberculosis in critically ill patients. A positive urinary LAM should prompt consideration to initiate antituberculous treatment while the results of further diagnostic testing are awaited.
BACKGROUND:Tuberculosis is a major global public health concern. Patients with tuberculosis who require critical care have a high mortality and delay in initiating antituberculous therapy is associated with increased mortality. Lipoarabinomannan (LAM) is a lipopolysaccharide found in the cell wall of Mycobacterium tuberculosis. Urinary LAM may be used as a bedside diagnostic test for tuberculosis. METHODS: The study was a single centre, prospective observational study that compared the utility of urinary LAM with conventional tuberculosis diagnostic modalities in patients with suspected tuberculosis who required intensive care admission. Urinary LAM testing was performed using the Alere Determine TB LAM Ag lateral flow assay test strips. A patient was classified as having confirmed tuberculosis if they met the following criteria: a clinical presentation compatible with tuberculosis, with either a positive TB culture, a positive GeneXpert, or a histological diagnosis of tuberculosis. RESULTS: Fifty patients were included in the study, with 12 having confirmed tuberculosis. All patients received mechanical ventilation, and the ICU mortality was 60%. Urinary LAM had a sensitivity of 50.0% (95% CI, 21.1 to 78.9%) and a specificity of 84.2% (95% CI, 68.8 to 94.0%) for confirmed tuberculosis. CONCLUSION: Urinary LAM allows for rapid bedside diagnosis of tuberculosis in critically illpatients. A positive urinary LAM should prompt consideration to initiate antituberculous treatment while the results of further diagnostic testing are awaited.
Authors: Stephanie Bjerrum; Ian Schiller; Nandini Dendukuri; Mikashmi Kohli; Ruvandhi R Nathavitharana; Alice A Zwerling; Claudia M Denkinger; Karen R Steingart; Maunank Shah Journal: Cochrane Database Syst Rev Date: 2019-10-21
Authors: Jacqueline M Achkar; Stephen D Lawn; Mahomed-Yunus S Moosa; Colleen A Wright; Victoria O Kasprowicz Journal: J Infect Dis Date: 2011-11-15 Impact factor: 5.226
Authors: Inge Kroidl; Petra Clowes; Joshua Mwakyelu; Leonard Maboko; Abubakary Kiangi; Andrea Rachow; Klaus Reither; Jutta Jung; Anthony Nsojo; Elmar Saathoff; Michael Hoelscher Journal: Scand J Infect Dis Date: 2013-11-25
Authors: Stephen D Lawn; Andrew D Kerkhoff; Rosie Burton; Charlotte Schutz; Andrew Boulle; Monica Vogt; Ankur Gupta-Wright; Mark P Nicol; Graeme Meintjes Journal: BMC Med Date: 2017-03-21 Impact factor: 8.775
Authors: J R Zahar; E Azoulay; E Klement; A De Lassence; J C Lucet; B Regnier; B Schlemmer; J P Bedos Journal: Intensive Care Med Date: 2001-03 Impact factor: 17.440