结核病诊断挑战中的一项突破：在埃塞俄比亚哈瓦萨大学综合专科医院，对一部分人类免疫缺陷病毒（HIV）患者采用侧向流动尿液脂阿拉伯甘露聚糖（LAM）检测法诊断活动性结核病
A Breakthrough in the Challenges of Tuberculosis Diagnosis: Lateral Flow Urine Lipoarabinomannan (LAM) Assay for the Diagnosis of Active Tuberculosis in a Subset of Human Immuno Deficiency Virus (HIV) Patients at Hawassa University Comprehensive Specialized Hospital, Hawassa, Ethiopia.
作者信息
Ketema Worku, Woubishet Kindie, Tesfaye Sisay, Gutema Selamawit, Taye Kefyalew, Shibeshi Mulugeta Sitot, Tagesse Negash
机构信息
Department of Pediatrics and Child Health, College of Health Sciences, Hawassa University, Hawassa, Sidama, Ethiopia.
Department of Internal Medicine, College of Health Sciences, Hawassa University, Hawassa, Sidama, Ethiopia.
出版信息
Int Med Case Rep J. 2022 Aug 2;15:393-397. doi: 10.2147/IMCRJ.S373197. eCollection 2022.
BACKGROUND
Tuberculosis is commonly detected late or not at all in HIV-positive people. Rapid and sensitive molecular tests like Gene X-pert have recently become available to replace or supplement existing conventional tests for detecting tuberculosis, and the World Health Organization (WHO) recommends that these rapid techniques be used as the initial diagnostic test for tuberculosis to avoid delays in starting appropriate treatment. The lipoarabinomannan was approved by the national ministry of health in August 2021 for the detection of active tuberculosis in specified groups.
CASE SUMMARY
It is not uncommon for tuberculosis to be difficult to diagnose in this population, and we believe that our experiences with urine lipoarabinomannan for the detection of active tuberculosis will benefit other clinicians and, ultimately, patients. We discussed the experiences of two human immunodeficiency virus (HIV) patients with putative active tuberculosis, whose tuberculosis workups were negative by conventional methods, including gene expert but found to be positive by urine lipoarabinomannan and who were started on anti-tuberculosis medicines and improved. They are now in a good condition and are taking their medications regularly without any problems.
CONCLUSION
Ending the suffering of HIV patients necessitates lobbying for more accurate tuberculosis diagnosis. The urine Lipoarabinomannan (LAM) assay will address the shortcomings of traditional sputum-based diagnostic tests including sputum Acid Fast Bacilli (AFB) and Gene X-pert, making it a credible alternative for diagnosing tuberculosis in people with HIV. The results of this case series demonstrated that TB LAM is a milestone for the difficulties in TB diagnosis in HIV patients. As of now, the national guideline only suggests urine LAM for HIV patients who fulfill the set criteria. We recommend the stakeholders to increase the availability, and extrapolate the recommendation to other populations including non-HIV patients.
背景
在艾滋病毒呈阳性的人群中，结核病通常发现较晚或根本未被发现。像Gene X-pert这样快速且灵敏的分子检测方法最近已可用于替代或补充现有的检测结核病的传统方法，世界卫生组织（WHO）建议将这些快速技术用作结核病的初始诊断检测，以避免在开始适当治疗方面出现延误。脂阿拉伯甘露聚糖于2021年8月被国家卫生部批准用于特定人群中活动性结核病的检测。
病例摘要
在这一人群中，结核病难以诊断的情况并不少见，我们相信我们使用尿脂阿拉伯甘露聚糖检测活动性结核病的经验将使其他临床医生受益，并最终使患者受益。我们讨论了两名疑似患有活动性结核病的人类免疫缺陷病毒（HIV）患者的经验，他们的结核病检查通过包括基因专家检测在内的传统方法均为阴性，但尿脂阿拉伯甘露聚糖检测呈阳性，随后他们开始接受抗结核药物治疗并有所好转。他们现在状况良好，正在定期服药，没有任何问题。
结论
要结束艾滋病毒患者的痛苦，就必须争取更准确的结核病诊断。尿脂阿拉伯甘露聚糖（LAM）检测将弥补传统痰基诊断检测（包括痰涂片抗酸杆菌（AFB）和Gene X-pert）的不足，使其成为诊断艾滋病毒感染者结核病的可靠替代方法。该病例系列结果表明，结核LAM检测是解决艾滋病毒患者结核病诊断难题的一个里程碑。截至目前，国家指南仅建议对符合既定标准的艾滋病毒患者进行尿LAM检测。我们建议相关利益方提高其可及性，并将该建议推广至包括非艾滋病毒患者在内的其他人群。
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