Comparative Analysis of Diagnostic Methods for Tuberculosis in an HIV-Positive Patient with Acute Respiratory Failure
DOI:
https://doi.org/10.57125/FEM.2024.12.30.04Keywords:
Tuberculosis, HIV, acute respiratory failure, TB LAM, GeneXpertAbstract
Aims: To compare the diagnostic utility of TB LAM testing against the gold standard BAL with GeneXpert in a critically ill patient with advanced HIV.
Methodology: A case report of a 28-year-old man with severe respiratory distress, confirmed HIV (CD4 count of 12 cells/cc³), and negative TB LAM test. Initial treatments included caspofungin, ampicillin-sulbactam, and cotrimoxazole forte. Imaging showed alveolar consolidations, and blood cultures were negative.
Results: Notwithstanding the application of empirically validated therapeutic interventions targeting tuberculosis (TB), fungal infections, and Pneumocystis jirovecii, the patient's clinical status progressively deteriorated, culminating in fatality.
Scientific Novelty: This case highlighted the need for combining urine LAM testing with GeneXpert for accurate TB diagnosis in advanced HIV patients.
Conclusion: GeneXpert is essential for confirming TB and rifampicin resistance, while urine LAM should be complemented with additional tests when clinical suspicion remains high. Incorporating these assessments elevates diagnostic precision and improves patient prognoses.
References
Farfán-Cano GG, Farfán-Cano SG, Farfán-Cano HR, Silva-Rojas GA, Loor-Parada WF, Silva-Rojas KJ. Approach to the diagnosis of pulmonary opportunistic infections in adults with AIDS. IAJMH [Internet]. 2021 Feb 7 [cited 2024 Apr 12];4. Available from: https://iajmh.com/iajmh/article/view/169
Farfán-Cano GG, Farfán-Cano SG, Farfán-Cano HR, Silva-Rojas GA. HIV-associated opportunistic infections. Ciencia Ecuador [Internet]. 2022 Oct 5 [cited 2024 Apr 12];4(4):1–8. Available from: https://cienciaecuador.com.ec/index.php/ojs/article/view/71
UNAIDS. Tuberculosis and HIV [Internet]. Geneva: UNAIDS; S.F. p. 1–12. (Tuberculosis and HIV). Available from: https://www.unaids.org/sites/default/files/media_asset/tb-and-hiv_en.pdf
OMS. HIV and Tuberculosis [Internet]. World Health Organization. 2021 [cited 2024 May 28]. Available from: https://www.who.int/westernpacific/health-topics/hiv-aids/hiv-and-tuberculosis
Huerga H, Mathabire Rucker SC, Bastard M, Mpunga J, Amoros Quiles I, Kabaghe C, Sannino L, Szumilin E. Urine Lipoarabinomannan Testing for All HIV Patients Hospitalized in Medical Wards Identifies a Large Proportion of Patients With Tuberculosis at Risk of Death. Open Forum Infectious Diseases [Internet]. 2021 Feb 1 [cited 2024 May 23];8(2):ofaa639. Available from: https://academic.oup.com/ofid/article/doi/10.1093/ofid/ofaa639/6046201
Mthiyane T, Peter J, Allen J, Connolly C, Davids M, Rustomjee R, Holtz TH, Malinga L, Dheda K. Urine lipoarabinomannan (LAM) and antimicrobial usage in seriously-ill HIV-infected patients with sputum smear-negative pulmonary tuberculosis. J Thorac Dis [Internet]. 2019 Aug [cited 2024 May 23];11(8):3505–14. Available from: http://jtd.amegroups.com/article/view/31140/22081
OMS, OPS. WHO Consolidated guidelines on tuberculosis. Module 3: Diagnosis. Rapid diagnostic methods for the detection of tuberculosis, 2020. [Internet]. 2020th ed. Vol. 1. Pan American Health Organization; 2020 [cited 2024 May 17]. Available from: https://iris.paho.org/handle/10665.2/55926
Alencastro Placencia SA, Encalada Moreira EG. Prevalence of opportunistic pathogens causing neuroinfection in patients with HIV/AIDS at Hospital General Guasmo Sur, period 2018-2021. [Internet] [Tesis de Grado]. [Guayaquil, Ecuador]: Universidad Católica de Santiago de Guayaquil; 2022. Available from: http://repositorio.ucsg.edu.ec/bitstream/3317/19907/1/T-UCSG-PRE-MED-1394.pdf
ABBOT. Determine TB LAM [Internet]. [cited 2024 May 17]. Available from: https://www.globalpointofcare.abbott/co/es/product-details/determine-tb-lam.html
OMS. Tuberculosis diagnosis Xpert MTB/Rif® [Internet]. OMS; 2014. Available from: https://www3.paho.org/hq/dmdocuments/2014/2014-hoja-informativa-Diagnostico-tb-1.pdf
Esmail A, Pooran A, Sabur NF, Fadul M, Brar MS, Oelofse S, Tomasicchio M, Dheda K. An Optimal Diagnostic Strategy for Tuberculosis in Hospitalized HIV-Infected Patients Using GeneXpert MTB/RIF and Alere Determine TB LAM Ag. Land GA, editor. J Clin Microbiol [Internet]. 2020 Sep 22 [cited 2024 May 17];58(10):e01032-20. Available from: https://journals.asm.org/doi/10.1128/JCM.01032-20
Bjerrum S, Schiller I, Dendukuri N, Kohli M, Nathavitharana RR, Zwerling AA, Denkinger CM, Steingart KR, Shah M. Lateral flow urine lipoarabinomannan assay for detecting active tuberculosis in people living with HIV. Cochrane Infectious Diseases Group, editor. Cochrane Database of Systematic Reviews [Internet]. 2019 Oct 21 [cited 2024 May 22];2019(10). Available from: https://doi.wiley.com/10.1002/14651858.CD011420.pub3
Åhsberg J, Tersbøl BP, Puplampu P, Kwashie A, Commey JO, Adusi-Poku Y, Moseholm E, Andersen ÅB, Kenu E, Lartey M, Johansen IS, Bjerrum S. Use of the urine Determine LAM test in the context of tuberculosis diagnosis among inpatients with HIV in Ghana: a mixed methods study. Front Public Health [Internet]. 2024 Jan 5 [cited 2024 May 17];11:1271763. Available from: https://www.frontiersin.org/articles/10.3389/fpubh.2023.1271763/full
WHO. Practical application of the Lateral Flow Immunochromatographic Urine Lipoarabinomannan Assay (LAM-ICL) for the detection of active tuberculosis in HIV-positive individuals [Internet]. Organización Mundial de la Salud; 2021. Available from: https://iris.paho.org/handle/10665.2/55189
Shah M, Hanrahan C, Wang ZY, Dendukuri N, Lawn SD, Denkinger CM, Steingart KR. Lateral flow urine lipoarabinomannan assay for detecting active tuberculosis in HIV-positive adults. Cochrane Infectious Diseases Group, editor. Cochrane Database of Systematic Reviews [Internet]. 2016 May 10 [cited 2024 May 22]; Available from: https://doi.wiley.com/10.1002/14651858.CD011420.pub2
Tlali M, Fielding KL, Karat AS, Hoffmann CJ, Muravha T, Grant AD, Charalambous S. Sensitivity of the lateral flow urine lipoarabinomannan assay in ambulant adults with advanced HIV disease: data from the TB Fast Track study. Transactions of The Royal Society of Tropical Medicine and Hygiene [Internet]. 2020 Aug 1 [cited 2024 May 22];114(8):556–60. Available from: https://academic.oup.com/trstmh/article/114/8/556/5822891
Shah M, Ssengooba W, Armstrong D, Nakiyingi L, Holshouser M, Ellner JJ, Joloba M, Manabe YC, Dorman SE. Comparative performance of urinary lipoarabinomannan assays and Xpert MTB/RIF in HIV-infected individuals. AIDS [Internet]. 2014 Jun 1 [cited 2024 May 22];28(9):1307–14. Available from: https://journals.lww.com/00002030-201406010-00008
Gao M, Wu Q, Wang X, Sun X, Li M, Bai G. Advancements in LAM-based diagnostic kit for tuberculosis detection: enhancing TB diagnosis in HIV-negative individuals. Front Microbiol [Internet]. 2024 Feb 20 [cited 2024 May 22];15:1367092. Available from: https://www.frontiersin.org/articles/10.3389/fmicb.2024.1367092/full
Bjerrum S, Åhsberg J, Szekely R, Opintan J, Lartey M, Shah M, Mitarai S, Broger T, Ruhwald M, Johansen IS. Diagnostic Accuracy of Urine Lipoarabinomannan Testing in Early Morning Urine versus Spot Urine for Diagnosis of Tuberculosis among People with HIV. Asempa TE, editor. Microbiol Spectr [Internet]. 2022 Apr 27 [cited 2024 May 22];10(2):e00208-22. Available from: https://journals.asm.org/doi/10.1128/spectrum.00208-22
Amaya, Contrera M, Arrieta F, Montano A, Pírez C. Performance of GeneXpert in the diagnosis of pulmonary and extrapulmonary tuberculosis in the paediatric age group. Arch Pediatr Urug [Internet]. 2020 Dec [cited 2024 May 17];91(S2):S12–23. Available from: http://www.scielo.edu.uy/scielo.php?script=sci_arttext&pid=S1688-12492020000800012
Ministerio de Salud, Gobierno de Chile. Operational Manual Implementation of GeneXpert MTB/RIF in the Tuberculosis Programme, Tuberculosis Control and Elimination Programme 2017 [Internet]. 2017th ed. Chile: Ministerio de Salud; 2017. 25 p. Available from: https://diprece.minsal.cl/wrdprss_minsal/wp-content/uploads/2018/02/2018.01.23_MANUAL-XPERT.pdf
Msp. Protocol for the Clinical Use of Real-Time PCR (GeneXpert) [Internet]. Ministerio de Salud Pública Zona 9; n.d. Available from: https://enlace.17d07.mspz9.gob.ec/biblioteca/vigi/MANUALES/DECRETOS%20DE%20TB/protocolo%20genexpert.pdf
Xpert® MTB/RIF Ultra [Internet]. [cited 2024 May 22]. Available from: https://www.cepheid.com/es-ES/tests/tb-emerging-infectious-diseases/xpert-mtb-rif-ultra.html
Rigouts L, Keysers J, Rabab R, Fissette K, Van Deun A, De Jong BC. GeneXpert MTB/RIF Ultra performance to detect uncommon rpoB mutations in Mycobacterium tuberculosis. BMC Res Notes [Internet]. 2023 Jul 14 [cited 2024 May 17];16(1):146. Available from: https://bmcresnotes.biomedcentral.com/articles/10.1186/s13104-023-06394-z
Zhao J, Pu D, Zhang Y, Qu J, Lu B, Cao B. Comparison of Performances of GeneXpert MTB/RIF, Bactec MGIT 960, and Bactec Myco/F Systems in Detecting Mycobacterium tuberculosis in Biopsy Tissues: a Retrospective Study. Wesley Long S, editor. Microbiol Spectr [Internet]. 2023 Jun 15 [cited 2024 May 17];11(3):e01414-22. Available from: https://journals.asm.org/doi/10.1128/spectrum.01414-22
Drain PK, Losina E, Coleman SM, Giddy J, Ross D, Katz JN, Bassett IV. Value of Urine Lipoarabinomannan Grade and Second Test for Optimizing Clinic-Based Screening for HIV-Associated Pulmonary Tuberculosis. JAIDS Journal of Acquired Immune Deficiency Syndromes [Internet]. 2015 Mar 1 [cited 2024 May 22];68(3):274–80. Available from: https://journals.lww.com/00126334-201503010-00005
Gupta-Wright A, Peters JA, Flach C, Lawn SD. Detection of lipoarabinomannan (LAM) in urine is an independent predictor of mortality risk in patients receiving treatment for HIV-associated tuberculosis in sub-Saharan Africa: a systematic review and meta-analysis. BMC Med [Internet]. 2016 Dec [cited 2024 May 22];14(1):53. Available from: http://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-016-0603-9
Andama A, Jaganath D, Crowder R, Asege L, Nakaye M, Katumba D, Mwebe S, Semitala F, Worodria W, Joloba M, Mohanty S, Somoskovi A, Cattamanchi A. Accuracy and incremental yield of urine Xpert MTB/RIF Ultra versus Determine TB-LAM for diagnosis of pulmonary tuberculosis. Diagnostic Microbiology and Infectious Disease [Internet]. 2020 Jan [cited 2024 May 22];96(1):114892. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0732889319305061
Dhana A, Hamada Y, Kengne AP, Kerkhoff AD, Rangaka MX, Kredo T, Baddeley A, Miller C, Gupta-Wright A, Fielding K, Wood R, Huerga H, Rücker SCM, Heidebrecht C, Wilson D, Bjerrum S, Johansen IS, Thit SS, Kyi MM, Hanson J, Barr DA, Meintjes G, Maartens G. Tuberculosis screening among HIV-positive inpatients: a systematic review and individual participant data meta-analysis. The Lancet HIV [Internet]. 2022 Apr [cited 2024 May 22];9(4):e233–41. Available from: https://linkinghub.elsevier.com/retrieve/pii/S2352301822000029
Simieneh A, Tadesse M, Kebede W, Gashaw M, Abebe G. Combination of Xpert® MTB/RIF and DetermineTM TB-LAM Ag improves the diagnosis of extrapulmonary tuberculosis at Jimma University Medical Center, Oromia, Ethiopia. Anupurba S, editor. PLoS ONE [Internet]. 2022 Feb 3 [cited 2024 May 22];17(2):e0263172. Available from: https://dx.plos.org/10.1371/journal.pone.0263172
García-Basteiro AL, DiNardo A, Saavedra B, Silva DR, Palmero D, Gegia M, Migliori GB, Duarte R, Mambuque E, Centis R, Cuevas LE, Izco S, Theron G. Point of care diagnostics for tuberculosis. Pulmonology [Internet]. 2018 Mar [cited 2024 May 22];24(2):73–85. Available from: https://linkinghub.elsevier.com/retrieve/pii/S2173511517301835
Balcha TT, Winqvist N, Sturegård E, Skogmar S, Reepalu A, Jemal ZH, Tibesso G, Schön T, Björkman P. Detection of lipoarabinomannan in urine for identification of active tuberculosis among HIV ‐positive adults in E thiopian health centres. Tropical Med Int Health [Internet]. 2014 Jun [cited 2024 May 22];19(6):734–42. Available from: https://onlinelibrary.wiley.com/doi/10.1111/tmi.12308
Nakiyingi L, Moodley VM, Manabe YC, Nicol MP, Holshouser M, Armstrong DT, Zemanay W, Sikhondze W, Mbabazi O, Nonyane BAS, Shah M, Joloba ML, Alland D, Ellner JJ, Dorman SE. Diagnostic Accuracy of a Rapid Urine Lipoarabinomannan Test for Tuberculosis in HIV-Infected Adults. JAIDS Journal of Acquired Immune Deficiency Syndromes [Internet]. 2014 Jul 1 [cited 2024 May 22];66(3):270–9. Available from: https://journals.lww.com/00126334-201407010-00005
Drain PK, Losina E, Coleman SM, Giddy J, Ross D, Katz JN, Walensky RP, Freedberg KA, Bassett IV. Diagnostic accuracy of a point-of-care urine test for tuberculosis screening among newly-diagnosed hiv-infected adults: a prospective, clinic-based study. BMC Infect Dis [Internet]. 2014 Dec [cited 2024 May 22];14(1):110. Available from: https://bmcinfectdis.biomedcentral.com/articles/10.1186/1471-2334-14-110
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