Performance of Lipoarabinomannan Assay using Cerebrospinal fluid for the diagnosis of Tuberculous meningitis among HIV patients

Richard Kwizera, Fiona V. Cresswell, Gerald Mugumya, Micheal Okirwoth, Enock Kagimu, Ananta S. Bangdiwala, Darlisha A. Williams, Joshua Rhein, David R. Boulware, David B. Meya

Research output: Contribution to journalArticlepeer-review

12 Scopus citations

Abstract

Background: The diagnostic utility of the Mycobacteria tuberculosis lipoarabinomannan (TB-LAM) antigen lateral flow assay on cerebrospinal fluid (CSF) for the diagnosis of tuberculous meningitis (TBM) has not been extensively studied and the few published studies have conflicting results. Methods: Lumbar CSF from 59 HIV-positive patients with suspected TBM was tested with TB-LAM and Xpert MTB/Rif Ultra. The diagnostic performance of CSF TB-LAM was compared to positive CSF Xpert MTB/Rif Ultra (definite TBM) and a composite reference of probable or definite TBM according to the uniform case definition. Results: Of 59 subjects, 12 (20%) had definite TBM and five (9%) had probable TBM. With reference to definite TBM, CSF TB-LAM assay had a diagnostic sensitivity of 33% and specificity of 96%. When compared to a composite reference of definite or probable TBM, the sensitivity was 24% and specificity was 95%. There were two false positive tests with TB-LAM (3+ grade). In-hospital mortality in CSF TB-LAM positive patients was 17% compared to 0% in those with definite TBM by Xpert MTB/Rif Ultra but negative LAM. Conclusions: Lumbar CSF TB-LAM has a poor performance in diagnosing TBM. Both urine TB-LAM and Xpert Ultra should be further investigated in the diagnosis of TBM.

Original languageEnglish (US)
Article number123
JournalWellcome Open Research
Volume4
DOIs
StatePublished - 2019

Bibliographical note

Publisher Copyright:
© 2019 Kwizera R et al.

Keywords

  • Cerebrospinal fluid
  • Diagnostics
  • Extra-pulmonary TB
  • HIV
  • Lipoarabinomannan
  • TB-LAM
  • Tuberculous meningitis
  • Xpert MTB/Rif Ultra

PubMed: MeSH publication types

  • Journal Article

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