在乌干达患有晚期人类免疫缺陷病毒病且疑似脑膜炎的成年人中，采用结核脂阿拉伯甘露聚糖和Xpert MTB/RIF Ultra进行标准化尿液结核筛查。
Standardized Urine-Based Tuberculosis (TB) Screening With TB-Lipoarabinomannan and Xpert MTB/RIF Ultra in Ugandan Adults With Advanced Human Immunodeficiency Virus Disease and Suspected Meningitis.
作者信息
Cresswell Fiona V, Ellis Jayne, Kagimu Enock, Bangdiwala Ananta S, Okirwoth Michael, Mugumya Gerald, Rutakingirwa Morris, Kasibante John, Quinn Carson M, Ssebambulidde Kenneth, Rhein Joshua, Nuwagira Edwin, Tugume Lillian, Martyn Emily, Skipper Caleb P, Muzoora Conrad, Grint Daniel, Meya David B, Bahr Nathan C, Elliott Alison M, Boulware David R
机构信息
Infectious Diseases Institute, Makerere University, Kampala, Uganda.
Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom.
出版信息
Open Forum Infect Dis. 2020 Mar 24;7(4):ofaa100. doi: 10.1093/ofid/ofaa100. eCollection 2020 Apr.
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; = .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; = .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.
背景
肺外结核病（TB）的诊断仍然具有挑战性。我们试图通过对住院成人尿液进行结核分枝杆菌脂阿拉伯甘露聚糖（TB-LAM）侧向流动试验和Xpert MTB/RIF Ultra（Ultra）检测来确定播散性结核病的患病率。
方法
2018年至2020年期间，我们在乌干达前瞻性纳入了疑似脑膜炎的人类免疫缺陷病毒（HIV）阳性成人。参与者接受了标准化的基于尿液的结核病筛查。用TB-LAM（Alere）检测尿液（60微升），其余尿液离心，细胞沉淀重悬于2毫升尿液中用于Xpert Ultra检测。
结果
我们纳入了348例HIV阳性住院患者，中位CD4为37个细胞/微升（四分位间距，13 - 102个细胞/微升）。总体而言，26%（348例中的90例；95%置信区间[CI]，21% - 30%）通过任何一种尿液检测有播散性结核病的证据。在243例同时有尿液TB-LAM和Ultra检测结果的参与者中，20%（243例中的48例）为TB-LAM阳性，12%（243例中的29例）为Ultra阳性，6%（243例中的14例）两种检测均为阳性。在确诊和疑似结核性脑膜炎患者中，37%（38例中的14例）为TB-LAM阳性，41%（37例中的15例）为Ultra阳性。在隐球菌性脑膜炎患者中，22%（183例中的40例）为TB-LAM阳性，4.4%（135例中的6例）为Ultra阳性。通过任何一种检测有播散性结核病证据的患者死亡率有升高趋势（优势比 = 1.44；95% CI，0.83 - 2.49；P = 0.19），而确诊为结核性脑膜炎且尿液Ultra阳性的患者死亡率高出6倍（优势比 = 5.67；95% CI，1.13 - 28.5；P = 0.04）。
结论
在患有晚期HIV疾病且疑似脑膜炎的乌干达住院患者中，用尿液TB-LAM和Ultra进行系统筛查发现尿液结核病检测阳性率很高（26%）。在结核性脑膜炎患者中，超过三分之一的尿液检测呈阳性。Ultra和TB-LAM之间几乎没有一致性，这值得进一步研究。
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