Evaluation of feasibility and utility of urinary lipoarabinomannan assay against conventional sputum microscopy in the detection of tuberculosis among people with and without HIV infection

IF 2.3 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Clinical Epidemiology and Global Health Pub Date : 2024-11-01 DOI:10.1016/j.cegh.2024.101827

Chakrapani Chatla , Neetu Mishra , Malathi Jojula , Vijay Nema , Rajesham Adepu , Mallikarjun Puttala

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Abstract

Background

Tuberculosis (TB) is a major global public health challenge. Lipoarabinomannan (LAM) assessment in urine is a potential molecular diagnostic tool for TB.

Methods

We evaluated the feasibility and utility of urinary LAM in detecting TB along with sputum smear microscopy (SSM) and the TrueNAT test. In an observational cross-sectional pilot study, we collected sputum and urine samples from 240 subjects visiting the Designated Microscopy Center, Warangal during Apr-Sep 2021. LED microscopy, TrueNAT and liquid culture were performed on sputum while LAM test was conducted on urine samples.

Results

Mean age of the subjects was 45.1 (SD = 16.1) years. The majority were men (66 %), married (89 %) and urban (52 %) subjects. Overall sensitivity of urine LAM was 63.6 % and specificity 80.1 % while that of LED microscopy were 59.6 % and 56.7 % respectively. TrueNAT had sensitivity of 58.6 % and specificity of 80.1 %. However, a combination of LAM + TrueNAT had 79.8 % sensitivity. Among PLHIV, LAM + SSM has better sensitivity than any other combination of these tests or alone across all CD4 count categories.

Conclusion

Urinary LAM can be a more useful, feasible and better TB diagnostic biomarker over LED microscopy in diagnosing TB among the subjects who have symptoms irrespective of HIV status and recommend further evaluation of next-generation urinary LAM diagnostics to reach the unreached through a point of care tool.

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评估尿液脂联素甘露聚糖检测法与传统痰液显微镜检测法在检测艾滋病毒感染者和非艾滋病毒感染者中结核病的可行性和实用性

背景结核病（TB）是一项重大的全球公共卫生挑战。我们评估了尿液中的脂联素甘露聚糖（LAM）与痰涂片显微镜检查（SSM）和 TrueNAT 检测一起检测结核病的可行性和实用性。在一项观察性横断面试点研究中，我们收集了 2021 年 4 月至 9 月期间在瓦兰加尔市指定显微镜中心就诊的 240 名受试者的痰液和尿液样本。对痰液进行了 LED 显微镜检查、TrueNAT 和液体培养，对尿液样本进行了 LAM 测试。大多数受试者为男性（66%）、已婚（89%）和城市居民（52%）。尿液 LAM 的总体灵敏度为 63.6%，特异性为 80.1%，而 LED 显微镜的灵敏度和特异性分别为 59.6% 和 56.7%。TrueNAT 的灵敏度为 58.6%，特异性为 80.1%。不过，LAM + TrueNAT 组合的灵敏度为 79.8%。在艾滋病毒感染者中，在所有 CD4 细胞计数类别中，尿液 LAM + SSM 的灵敏度均高于这些检测方法的任何其他组合或单独使用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Epidemiology and Global Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-

CiteScore

4.60

自引率

7.70%

发文量

218

审稿时长

66 days

期刊介绍： Clinical Epidemiology and Global Health (CEGH) is a multidisciplinary journal and it is published four times (March, June, September, December) a year. The mandate of CEGH is to promote articles on clinical epidemiology with focus on developing countries in the context of global health. We also accept articles from other countries. It publishes original research work across all disciplines of medicine and allied sciences, related to clinical epidemiology and global health. The journal publishes Original articles, Review articles, Evidence Summaries, Letters to the Editor. All articles published in CEGH are peer-reviewed and published online for immediate access and citation.