Abstract
BackgroundTuberculosis is a major global public health concern. Patients with tuberculosis who require critical care have a high mortality and delay in initiating antituberculous therapy is associated with increased mortality. Lipoarabinomannan (LAM) is a lipopolysaccharide found in the cell wall of Mycobacterium tuberculosis. Urinary LAM may be used as a bedside diagnostic test for tuberculosis.MethodsThe study was a single centre, prospective observational study that compared the utility of urinary LAM with conventional tuberculosis diagnostic modalities in patients with suspected tuberculosis who required intensive care admission. Urinary LAM testing was performed using the Alere Determine TB LAM Ag lateral flow assay test strips. A patient was classified as having confirmed tuberculosis if they met the following criteria: a clinical presentation compatible with tuberculosis, with either a positive TB culture, a positive GeneXpert, or a histological diagnosis of tuberculosis.ResultsFifty patients were included in the study, with 12 having confirmed tuberculosis. All patients received mechanical ventilation, and the ICU mortality was 60%. Urinary LAM had a sensitivity of 50.0% (95% CI, 21.1 to 78.9%) and a specificity of 84.2% (95% CI, 68.8 to 94.0%) for confirmed tuberculosis.ConclusionUrinary LAM allows for rapid bedside diagnosis of tuberculosis in critically ill patients. A positive urinary LAM should prompt consideration to initiate antituberculous treatment while the results of further diagnostic testing are awaited.
Highlights
Tuberculosis is a major global public health concern
The study was conducted according to locally accepted ethical guidelines for research involving critically ill patients who are incapable of giving informed consent: the study should be of minimal risk, involve no alteration in the standard of care, be non-interventional and should be justified, of social value and in the interest of public health
In the interim this study provides both guidance to physicians treating intensive care unit (ICU) patients and a basis for future studies
Summary
Patients with tuberculosis who require critical care have a high mortality and delay in initiating antituberculous therapy is associated with increased mortality. Urinary LAM may be used as a bedside diagnostic test for tuberculosis. Tuberculosis (TB) is a major contributor to mortality globally [1]. The gold standard for TB diagnosis is Vasconcellos et al BMC Infectious Diseases (2021) 21:281 of extrapulmonary TB is higher, in HIV positive patients [5,6,7]. A diagnostic test for TB would ideally be able to detect pulmonary and extrapulmonary TB and perform well in both HIV positive and negative patients. Delays in diagnosis and initiation of treatment result in higher mortality rates [2, 3]. The ideal test would be point of care and would deliver an answer at the bedside
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