Is Urinary Lipoarabinomannan the Result of Renal Tuberculosis? Assessment of the Renal Histology in an Autopsy Cohort of Ugandan HIV-Infected Adults.
Is Urinary Lipoarabinomannan the Result of Renal Tuberculosis? Assessment of the Renal Histology in an Autopsy Cohort of Ugandan HIV-Infected Adults.
复制标题
DOI：
10.1371/journal.pone.0123323
复制
发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Manabe YC
中科院分区：
文献类型：
--
作者：
Cox JA;Lukande RL;Kalungi S;Van Marck E;Van de Vijver K;Kambugu A;Nelson AM;Colebunders R;Manabe YC
尿阿拉伯糖甘露聚糖脂（LAM），分枝杆菌细胞壁成分的检测，用于诊断结核病（TB）。LAM如何进入尿液尚不清楚。为了研究尿LAM阳性是否是肾结核感染的结果，我们在乌干达住院的HIV感染成人尸检队列中将尿LAM抗原检测结果与肾组织学结果相关联。我们进行了一个完整的尸检，包括肾脏采样，在艾滋病毒感染的成年人，在住院期间死亡后，从最近的亲属获得书面知情同意书。通过死后导尿或通过膀胱穿刺收集死后尿液，并用侧向流测定法（LFA）和ELISA测定法检测LAM。两名病理学家评估了肾脏组织学。我们将LAM测定结果与组织学结果相关联。在尿LAM ELISA和/或LFA阳性的13/36（36%）例患者中，8/13（62%）例患者患有肾结核。其余5例LAM阳性患者为播散性结核，无肾脏受累。在23例LAM阴性患者中，3例为播散性结核，无肾脏受累。其余的LAM阴性患者没有结核感染，主要死于真菌和细菌感染。LAM LFA诊断任何部位结核病的敏感性为81%，特异性为100%，LAM ELISA的敏感性为63%，特异性为100%。54%（7/13）的LAM LFA阳性患者在死亡时未接受抗结核治疗。肾结核感染解释了大多数患者的LAM阳性。无肾脏受累的播散性结核病患者也可诊断为LAM。这表明在少数患者中存在导致尿LAM阳性的其他机制。
The detection of urinary lipoarabinomannan (LAM), a mycobacterial cell wall component, is used to diagnose tuberculosis (TB). How LAM enters the urine is not known. To investigate if urinary LAM-positivity is the result of renal TB infection we correlated the outcomes of urinary LAM-antigen testing to renal histology in an autopsy cohort of hospitalized, Ugandan, HIV-infected adults. We performed a complete autopsy, including renal sampling, in HIV-infected adults that died during hospitalization after written informed consent was obtained from the next of kin. Urine was collected postmortem through post-mortem catheterisation or by bladder puncture and tested for LAM with both a lateral flow assay (LFA) and an ELISA assay. Two pathologists assessed the kidney histology. We correlated the LAM-assay results and the histology findings. Of the 13/36 (36%) patients with a positive urinary LAM ELISA and/or LFA, 8/13 (62%) had renal TB. The remaining 5 LAM-positive patients had disseminated TB without renal involvement. Of the 23 LAM-negative patients, 3 had disseminated TB without renal involvement. The remaining LAM-negative patients had no TB infection and died mostly of fungal and bacterial infections. LAM LFA had a sensitivity of 81% and specificity of 100% to diagnose TB at any location, and the LAM ELISA a sensitivity of 63% and a specificity of 100%. 54% (7/13) LAM LFA-positive patients were not on anti-TB treatment at the time of death. Renal TB infection explained LAM-positivity in the majority of patients. Patients with disseminated TB without renal involvement can also be diagnosed with LAM. This suggests that other mechanisms that lead to urinary LAM-positivity exist in a minority of patients.
登录
查看更多内容
DOI：
10.1097/qai.0b013e3181b98430
发表时间：
2009-10-01
影响因子：
3.6
作者：
Shah, Maunank;Variava, Ebrahim;Martinson, Neil A.
通讯作者：
Martinson, Neil A.
影响因子：
9.4
作者：
Shah, Maunank;Martinson, Neil A.;Dorman, Susan E.
通讯作者：
Dorman, Susan E.
影响因子：
--
作者：
Patel VB;Bhigjee AI;Paruk HF;Singh R;Meldau R;Connolly C;Ndung'u T;Dheda K
通讯作者：
Dheda K
影响因子：
3.7
作者：
Reither K;Saathoff E;Jung J;Minja LT;Kroidl I;Saad E;Huggett JF;Ntinginya EN;Maganga L;Maboko L;Hoelscher M
通讯作者：
Hoelscher M
HIV感染的住院患者的TB检测的尿液脂肪氨基氨基少量测试的诊断准确性。
DOI：
10.1183/09031936.00201711
发表时间：
2012-11
期刊：
The European respiratory journal
影响因子：
--
作者：
Peter JG;Theron G;van Zyl-Smit R;Haripersad A;Mottay L;Kraus S;Binder A;Meldau R;Hardy A;Dheda K
通讯作者：
Dheda K