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Utility of urine lipoarabinomannan (LAM) in diagnosing mycobacteria infection among hospitalized HIV-positive patients.
Liu, Danping; Gu, Ling; Zhang, Renfang; Liu, Li; Shen, Yinzhong; Shao, Yueming; Wang, Jiangrong; Sun, Jianjun; Qi, Tangkai; Wang, Zhenyan; Tang, Yang; Song, Wei; Xun, Jingna; Lu, Hongzhou; Chen, Jun.
  • Liu D; Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.
  • Gu L; Scientific Research Center, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.
  • Zhang R; Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.
  • Liu L; Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.
  • Shen Y; Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.
  • Shao Y; Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.
  • Wang J; Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.
  • Sun J; Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.
  • Qi T; Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.
  • Wang Z; Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.
  • Tang Y; Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.
  • Song W; Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.
  • Xun J; Scientific Research Center, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.
  • Lu H; Department of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Shenzhen Third People's Hospital, Shenzhen, Guangdong, China. Electronic address: luhongzhou@fudan.edu.cn.
  • Chen J; Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China. Electronic address: qtchenjun@163.com.
Int J Infect Dis ; 118: 65-70, 2022 May.
Article in English | MEDLINE | ID: covidwho-1838853
ABSTRACT

OBJECTIVES:

Cross-reactivity with nontuberculous mycobacteria (NTM) species might limit the use of urine lipoarabinomannan (LAM) test to diagnose tuberculosis (TB) in people living with HIV (PLWH). This study aimed to investigate the utility of the LAM test among hospitalized HIV-positive patients.

METHODS:

This prospective study enrolled HIV-positive inpatients with any TB symptom or seriously ill patients with advanced immunodeficiency. Urine samples were tested using the Alere Determine LAM Ag, and participants were categorized as confirmed TB, confirmed NTM infection, unclassified mycobacteria infection, and no mycobacteria infection based on microbiologic reference standards.

RESULTS:

A total of 382 participants were included. The prevalence of confirmed TB and NTM infection was 5.24% (20 of 382) and 4.45% (17 of 382), respectively. The sensitivity and specificity of the urine LAM for TB diagnosis were 65.00% (95% confidence interval [CI] 40.78-84.61) and 89.36% (95% CI 85.68-92.36), respectively. The LAM test for NTM yielded a sensitivity of 58.82% (95% CI 32.92-81.56) and specificity of 88.61% (95% CI 84.87-91.70). Notably, the negative predictive values of the urine LAM for TB and NTM were 97.85% (95% CI 95.63-99.13) and 97.85% (95% CI 95.63-99.13), respectively.

CONCLUSIONS:

Cross-reactivity with NTM cause high false-positive LAM for TB diagnosis in PLWH. The correct identification of mycobacteria species is crucial for deciding treatment strategies.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Tuberculosis / HIV Infections / HIV Seropositivity / Mycobacterium Infections, Nontuberculous Type of study: Cohort study / Diagnostic study / Observational study / Prognostic study / Randomized controlled trials Limits: Humans Language: English Journal: Int J Infect Dis Journal subject: Communicable Diseases Year: 2022 Document Type: Article Affiliation country: J.ijid.2022.02.046

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Tuberculosis / HIV Infections / HIV Seropositivity / Mycobacterium Infections, Nontuberculous Type of study: Cohort study / Diagnostic study / Observational study / Prognostic study / Randomized controlled trials Limits: Humans Language: English Journal: Int J Infect Dis Journal subject: Communicable Diseases Year: 2022 Document Type: Article Affiliation country: J.ijid.2022.02.046