Disseminated tuberculosis among hospitalised HIV patients in South Africa: a common condition that can be rapidly diagnosed using urine-based assays
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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DOI：
10.1038/s41598-017-09895-7
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发表时间：
2017-09-07
影响因子：
4.6
通讯作者：
Meintjes, Graeme
中科院分区：
文献类型：
--
作者：
Kerkhoff, Andrew D.;Barr, David A.;Meintjes, Graeme
艾滋病毒相关的播散性结核病（结核病）一直未得到充分认识和描述。血培养是金标准诊断试验，但昂贵、缓慢，并且可能低估结核病传播。在一组住院的HIV患者中，我们的目的是报告TB血培养阳性的患病率，快速诊断作为诊断替代品的性能，以及更好地确定播散性TB的临床表型。通过痰、尿和血液检测对HIV住院患者进行系统调查。总体而言，132/410（32.2%）例患者确诊为TB; 41/132（31.1%）例患者的TB血培养阳性，其中9/41（22.0%）例患者在90天内死亡。与痰液诊断相反，尿液Xpert和尿液-脂阿拉伯甘露聚糖（LAM）联合鉴定了88%的TB血培养阳性患者，包括9/9名在90天内死亡的患者。对于确诊的结核病患者，主要临床变量的一半变化是由两个主成分（PC）捕获的。尿液Xpert、尿液LAM和TB血培养阳性患者在这些轴上相似地聚集，与局部疾病患者不同。来自尿液Xpert、尿液LAM和MTB血培养的阳性检测总数与PC相关（两者p < 0.001）。PC 1和PC 2独立预测90天死亡率（OR分别为2.6，95%CI = 1.3-6.4和2.4，95%CI = 1.3-4.5）。播散性结核病不是一种非特异性诊断，而是一种独特的、危及生命的疾病，可以使用快速尿液检测进行诊断，并需要进行特定的干预性试验。
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.