Disseminated Tuberculosis Among Hospitalised HIV Patients in South Africa: A Common Condition that Can Be Rapidly Diagnosed Using Urine-Based Assays

Hdl Handle:
http://hdl.handle.net/10144/619021
Title:
Disseminated Tuberculosis Among Hospitalised HIV Patients in South Africa: A Common Condition that Can Be Rapidly Diagnosed Using Urine-Based Assays
Authors:
Kerkhoff, A; Barr, D; Schutz, C; Burton, R; Nicol, M; Lawn, S; Meintjes, G
Journal:
Scientific Reports
Abstract:
HIV-associated disseminated TB (tuberculosis) has been under-recognised and poorly characterised. Blood culture is the gold-standard diagnostic test, but is expensive, slow, and may under-diagnose TB dissemination. In a cohort of hospitalised HIV patients, we aimed to report the prevalence of TB-blood-culture positivity, performance of rapid diagnostics as diagnostic surrogates, and better characterise the clinical phenotype of disseminated TB. HIV-inpatients were systematically investigated using sputum, urine and blood testing. Overall, 132/410 (32.2%) patients had confirmed TB; 41/132 (31.1%) had a positive TB blood culture, of these 9/41 (22.0%) died within 90-days. In contrast to sputum diagnostics, urine Xpert and urine-lipoarabinomannan (LAM) combined identified 88% of TB blood-culture-positive patients, including 9/9 who died within 90-days. For confirmed-TB patients, half the variation in major clinical variables was captured on two principle components (PCs). Urine Xpert, urine LAM and TB-blood-culture positive patients clustered similarly on these axes, distinctly from patients with localised disease. Total number of positive tests from urine Xpert, urine LAM and MTB-blood-culture correlated with PCs (p < 0.001 for both). PC1&PC2 independently predicted 90-day mortality (ORs 2.6, 95%CI = 1.3-6.4; and 2.4, 95%CI = 1.3-4.5, respectively). Rather than being a non-specific diagnosis, disseminated TB is a distinct, life-threatening condition, which can be diagnosed using rapid urine-based tests, and warrants specific interventional trials.
Publisher:
Nature Publishing Group
Issue Date:
7-Sep-2017
URI:
http://hdl.handle.net/10144/619021
DOI:
10.1038/s41598-017-09895-7
PubMed ID:
28883510
Submitted date:
2017-09-12
Language:
en
ISSN:
2045-2322
Appears in Collections:
TB

Full metadata record

DC FieldValue Language
dc.contributor.authorKerkhoff, Aen
dc.contributor.authorBarr, Den
dc.contributor.authorSchutz, Cen
dc.contributor.authorBurton, Ren
dc.contributor.authorNicol, Men
dc.contributor.authorLawn, Sen
dc.contributor.authorMeintjes, Gen
dc.date.accessioned2017-09-22T14:27:46Z-
dc.date.available2017-09-22T14:27:46Z-
dc.date.issued2017-09-07-
dc.date.submitted2017-09-12-
dc.identifier.citationDisseminated Tuberculosis Among Hospitalised HIV Patients in South Africa: A Common Condition that Can Be Rapidly Diagnosed Using Urine-Based Assays. 2017, 7 (1):10931 Sci Repen
dc.identifier.issn2045-2322-
dc.identifier.pmid28883510-
dc.identifier.doi10.1038/s41598-017-09895-7-
dc.identifier.urihttp://hdl.handle.net/10144/619021-
dc.description.abstractHIV-associated disseminated TB (tuberculosis) has been under-recognised and poorly characterised. Blood culture is the gold-standard diagnostic test, but is expensive, slow, and may under-diagnose TB dissemination. In a cohort of hospitalised HIV patients, we aimed to report the prevalence of TB-blood-culture positivity, performance of rapid diagnostics as diagnostic surrogates, and better characterise the clinical phenotype of disseminated TB. HIV-inpatients were systematically investigated using sputum, urine and blood testing. Overall, 132/410 (32.2%) patients had confirmed TB; 41/132 (31.1%) had a positive TB blood culture, of these 9/41 (22.0%) died within 90-days. In contrast to sputum diagnostics, urine Xpert and urine-lipoarabinomannan (LAM) combined identified 88% of TB blood-culture-positive patients, including 9/9 who died within 90-days. For confirmed-TB patients, half the variation in major clinical variables was captured on two principle components (PCs). Urine Xpert, urine LAM and TB-blood-culture positive patients clustered similarly on these axes, distinctly from patients with localised disease. Total number of positive tests from urine Xpert, urine LAM and MTB-blood-culture correlated with PCs (p < 0.001 for both). PC1&PC2 independently predicted 90-day mortality (ORs 2.6, 95%CI = 1.3-6.4; and 2.4, 95%CI = 1.3-4.5, respectively). Rather than being a non-specific diagnosis, disseminated TB is a distinct, life-threatening condition, which can be diagnosed using rapid urine-based tests, and warrants specific interventional trials.en
dc.language.isoenen
dc.publisherNature Publishing Groupen
dc.rightsArchived with thanks to Scientific Reportsen
dc.titleDisseminated Tuberculosis Among Hospitalised HIV Patients in South Africa: A Common Condition that Can Be Rapidly Diagnosed Using Urine-Based Assaysen
dc.identifier.journalScientific Reportsen
All Items in MSF are protected by copyright, with all rights reserved, unless otherwise indicated.