Lipoarabinomannan in urine during tuberculosis treatment : association with host and pathogen factors and mycobacteriuria

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dc.contributor.authorWood, Robin
dc.contributor.authorRacow, Kimberly
dc.contributor.authorBekker, Linda-Gail
dc.contributor.authorMiddelkoop, Keren
dc.contributor.authorVogt, Monica
dc.contributor.authorKreiswirth, Barry N.
dc.contributor.authorLawn, Stephen D.
dc.date.accessioned2012-05-18T09:59:30Z
dc.date.available2012-05-18T09:59:30Z
dc.date.issued2012-02
dc.date.updated2012-05-10T15:10:59Z
dc.descriptionThe original publication is available at http://www.biomedcentral.com/1471-2334/12/47en_ZA
dc.descriptionBibliography
dc.description.abstracten_ZA
dc.description.abstractABSTRACT: Background: Detection of lipoarabinomannan (LAM), a Mycobacterium tuberculosis (Mtb) cell wall antigen, is a potentially attractive diagnostic. However, the LAM-ELISA assay has demonstrated variable sensitivity in diagnosing TB in diverse clinical populations. We therefore explored pathogen and host factors potentially impacting LAM detection. Methods: LAM-ELISA assay testing, sputum smear and culture status, HIV status, CD4 cell count, proteinuria and TB outcomes were prospectively determined in adults diagnosed with TB and commencing TB treatment at a South African township TB clinic. Sputum TB isolates were characterised by IS61110-based restriction fragment length polymorphism (RFLP) and urines were tested for mycobacteriuria by Xpert® MTB/RIF assay. Results: 32/199 (16.1%) of patients tested LAM-ELISA positive. Median optical density and proportion testing LAM positive remained unchanged during 2 weeks of treatment and then declined over 24 weeks. LAM was associated with positive sputum smear and culture status, HIV infection and low CD4 cell counts but not proteinuria, RFLP strain or TB treatment outcome. The sensitivity of LAM for TB in HIV-infected patients with CD4 counts of ≥ 200, 100-199, 50-99, and < 50 cells/μl, was 15.2%, 32%, 42.9%, and 69.2% respectively. Mycobacteriuria was found in 15/ 32 (46.9%) of LAM positive patients and in none of the LAM negative controls. Conclusions: Urinary LAM was related to host immune factors, was unrelated to Mtb strain and declined steadily after an initial 2 weeks of TB treatment. The strong association of urine LAM with mycobacteriuria is a new finding, indicating frequent TB involvement of the renal tract in advanced HIV infection.en_ZA
dc.description.versionPublishers' Versionen_ZA
dc.format.extent11 p. : ill.
dc.identifier.citationWood, R. et al 2012. Lipoarabinomannan in urine during tuberculosis treatment : association with host and pathogen factors and mycobacteriuria. BMC Infectious Diseases, 12(1):47en_ZA
dc.identifier.issn1471-2334 (online)
dc.identifier.urihttp://dx.doi.org/10.1186/1471-2334-12-47
dc.identifier.urihttp://hdl.handle.net/10019.1/21136
dc.language.isoen_ZAen_ZA
dc.language.rfc3066en
dc.publisherBioMed Centralen_ZA
dc.rights.holderWood et al.; licensee BioMed Central Ltd.en_ZA
dc.subjectLipoarabinomannan (LAM)en_ZA
dc.subjectMycobacterium tuberculosis (Mtb)en_ZA
dc.subjectTuberculosis -- Diagnosisen_ZA
dc.subjectPathogens impacting LAMen_ZA
dc.subjectHIV-positve patients -- Tuberculosis -- Researchen_ZA
dc.subjectRenibacterium salmoninarum -- Researchen_ZA
dc.titleLipoarabinomannan in urine during tuberculosis treatment : association with host and pathogen factors and mycobacteriuriaen_ZA
dc.typeArticleen_ZA
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