Urine Lipoarabinomannan Point-of-care Testing in Patients Affected by Pulmonary Nontuberculous Mycobacteria--experiences from the Danish Cystic Fibrosis Cohort Study

Overview

Journal BMC Infect Dis

Publisher Biomed Central

Specialty Infectious Diseases

Date 2014 Dec 5

PMID 25471640

Citations 13

Authors

Tavs Qvist

Isik S Johansen

Tania Pressler

Niels Hoiby

Aase B Andersen

Terese L Katzenstein

Stephanie Bjerrum

Affiliations

Soon will be listed here.

Abstract

Background: The urine lipoarabinomannan (LAM) strip test has been suggested as a new point-of-care test for active tuberculosis (TB) among human immunodeficiency virus (HIV) infected individuals. It has been questioned if infections with nontuberculous mycobacteria (NTM) affect assay specificity. We set forth to investigate if the test detects LAM in urine from a Danish cystic fibrosis (CF) population characterized by a high NTM prevalence and negligible TB exposure.

Method: Patients followed at the Copenhagen CF Center were comprehensively screened for pulmonary NTM infection between May 2012 and December 2013. Urine samples were tested for LAM using the 2013 Determine™ TB LAM Ag strip test.

Results: Three-hundred and six patients had a total of 3,322 respiratory samples cultured for NTM and 198 had urine collected (65%). A total of 23/198 (12%) had active pulmonary NTM infection. None had active TB. The TB-LAM test had an overall positive rate of 2.5% applying a grade 2 cut-point as positivity threshold, increasing to 10.6% (21/198) if a grade 1 cut-point was applied. Among patients with NTM infection 2/23 (8.7%) had a positive LAM test result at the grade 2 cut-point and 9/23 (39.1%) at the grade 1 cut -point. Test specificity for NTM diagnosis was 98.3% and 93.1 for grade 2 and 1 cut-point respectively.

Conclusions: This is the first study to assess urine LAM detection in patients with confirmed NTM infection. The study demonstrated low cross-reactivity due to NTM infection when using the recommended grade 2 cut-point as positivity threshold. This is reassuring in regards to interpretation of the LAM test for TB diagnosis in a TB prevalent setting. The test was not found suitable for NTM detection among patients with CF.

Citing Articles

Prospective Analysis of urINe LAM to Eliminate NTM Sputum Screening (PAINLESS) study: Rationale and trial design for testing urine lipoarabinomannan as a marker of NTM lung infection in cystic fibrosis.

Calhoun K, Armantrout E, Poch K, Caceres S, Lovell V, Jones M PLoS One. 2025; 20(3):e0309191.

PMID: 40063876 PMC: 11893114. DOI: 10.1371/journal.pone.0309191.

Parallel use of low-complexity automated nucleic acid amplification tests on respiratory samples and stool with or without lateral flow lipoarabinomannan assays to detect pulmonary tuberculosis disease in children.

Olbrich L, Kay A, Bjerrum S, Yang B, Ahsberg J, Nathavitharana R Cochrane Database Syst Rev. 2025; 5:CD016071.

PMID: 39908066 PMC: 11089514. DOI: 10.1002/14651858.CD016071.

Calhoun K, Armantrout E, Poch K, Caceres S, Lovell V, Jones M medRxiv. 2024; .

PMID: 39148848 PMC: 11326329. DOI: 10.1101/2024.08.08.24311698.

Prospective multicentre accuracy evaluation of the FUJIFILM SILVAMP TB LAM test for the diagnosis of tuberculosis in people living with HIV demonstrates lot-to-lot variability.

Szekely R, Sossen B, Mukoka M, Muyoyeta M, Nakabugo E, Hella J PLoS One. 2024; 19(5):e0303846.

PMID: 38820372 PMC: 11142480. DOI: 10.1371/journal.pone.0303846.

Collected Thoughts on Mycobacterial Lipoarabinomannan, a Cell Envelope Lipoglycan.

Torrelles J, Chatterjee D Pathogens. 2023; 12(11).

PMID: 38003746 PMC: 10675199. DOI: 10.3390/pathogens12111281.

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