title: The diagnostic accuracy of pericardial and urinary lipoarabinomannan (LAM) assays in patients with suspected tuberculous pericarditis.
abstract: We evaluated the diagnostic accuracy of urinary and pericardial fluid (PF) lipoarabinomannan (LAM) assays in tuberculous pericarditis (TBP). From October 2009 through September 2012, 151 patients with TBP were enrolled. Mycobacterium tuberculosis culture and/or pericardial histology were the reference standard for definite TBP. 49% (74/151), 33.1% (50/151) and 17.9% (27/151) of patients had definite-, probable-, and non-TB respectively; 69.5% (105/151) were HIV positive. LAM ELISA had the following sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, positive predictive value and negative predictive values (95% confidence interval): urinary - 17.4% (9.1-30.7), 93.8% (71.7-98.9), 2.8 (0.1-63.3), 0.9 (0.8-0.9), 88.9% (56.5-98.0), and 28.3% (17.9-41.6); PF - 11.6% (6.0-21.3), 88% (70.0-95.8), 0.9 (0.08-12.0), 1.0 (0.9-1.1), 72.7% (43.4-90.1), and 26.6% (18.2-36.9). Sensitivity increased with a CD4 ≤ 100 cells/mm(3) from 3.5% to 50% (p < 0.001) for urinary LAM ELISA; for urinary LAM strip test, grade 1 and 2 cut-points performed similarly, irrespective of HIV status or CD4 count. For PF LAM strip tests, switching cut-points from grade 1 to 2 significantly reduced test sensitivity (54.5% versus 19.7%; p < 0.001). Urinary and PF LAM assays have low sensitivity but high specificity for diagnosis of TBP. The sensitivity of urinary LAM is increased in HIV-infected patients with a CD4 ≤ 100 cells/mm(3).
authors.affiliation: The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa.
authors.forename: Shaheen
authors.initials: S
authors.lastname: Pandie
authors.affiliation: TB Vaccine Group, Jenner Institute, University of Oxford, Oxford, UK.|Lung Infections and Immunity Unit and UCT Lung Institute, Division of Pulmonology, Department of Medicine, Groote Schuur Hospital, Cape Town, South Africa.|University of Cape Town, Cape Town, South Africa.
authors.forename: Jonathan G
authors.initials: JG
authors.lastname: Peter
authors.affiliation: The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa.
authors.forename: Zita S
authors.initials: ZS
authors.lastname: Kerbelker
authors.affiliation: Lung Infections and Immunity Unit and UCT Lung Institute, Division of Pulmonology, Department of Medicine, Groote Schuur Hospital, Cape Town, South Africa.|University of Cape Town, Cape Town, South Africa.
authors.forename: Richard
authors.initials: R
authors.lastname: Meldau
authors.affiliation: Lung Infections and Immunity Unit and UCT Lung Institute, Division of Pulmonology, Department of Medicine, Groote Schuur Hospital, Cape Town, South Africa.|University of Cape Town, Cape Town, South Africa.
authors.forename: Grant
authors.initials: G
authors.lastname: Theron
authors.affiliation: Lung Infections and Immunity Unit and UCT Lung Institute, Division of Pulmonology, Department of Medicine, Groote Schuur Hospital, Cape Town, South Africa.|University of Cape Town, Cape Town, South Africa.
authors.forename: Ureshnie
authors.initials: U
authors.lastname: Govender
authors.affiliation: The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa.
authors.forename: Mpiko
authors.initials: M
authors.lastname: Ntsekhe
authors.affiliation: Lung Infections and Immunity Unit and UCT Lung Institute, Division of Pulmonology, Department of Medicine, Groote Schuur Hospital, Cape Town, South Africa.|University of Cape Town, Cape Town, South Africa.|Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
authors.forename: Keertan
authors.initials: K
authors.lastname: Dheda
authors.affiliation: The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa.|Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
authors.forename: Bongani M
authors.initials: BM
authors.lastname: Mayosi
mesh_terms: D000328:Adult; D018791:CD4 Lymphocyte Count; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D015658:HIV Infections / Q000150:complications; D006801:Humans; D016013:Likelihood Functions; D008070:Lipopolysaccharides / Q000378:metabolism* / Q000652:urine*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009169:Mycobacterium tuberculosis; D010495:Pericarditis, Tuberculous / Q000378:metabolism* / Q000652:urine*; D010496:Pericardium / Q000378:metabolism*; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
chemical_list: D008070:Lipopolysaccharides; C050016:lipoarabinomannan