When smear and molecular diagnostics fail: identification of tuberculosis in advanced HIV infection using the newly developed urine lipoarabinomannan lateral-flow assay

Abstract

In HIV infection, progression of immunodeficiency is associated with increased risk of paucibacillary and disseminated forms of tuberculosis (TB). As a result, the clinical presentation may be atypical and the conventional diagnostic assays often unreliable, resulting in significant treatment delays. Here, we report a case of HIV-associated immune reconstitution inflammatory syndrome and TB meningitis. Although the smear and molecular assays were negative,Mycobacterium tuberculosiswas identified in our patient using the new Determine-lipoarabinomannan (LAM) lateral-flow urine ‘dip-stick’ assay. This case report illustrates the clinical value of this assay for the diagnosis of TB in a subgroup of HIV-infected patients with advanced immunodeficiency. Also, although two recent studies have evaluated the use of the Determine TB-LAM assay in clinical settings, to the best of our knowledge, this is the first case report of TB diagnosed using this novel assay.

Clinical utility of anti-lipoarabinomannan antibodies testing for the diagnosis of tuberculous arthritis

“…The accuracy of a commercial kit testing antibodies to LAM, a lipoglycan of the mycobacterial cell wall, has been recently tested showing a good discrimination power between TB and non-TB subjects (Malaviya & Kotwal 2003 ). The use of anti-LAM antibodies testing has been reported to be of utility in diagnosing pulmonary and extrapulmonary TB (Dhana et al 2014 ; Yokoyama et al 2005 ; Lawn et al 2014 ; Bua et al 2009 ).…”