Urine Tuberculosis Lipoarabinomannan Predicts Mortality in Hospitalized Human Immunodeficiency Virus-Infected Children

LaCourse, Sylvia M; Cranmer, Lisa M; Njuguna, Irene; Gatimu, John; Stern, Joshua; Maleche‐Obimbo, Elizabeth; Walson, Judd L.; Wamalwa, Dalton; John‐Stewart, Grace; Pavlinac, Patricia B

doi:10.1093/cid/ciy011

Cited by 12 publications

(6 citation statements)

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“…Together with these recent reports, our findings emphasize the potential value of LAM-testing for diagnosing TB in HIV-negative, SAM children. Urinary LAM-positivity was also proposed as a prognostic marker of clinical severity and mortality in HIV-positive adults [39][40][41] or hospitalized HIV-positive children [42]. In our study, most children in Group 1 were from intensive care units.…”

Section: Plos Onementioning

confidence: 57%

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Potential value of urine lateral-flow lipoarabinomannan (LAM) test for diagnosing tuberculosis among severely acute malnourished children

Schramm¹,

Nganaboy²,

Uwiragiye³

et al. 2021

PLoS ONE

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Background Tuberculosis (TB) is a serious co-morbidity among children with severe acute malnutrition (SAM) and TB diagnosis remains particularly challenging in the very young. We explored whether, in a low HIV-prevalence setting, the detection of mycobacterial lipoarabinomannan (LAM) antigen in urine may assist TB diagnosis in SAM children, a pediatric population currently not included in LAM-testing recommendations. To that end, we assessed LAM test-positivity among SAM children with and without signs or symptoms of TB. Methods A cross-sectional assessment (February 2016-August 2017) included children <5 years with SAM from an Intensive-Therapeutic-Feeding-Centre in Madaoua, Niger. Group 1: children with signs or symptoms suggestive of TB. Group 2: children without any sign or symptom of TB. Urine-specimens were subjected to DetermineTM TB-LAM lateral-flow-test (using a 4-grade intensity scale for positives). LAM-results were used for study purposes and not for patient management. Programmatic TB-diagnosis was primarily based on patients’ clinical symptoms and TB contact history with no systematic access to X-ray or microbiological reference testing. Results 102 (Group 1) and 100 children (Group 2) were included (median age 18 months, 59.4% male, 1.0% HIV-positive). In Group 1, 22 (21.6%) children were started on TB-treatment (probable TB) and none of the children in Group 2. LAM-positivity was 52.0% (53/102) and 37.0% (37/100) in Group 1 and 2, respectively. Low-intensity (Grade 1) LAM test-positivity was similarly high in both Groups (37.3% and 36.0%, respectively), while Grade 2 or 3-positives were mainly detected in Group 1 (Group 1: 14.7%, Group 2: 1.0%, p<0.001). When considering only Grades >1 as positive, LAM-testing detected 22.7% (95%CI: 7.8, 45.4) among probable TB cases, while 99% (95%CI: 94.6, 99.9) of unlikely TB cases (Group 2) tested negative. Conclusion These findings suggest the potential utility of LAM urine testing in HIV-negative children with SAM. Determine LAM-positivity with Grades >1 may identify HIV-negative SAM children that are eligible for rapid TB-treatment initiation, though low-intensity (Grade 1) LAM-positive results may not be helpful in this way. Further studies in this specific pediatric population are warranted, including evaluations of new generation LAM tests.

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Section: Plos Onementioning

confidence: 57%

“…Urinary LAM-positivity was also proposed as a prognostic marker of clinical severity and mortality in HIV-positive adults [ 39 – 41 ] or hospitalized HIV-positive children [ 42 ]. In our study, most children in Group 1 were from intensive care units.…”

Section: Discussionmentioning

confidence: 99%

Potential value of urine lateral-flow lipoarabinomannan (LAM) test for diagnosing tuberculosis among severely acute malnourished children

Schramm¹,

Nganaboy²,

Uwiragiye³

et al. 2021

PLoS ONE

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“…Then we went over the text, and 95 studies were eliminated for various reasons. Finally, 67 articles with a total of 164 reports and 23727 samples were included 6 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , ...…”

Section: Resultsmentioning

confidence: 99%

Diagnostic value of Lipoarabinomannan antigen for detecting Mycobacterium tuberculosis in adults and children with or without HIV infection

Yin

Qiqing

et al. 2022

Clinical Laboratory Analysis

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“…The same conditions apply to HIV positive children [45]. There is supportive evidence that LAM assay can predict the mortality of HIV infected children missed during respiratory sampling [46].…”

Section: Lipoarabinomannan Urine Strip Test (Lam)mentioning

confidence: 99%

Tuberculosis Diagnosis in the Era of SARS-CoV-2

Bandara

Magana-Arachchi

2022

SAJRM

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Tuberculosis (TB) continues to be a global public health emergency responsible for approximately 1.3 million deaths annually. Enduring the existing TB challenges, the emergence of “severe acute respiratory syndrome coronavirus 2” (SARS-CoV-2), a similar respiratory infection threatened the success of TB control over the past few years. Contemplating the irreversible damage of the human immunodeficiency virus (HIV), one of the leading immune-suppressive conditions, a similar or worst expected with this synergism: TB-HIV-SARS-CoV-2. Therefore, an integrated approach is much demanded before the impending revolution, "Next Global Pandemic". The advancement of molecular diagnostic techniques, blood transcriptomics uncovered the importance of studying the cross-talk between host and pathogens. RNA-sequencing is a high-throughput sequencing technique allowing detailed characterization of gene expression profiles. With the impact of SARS-CoV-2 on host immunity, pathogen-derived biomarker identification is more disease-specific and constrains individual variations faced during host biomarker identification. However, several technical hurdles are encountered during the study of intracellular pathogens like Mycobacterium tuberculosis. The development of advanced RNA-sequencing techniques to tackle the issues targeting the host and pathogen interactions is in their infancy and restricted to in-vitro studies. Few studies on serum exosomal RNA-sequencing of active and latent TB patients enlightened the path of TB biomarker discovery urging the necessity of more studies. Thus, this review will explicitly discuss the existing TB diagnostic tools to understand where we stand in TB diagnosis and the recent advancements in blood transcriptomics emphasizing the importance of targeting the pathogen-derived biomarkers as a potential source for future diagnostics.

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Urine Tuberculosis Lipoarabinomannan Predicts Mortality in Hospitalized Human Immunodeficiency Virus-Infected Children

Abstract: NCT02063880.

Cited by 12 publications

References 10 publications

Potential value of urine lateral-flow lipoarabinomannan (LAM) test for diagnosing tuberculosis among severely acute malnourished children

Potential value of urine lateral-flow lipoarabinomannan (LAM) test for diagnosing tuberculosis among severely acute malnourished children

Diagnostic value of Lipoarabinomannan antigen for detecting Mycobacterium tuberculosis in adults and children with or without HIV infection

Tuberculosis Diagnosis in the Era of SARS-CoV-2

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