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

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dc.contributor.authorWood, Robinen_ZA
dc.contributor.authorRacow, Kimberlyen_ZA
dc.contributor.authorBekker, Linda-Gailen_ZA
dc.contributor.authorMiddelkoop, Kerenen_ZA
dc.contributor.authorVogt, Monicaen_ZA
dc.contributor.authorKreiswirth, Barryen_ZA
dc.contributor.authorLawn, Stephenen_ZA
dc.date.accessioned2015-10-28T06:50:56Z
dc.date.available2015-10-28T06:50:56Z
dc.date.issued2012en_ZA
dc.description.abstractBACKGROUND: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(R) 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 [greater than or equal to] 200, 100-199, 50-99, and < 50 cells/mul, 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.identifier.apacitationWood, R., Racow, K., Bekker, L., Middelkoop, K., Vogt, M., Kreiswirth, B., & Lawn, S. (2012). Lipoarabinomannan in urine during tuberculosis treatment: association with host and pathogen factors and mycobacteriuria. <i>BMC Infectious Diseases</i>, http://hdl.handle.net/11427/14430en_ZA
dc.identifier.chicagocitationWood, Robin, Kimberly Racow, Linda-Gail Bekker, Keren Middelkoop, Monica Vogt, Barry Kreiswirth, and Stephen Lawn "Lipoarabinomannan in urine during tuberculosis treatment: association with host and pathogen factors and mycobacteriuria." <i>BMC Infectious Diseases</i> (2012) http://hdl.handle.net/11427/14430en_ZA
dc.identifier.citationWood, R., Racow, K., Bekker, L. G., Middelkoop, K., Vogt, M., Kreiswirth, B. N., & Lawn, S. D. (2012). Lipoarabinomannan in urine during tuberculosis treatment: association with host and pathogen factors and mycobacteriuria. BMC infectious diseases, 12(1), 47.en_ZA
dc.identifier.ris TY - Journal Article AU - Wood, Robin AU - Racow, Kimberly AU - Bekker, Linda-Gail AU - Middelkoop, Keren AU - Vogt, Monica AU - Kreiswirth, Barry AU - Lawn, Stephen AB - 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(R) 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 [greater than or equal to] 200, 100-199, 50-99, and < 50 cells/mul, 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. DA - 2012 DB - OpenUCT DO - 10.1186/1471-2334-12-47 DP - University of Cape Town J1 - BMC Infectious Diseases LK - https://open.uct.ac.za PB - University of Cape Town PY - 2012 T1 - Lipoarabinomannan in urine during tuberculosis treatment: association with host and pathogen factors and mycobacteriuria TI - Lipoarabinomannan in urine during tuberculosis treatment: association with host and pathogen factors and mycobacteriuria UR - http://hdl.handle.net/11427/14430 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/14430
dc.identifier.urihttp://dx.doi.org/10.1186/1471-2334-12-47
dc.identifier.vancouvercitationWood R, Racow K, Bekker L, Middelkoop K, Vogt M, Kreiswirth B, et al. Lipoarabinomannan in urine during tuberculosis treatment: association with host and pathogen factors and mycobacteriuria. BMC Infectious Diseases. 2012; http://hdl.handle.net/11427/14430.en_ZA
dc.language.isoengen_ZA
dc.publisherBioMed Central Ltden_ZA
dc.publisher.departmentDesmond Tutu HIV Centreen_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.holder2012 Wood et al; licensee BioMed Central Ltden_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/2.0en_ZA
dc.sourceBMC Infectious Diseasesen_ZA
dc.source.urihttp://www.biomedcentral.com/bmcinfectdis/en_ZA
dc.subject.otherAntigens, Bacterialen_ZA
dc.subject.otherLipopolysaccharidesen_ZA
dc.subject.otherMycobacterium tuberculosisen_ZA
dc.subject.otherLipoarabinomannanen_ZA
dc.titleLipoarabinomannan in urine during tuberculosis treatment: association with host and pathogen factors and mycobacteriuriaen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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