title: When smear and molecular diagnostics fail: identification of tuberculosis in advanced HIV infection using the newly developed urine lipoarabinomannan lateral-flow assay.
abstract: In HIV infection, progression of immunodeficiency is associated with increased risk of paucibacillary and disseminated forms of tuberculosis (TB). As a result, the clinical presentation may be atypical and the conventional diagnostic assays often unreliable, resulting in significant treatment delays. Here, we report a case of HIV-associated immune reconstitution inflammatory syndrome and TB meningitis. Although the smear and molecular assays were negative, Mycobacterium tuberculosis was identified in our patient using the new Determine-lipoarabinomannan (LAM) lateral-flow urine 'dip-stick' assay. This case report illustrates the clinical value of this assay for the diagnosis of TB in a subgroup of HIV-infected patients with advanced immunodeficiency. Also, although two recent studies have evaluated the use of the Determine TB-LAM assay in clinical settings, to the best of our knowledge, this is the first case report of TB diagnosed using this novel assay.
authors.affiliation: Department of Infectious Diseases, Helen Joseph Academic Hospital, Johannesburg, Gauteng, South Africa.
authors.forename: Ashar Vijay
authors.initials: AV
authors.lastname: Dhana
authors.forename: Pauline
authors.initials: P
authors.lastname: Howell
authors.forename: David
authors.initials: D
authors.lastname: Spencer
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D000995:Antitubercular Agents / Q000627:therapeutic use; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000209:etiology*; D008070:Lipopolysaccharides / Q000652:urine*; D009169:Mycobacterium tuberculosis; D014057:Tomography, X-Ray Computed; D014390:Tuberculosis, Meningeal / Q000150:complications / Q000188:drug therapy / Q000652:urine*
chemical_list: D019380:Anti-HIV Agents; D000995:Antitubercular Agents; D008070:Lipopolysaccharides; C050016:lipoarabinomannan