title: Performance of urine lipoarabinomannan assays for paediatric tuberculosis in Tanzania.
abstract: We evaluated the diagnostic performance of two tests based on the release of lipoarabinomannan (LAM) into the urine, the MTB-LAM-ELISA assay and the Determine TB-LAM-strip assay, in children with suspected tuberculosis (TB) in a high TB/HIV-prevalence setting.In a prospective study, 132 children with suspected active TB were assigned to diagnostic subgroups. Urine samples were subjected to testing by both assays to ascertain sensitivity and specificity. Host factors associated with positive LAM results were investigated and LAM excretion monitored after antituberculous treatment initiation.18 (13.6%) children had culture-confirmed pulmonary TB. The assays' sensitivity was higher in HIV-positive versus HIV-negative children: 70% (95% confidence interval 35-93%) versus 13% (0-53%) for MTB-LAM-ELISA and 50% (19-81%) versus 0% (0-37%) for Determine TB-LAM. In 35 (27%) children with excluded active TB, both assays showed a specificity of 97.1% (85-100%). Proteinuria and low body mass index were independently associated with LAM positivity. In most patients, LAM excretion declined to zero during or at conclusion of antituberculous treatment.HIV/TB co-infected children might benefit from LAM-based tests to aid early TB diagnosis and subsequent positive impact on morbidity and mortality. Using LAM as a rule-in and treatment-monitoring tool may also show further potential.
authors.affiliation: Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Germany National Institute for Medical Research-Mbeya Medical Research Centre, Mbeya, Tanzania Both authors contributed equally ikroidl@lrz.uni-muenchen.de.
authors.forename: Inge
authors.initials: I
authors.lastname: Kroidl
authors.affiliation: National Institute for Medical Research-Mbeya Medical Research Centre, Mbeya, Tanzania Both authors contributed equally.
authors.forename: Petra
authors.initials: P
authors.lastname: Clowes
authors.affiliation: Medical Services and Diagnostic, Swiss Tropical and Public Health Institute, Basel, Switzerland Medical Services and Diagnostic (Swiss TPH), University of Basel, Basel, Switzerland.
authors.forename: Klaus
authors.initials: K
authors.lastname: Reither
authors.affiliation: National Institute for Medical Research-Mbeya Medical Research Centre, Mbeya, Tanzania.
authors.forename: Bariki
authors.initials: B
authors.lastname: Mtafya
authors.affiliation: National Institute for Medical Research-Mbeya Medical Research Centre, Mbeya, Tanzania.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Rojas-Ponce
authors.affiliation: National Institute for Medical Research-Mbeya Medical Research Centre, Mbeya, Tanzania.
authors.forename: Elias N
authors.initials: EN
authors.lastname: Ntinginya
authors.affiliation: Dept for Paediatrics and Child Health, Mbeya Referral Hospital, Mbeya, Tanzania.
authors.forename: Mariam
authors.initials: M
authors.lastname: Kalomo
authors.affiliation: National Institute for Medical Research-Mbeya Medical Research Centre, Mbeya, Tanzania Medical Services and Diagnostic, Swiss Tropical and Public Health Institute, Basel, Switzerland Medical Services and Diagnostic (Swiss TPH), University of Basel, Basel, Switzerland Ifakara Health Institute, Bagamoyo, Tanzania.
authors.forename: Lilian T
authors.initials: LT
authors.lastname: Minja
authors.affiliation: National Institute for Medical Research-Mbeya Medical Research Centre, Mbeya, Tanzania.
authors.forename: Dickens
authors.initials: D
authors.lastname: Kowuor
authors.affiliation: Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Germany German Centre for Infection Research (DZIF), partner site Munich, Germany.
authors.forename: Elmar
authors.initials: E
authors.lastname: Saathoff
authors.affiliation: Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Germany German Centre for Infection Research (DZIF), partner site Munich, Germany National Institute for Medical Research-Mbeya Medical Research Centre, Mbeya, Tanzania.
authors.forename: Arne
authors.initials: A
authors.lastname: Kroidl
authors.affiliation: Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Germany German Centre for Infection Research (DZIF), partner site Munich, Germany.
authors.forename: Norbert
authors.initials: N
authors.lastname: Heinrich
authors.affiliation: National Institute for Medical Research-Mbeya Medical Research Centre, Mbeya, Tanzania.
authors.forename: Leonard
authors.initials: L
authors.lastname: Maboko
authors.affiliation: University of Zambia-University College London Medical School Research and Training Project, University Teaching Hospital, Lusaka, Zambia Division of Infection and Immunity, University College London, London, UK NIHR Biomedical Research Centre, University College London Hospitals, London, UK.
authors.forename: Matthew
authors.initials: M
authors.lastname: Bates
authors.affiliation: University of Zambia-University College London Medical School Research and Training Project, University Teaching Hospital, Lusaka, Zambia Division of Infection and Immunity, University College London, London, UK NIHR Biomedical Research Centre, University College London Hospitals, London, UK.
authors.forename: Justin
authors.initials: J
authors.lastname: O'Grady
authors.affiliation: University of Zambia-University College London Medical School Research and Training Project, University Teaching Hospital, Lusaka, Zambia Division of Infection and Immunity, University College London, London, UK NIHR Biomedical Research Centre, University College London Hospitals, London, UK.
authors.forename: Alimuddin
authors.initials: A
authors.lastname: Zumla
authors.affiliation: Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Germany German Centre for Infection Research (DZIF), partner site Munich, Germany National Institute for Medical Research-Mbeya Medical Research Centre, Mbeya, Tanzania.
authors.forename: Michael
authors.initials: M
authors.lastname: Hoelscher
authors.affiliation: Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Germany German Centre for Infection Research (DZIF), partner site Munich, Germany National Institute for Medical Research-Mbeya Medical Research Centre, Mbeya, Tanzania.
authors.forename: Andrea
authors.initials: A
authors.lastname: Rachow
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000652:urine*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003906:Developing Countries; D019353:Endemic Diseases; D004797:Enzyme-Linked Immunosorbent Assay / Q000379:methods; D005260:Female; D006801:Humans; D015994:Incidence; D008070:Lipopolysaccharides / Q000032:analysis / Q000652:urine*; D008297:Male; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013183:Sputum / Q000382:microbiology; D013636:Tanzania / Q000453:epidemiology; D014376:Tuberculosis / Q000175:diagnosis / Q000453:epidemiology* / Q000652:urine*; D016482:Urinalysis / Q000379:methods
chemical_list: D008070:Lipopolysaccharides; C050016:lipoarabinomannan