Journal
OPEN FORUM INFECTIOUS DISEASES
Volume 7, Issue 4, Pages -Publisher
OXFORD UNIV PRESS INC
DOI: 10.1093/ofid/ofaa100
Keywords
HIV; meningitis; TB-LAM; tuberculosis; Xpert MTB/RIF Ultra
Categories
Funding
- Wellcome Trust Clinical PhD Fellowship [210772/Z/18/Z]
- National Institute of Neurologic Disorders and Stroke [R01NS086312, K23NS110470]
- Fogarty International Center [K01TW010268]
- National Institute of Allergy and Infectious Diseases [T32AI055433, R01AI145437]
- DELTAS Africa Initiative [107743]
- New Partnership for Africa's Development Planning and Coordinating Agency (NEPAD Agency)
- Wellcome Trust [107743]
- UK Government
- UK Medical Research Council (MRC)
- UK Department for International Development (DFID) under the MRC/DFID Concordat
- European Union
- MRC [MC_UU_00027/5, MR/R010161/1, MC_UP_1204/15] Funding Source: UKRI
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Background. Diagnosis of extrapulmonary tuberculosis (TB) remains challenging. We sought to determine the prevalence of disseminated TB by testing urine with TB-lipoarabinomannan (TB-LAM) lateral flow assay and Xpert MTB/RIF Ultra (Ultra) in hospitalized adults. Methods. We prospectively enrolled human immunodeficiency virus (HIV)-positive adults with suspected meningitis in Uganda during 2018-2020. Participants underwent standardized urine-based TB screening. Urine (60 mcL) was tested with TB-LAM (Alere), and remaining urine was centrifuged with the cell pellet resuspended in 2 mL of urine for Xpert Ultra testing. Results. We enrolled 348 HIV-positive inpatients with median CD4 of 37 cells/mcL (interquartile range, 13-102 cells/mcL). Overall, 26% (90 of 348; 95% confidence interval [CI], 21%-30%) had evidence of disseminated TB by either urine assay. Of 243 participants with both urine TB-LAM and Ultra results, 20% (48 of 243) were TB-LAM-positive, 12% (29 of 243) were Ultra-positive, and 6% (14 of 243) were positive by both assays. In definite and probable TB meningitis, 37% (14 of 38) were TB-LAM-positive and 41% (15 of 37) were Ultra-positive. In cryptococcal meningitis, 22% (40 of 183) were TB-LAM-positive and 4.4% (6 of 135) were Ultra-positive. Mortality trended higher in those with evidence of disseminated TB by either assay (odds ratio = 1.44; 95% CI, 0.83-2.49; P = .19) and was 6-fold higher in those with definite TB meningitis who were urine Ultra-positive (odds ratio = 5.67; 95% CI, 1.13-28.5; P = .04). Conclusions. In hospitalized Ugandans with advanced HIV disease and suspected meningitis, systematic screening with urine TB-LAM and Ultra found a high prevalence of urine TB test positivity (26%). In those with TB meningitis, urine tests were positive in over one third. There was little concordance between Ultra and TB-LAM, which warrants further investigation.
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