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    Apr 11, 2021
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    Disseminated Tuberculosis Among Hospitalised HIV Patients in South Africa: A Common Condition that Can Be Rapidly Diagnosed Using Urine-Based Assays

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    Kerkhoff A et al - 2017 - ...
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    Authors
    Kerkhoff, A
    Barr, D
    Schutz, C
    Burton, R
    Nicol, M
    Lawn, S
    Meintjes, G
    Issue Date
    2017-09-07
    Submitted date
    2017-09-12
    
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    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
    URI
    http://hdl.handle.net/10144/619021
    DOI
    10.1038/s41598-017-09895-7
    PubMed ID
    28883510
    Language
    en
    ISSN
    2045-2322
    ae974a485f413a2113503eed53cd6c53
    10.1038/s41598-017-09895-7
    Scopus Count
    Collections
    TB

    entitlement

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