Lipoarabinomannan in urine during tuberculosis treatment: association with host and pathogen factors and mycobacteriuria
<p>Abstract</p> <p>Background</p> <p>Detection of lipoarabinomannan (LAM), a <it>Mycobacterium tuberculosis </it>(<it>Mtb</it>) cell wall antigen, is a potentially attractive diagnostic. However, the LAM-ELISA assay has demonstrated variable sens...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2012-02-01
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| Series: | BMC Infectious Diseases |
| Online Access: | http://www.biomedcentral.com/1471-2334/12/47 |
| _version_ | 1818277797693489152 |
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| author | Wood Robin Racow Kimberly Bekker Linda-Gail Middelkoop Keren Vogt Monica Kreiswirth Barry N Lawn Stephen D |
| author_facet | Wood Robin Racow Kimberly Bekker Linda-Gail Middelkoop Keren Vogt Monica Kreiswirth Barry N Lawn Stephen D |
| author_sort | Wood Robin |
| collection | DOAJ |
| description | <p>Abstract</p> <p>Background</p> <p>Detection of lipoarabinomannan (LAM), a <it>Mycobacterium tuberculosis </it>(<it>Mtb</it>) cell wall antigen, is a potentially attractive diagnostic. However, the LAM-ELISA assay has demonstrated variable sensitivity in diagnosing TB in diverse clinical populations. We therefore explored pathogen and host factors potentially impacting LAM detection.</p> <p>Methods</p> <p>LAM-ELISA assay testing, sputum smear and culture status, HIV status, CD4 cell count, proteinuria and TB outcomes were prospectively determined in adults diagnosed with TB and commencing TB treatment at a South African township TB clinic. Sputum TB isolates were characterised by IS<it>61110</it>-based restriction fragment length polymorphism (RFLP) and urines were tested for mycobacteriuria by Xpert<sup>® </sup>MTB/RIF assay.</p> <p>Results</p> <p>32/199 (16.1%) of patients tested LAM-ELISA positive. Median optical density and proportion testing LAM positive remained unchanged during 2 weeks of treatment and then declined over 24 weeks. LAM was associated with positive sputum smear and culture status, HIV infection and low CD4 cell counts but not proteinuria, RFLP strain or TB treatment outcome. The sensitivity of LAM for TB in HIV-infected patients with CD4 counts of ≥ 200, 100-199, 50-99, and < 50 cells/μl, was 15.2%, 32%, 42.9%, and 69.2% respectively. Mycobacteriuria was found in 15/32 (46.9%) of LAM positive patients and in none of the LAM negative controls.</p> <p>Conclusions</p> <p>Urinary LAM was related to host immune factors, was unrelated to <it>Mtb </it>strain and declined steadily after an initial 2 weeks of TB treatment. The strong association of urine LAM with mycobacteriuria is a new finding, indicating frequent TB involvement of the renal tract in advanced HIV infection.</p> |
| first_indexed | 2024-12-12T23:07:15Z |
| format | Article |
| id | doaj.art-12938f9d07bb4090aaf3a7f792935567 |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-12-12T23:07:15Z |
| publishDate | 2012-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj.art-12938f9d07bb4090aaf3a7f7929355672022-12-22T00:08:40ZengBMCBMC Infectious Diseases1471-23342012-02-011214710.1186/1471-2334-12-47Lipoarabinomannan in urine during tuberculosis treatment: association with host and pathogen factors and mycobacteriuriaWood RobinRacow KimberlyBekker Linda-GailMiddelkoop KerenVogt MonicaKreiswirth Barry NLawn Stephen D<p>Abstract</p> <p>Background</p> <p>Detection of lipoarabinomannan (LAM), a <it>Mycobacterium tuberculosis </it>(<it>Mtb</it>) cell wall antigen, is a potentially attractive diagnostic. However, the LAM-ELISA assay has demonstrated variable sensitivity in diagnosing TB in diverse clinical populations. We therefore explored pathogen and host factors potentially impacting LAM detection.</p> <p>Methods</p> <p>LAM-ELISA assay testing, sputum smear and culture status, HIV status, CD4 cell count, proteinuria and TB outcomes were prospectively determined in adults diagnosed with TB and commencing TB treatment at a South African township TB clinic. Sputum TB isolates were characterised by IS<it>61110</it>-based restriction fragment length polymorphism (RFLP) and urines were tested for mycobacteriuria by Xpert<sup>® </sup>MTB/RIF assay.</p> <p>Results</p> <p>32/199 (16.1%) of patients tested LAM-ELISA positive. Median optical density and proportion testing LAM positive remained unchanged during 2 weeks of treatment and then declined over 24 weeks. LAM was associated with positive sputum smear and culture status, HIV infection and low CD4 cell counts but not proteinuria, RFLP strain or TB treatment outcome. The sensitivity of LAM for TB in HIV-infected patients with CD4 counts of ≥ 200, 100-199, 50-99, and < 50 cells/μl, was 15.2%, 32%, 42.9%, and 69.2% respectively. Mycobacteriuria was found in 15/32 (46.9%) of LAM positive patients and in none of the LAM negative controls.</p> <p>Conclusions</p> <p>Urinary LAM was related to host immune factors, was unrelated to <it>Mtb </it>strain and declined steadily after an initial 2 weeks of TB treatment. The strong association of urine LAM with mycobacteriuria is a new finding, indicating frequent TB involvement of the renal tract in advanced HIV infection.</p>http://www.biomedcentral.com/1471-2334/12/47 |
| spellingShingle | Wood Robin Racow Kimberly Bekker Linda-Gail Middelkoop Keren Vogt Monica Kreiswirth Barry N Lawn Stephen D Lipoarabinomannan in urine during tuberculosis treatment: association with host and pathogen factors and mycobacteriuria BMC Infectious Diseases |
| title | Lipoarabinomannan in urine during tuberculosis treatment: association with host and pathogen factors and mycobacteriuria |
| title_full | Lipoarabinomannan in urine during tuberculosis treatment: association with host and pathogen factors and mycobacteriuria |
| title_fullStr | Lipoarabinomannan in urine during tuberculosis treatment: association with host and pathogen factors and mycobacteriuria |
| title_full_unstemmed | Lipoarabinomannan in urine during tuberculosis treatment: association with host and pathogen factors and mycobacteriuria |
| title_short | Lipoarabinomannan in urine during tuberculosis treatment: association with host and pathogen factors and mycobacteriuria |
| title_sort | lipoarabinomannan in urine during tuberculosis treatment association with host and pathogen factors and mycobacteriuria |
| url | http://www.biomedcentral.com/1471-2334/12/47 |
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