Utility of a novel lipoarabinomannan assay for the diagnosis of tuberculous meningitis in a resource-poor high-HIV prevalence setting

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dc.contributor.authorPatel, Vinod Ben_ZA
dc.contributor.authorBhigjee, Ahmed Ien_ZA
dc.contributor.authorParuk, Hoosain Fen_ZA
dc.contributor.authorSingh, Raveshen_ZA
dc.contributor.authorMeldau, Richarden_ZA
dc.contributor.authorConnolly, Cathyen_ZA
dc.contributor.authorNdung'u, Thumbien_ZA
dc.contributor.authorDheda, Keertanen_ZA
dc.date.accessioned2015-11-04T11:48:07Z
dc.date.available2015-11-04T11:48:07Z
dc.date.issued2009en_ZA
dc.description.abstractBACKGROUND: In Africa, tuberculous meningitis (TBM) is an important opportunistic infection in HIV-positive patients. Current diagnostic tools for TBM perform sub-optimally. In particular, the rapid diagnosis of TBM is challenging because smear microscopy has a low yield and PCR is not widely available in resource-poor settings. METHODS: We evaluated the performance outcome of a novel standardized lipoarabinomannan (LAM) antigen-detection assay, using archived cerebrospinal fluid samples, in 50 African TBM suspects of whom 68% were HIV-positive. RESULTS: Of the 50 participants 14, 23 and 13 patients had definite, probable and non-TBM, respectively. In the non-TB group there were 5 HIV positive patients who were lost to follow-up and in whom concomitant infection with Mycobacterium tuberculosis could not be definitively excluded. The test sensitivities and specificities were as follows: LAM assay 64% and 69% (cut-point 0.22), smear microscopy 0% and 100% and PCR 93% and 77%, respectively. CONCLUSION: In this preliminary proof-of-concept study, a rapid diagnosis of TBM could be achieved using LAM antigen detection. Although specificity was sub-optimal, the estimates provided here may be unreliable because of a classification bias inherent in the study design where it was not possible to exclude TBM in the presumed non-TBM cases owing to a lack of clinical follow-up. As PCR is largely unavailable, the LAM assay may well prove to be a useful adjunct for the rapid diagnosis of TBM in high HIV-incidence settings. These preliminary results justify further enquiry and prospective studies are now required to definitively establish the place of this technology for the diagnosis of TBM.en_ZA
dc.identifier.apacitationPatel, V. B., Bhigjee, A. I., Paruk, H. F., Singh, R., Meldau, R., Connolly, C., ... Dheda, K. (2009). Utility of a novel lipoarabinomannan assay for the diagnosis of tuberculous meningitis in a resource-poor high-HIV prevalence setting. <i>Cerebrospinal Fluid Research</i>, http://hdl.handle.net/11427/14667en_ZA
dc.identifier.chicagocitationPatel, Vinod B, Ahmed I Bhigjee, Hoosain F Paruk, Ravesh Singh, Richard Meldau, Cathy Connolly, Thumbi Ndung'u, and Keertan Dheda "Utility of a novel lipoarabinomannan assay for the diagnosis of tuberculous meningitis in a resource-poor high-HIV prevalence setting." <i>Cerebrospinal Fluid Research</i> (2009) http://hdl.handle.net/11427/14667en_ZA
dc.identifier.citationPatel, V. B., Bhigjee, A. I., Paruk, H. F., Singh, R., Meldau, R., Connolly, C., ... & Dheda, K. (2009). Utility of a novel lipoarabinomannan assay for the diagnosis of tuberculous meningitis in a resource-poor high-HIV prevalence setting. Cerebrospinal Fluid Res, 6(13), 2227-2231.en_ZA
dc.identifier.ris TY - Journal Article AU - Patel, Vinod B AU - Bhigjee, Ahmed I AU - Paruk, Hoosain F AU - Singh, Ravesh AU - Meldau, Richard AU - Connolly, Cathy AU - Ndung'u, Thumbi AU - Dheda, Keertan AB - BACKGROUND: In Africa, tuberculous meningitis (TBM) is an important opportunistic infection in HIV-positive patients. Current diagnostic tools for TBM perform sub-optimally. In particular, the rapid diagnosis of TBM is challenging because smear microscopy has a low yield and PCR is not widely available in resource-poor settings. METHODS: We evaluated the performance outcome of a novel standardized lipoarabinomannan (LAM) antigen-detection assay, using archived cerebrospinal fluid samples, in 50 African TBM suspects of whom 68% were HIV-positive. RESULTS: Of the 50 participants 14, 23 and 13 patients had definite, probable and non-TBM, respectively. In the non-TB group there were 5 HIV positive patients who were lost to follow-up and in whom concomitant infection with Mycobacterium tuberculosis could not be definitively excluded. The test sensitivities and specificities were as follows: LAM assay 64% and 69% (cut-point 0.22), smear microscopy 0% and 100% and PCR 93% and 77%, respectively. CONCLUSION: In this preliminary proof-of-concept study, a rapid diagnosis of TBM could be achieved using LAM antigen detection. Although specificity was sub-optimal, the estimates provided here may be unreliable because of a classification bias inherent in the study design where it was not possible to exclude TBM in the presumed non-TBM cases owing to a lack of clinical follow-up. As PCR is largely unavailable, the LAM assay may well prove to be a useful adjunct for the rapid diagnosis of TBM in high HIV-incidence settings. These preliminary results justify further enquiry and prospective studies are now required to definitively establish the place of this technology for the diagnosis of TBM. DA - 2009 DB - OpenUCT DO - 10.1186/1743-8454-6-13 DP - University of Cape Town J1 - Cerebrospinal Fluid Research LK - https://open.uct.ac.za PB - University of Cape Town PY - 2009 T1 - Utility of a novel lipoarabinomannan assay for the diagnosis of tuberculous meningitis in a resource-poor high-HIV prevalence setting TI - Utility of a novel lipoarabinomannan assay for the diagnosis of tuberculous meningitis in a resource-poor high-HIV prevalence setting UR - http://hdl.handle.net/11427/14667 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/14667
dc.identifier.urihttp://dx.doi.org/10.1186/1743-8454-6-13
dc.identifier.vancouvercitationPatel VB, Bhigjee AI, Paruk HF, Singh R, Meldau R, Connolly C, et al. Utility of a novel lipoarabinomannan assay for the diagnosis of tuberculous meningitis in a resource-poor high-HIV prevalence setting. Cerebrospinal Fluid Research. 2009; http://hdl.handle.net/11427/14667.en_ZA
dc.language.isoengen_ZA
dc.publisherBioMed Central Ltden_ZA
dc.publisher.departmentDivision of Pulmonologyen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an Open Access article distributed under the terms of the Creative Commons Attribution Licenseen_ZA
dc.rights.holder2009 Patel et al; licensee BioMed Central Ltd.en_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/2.0en_ZA
dc.sourceCerebrospinal Fluid Researchen_ZA
dc.source.urihttp://www.fluidsbarrierscns.com/en_ZA
dc.subject.otherProbable TBMen_ZA
dc.subject.otherTBM Groupen_ZA
dc.subject.otherHIV Negative Groupen_ZA
dc.subject.otherImmuno-chromatographic Strip Testen_ZA
dc.subject.otherTuberculosis Groupen_ZA
dc.subject.otherTuberculous Meningitisen_ZA
dc.titleUtility of a novel lipoarabinomannan assay for the diagnosis of tuberculous meningitis in a resource-poor high-HIV prevalence settingen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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