1. Potential value of urine lateral-flow lipoarabinomannan (LAM) test for diagnosing tuberculosis among severely acute malnourished children
- Author
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Laurent Hiffler, Piex Uwiragiye, Birgit Schramm, Jean-Claude Nshimiymana, Illa Abdou, Laurence Flevaud, Rodrigue C. Nganaboy, Helena Huerga, Aboubacar Abdoubara, Didier Mukeba, and Seyni Sounna
- Subjects
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 - Abstract
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.
- Published
- 2021