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

Autor: Laurent Hiffler, Piex Uwiragiye, Birgit Schramm, Jean-Claude Nshimiymana, Illa Abdou, Laurence Flevaud, Rodrigue C. Nganaboy, Helena Huerga, Aboubacar Abdoubara, Didier Mukeba, Seyni Sounna
Rok vydání: 2021
Předmět:
Bacterial Diseases
Lipopolysaccharides
Male
Pediatrics
Physiology
Fevers
Urine
Geographical Locations
Families
Medical Conditions
0302 clinical medicine
Medicine and Health Sciences
030212 general & internal medicine
Niger
Children
Multidisciplinary
biology
Body Fluids
Actinobacteria
Infectious Diseases
Child
Preschool
Tuberculosis Diagnosis and Management
Medicine
Female
Anatomy
Research Article
medicine.medical_specialty
Tuberculosis
Science
Severe Acute Malnutrition
Immunologic Tests
Urinalysis
Urine testing
Mycobacterium tuberculosis
03 medical and health sciences
Signs and Symptoms
Diagnostic Medicine
030225 pediatrics
medicine
Humans
Nutrition
Lipoarabinomannan
Bacteria
business.industry
Malnutrition
Organisms
Biology and Life Sciences
Infant
Correction
Tropical Diseases
medicine.disease
biology.organism_classification
Cross-Sectional Studies
Age Groups
People and Places
Africa
Population Groupings
Clinical Medicine
business
Mycobacterium Tuberculosis
Pediatric population
Zdroj: PLoS ONE
PLoS ONE, Vol 16, Iss 5, p e0250933 (2021)
ISSN: 1932-6203
Popis: 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 TM 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%, p1 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.
Databáze: OpenAIRE
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