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LETTER TO EDITOR
Year : 2019  |  Volume : 8  |  Issue : 4  |  Page : 413-414

Expected advantage of urine lipoarabinomannan for tuberculosis detection in human immunodeficiency virus-endemic setting


1 Sanitation 1 Medical Academic Center, Bangkok, Thailand
2 Department of Community Medicine, Dr. D.Y. Patil University, Pune, Maharashtra, India

Date of Submission15-Oct-2019
Date of Acceptance16-Oct-2019
Date of Web Publication26-Nov-2019

Correspondence Address:
Beuy Joob
Sanitation 1 Medical Academic Center, Bangkok
Thailand
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmy.ijmy_160_19

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How to cite this article:
Joob B, Wiwanitkit V. Expected advantage of urine lipoarabinomannan for tuberculosis detection in human immunodeficiency virus-endemic setting. Int J Mycobacteriol 2019;8:413-4

How to cite this URL:
Joob B, Wiwanitkit V. Expected advantage of urine lipoarabinomannan for tuberculosis detection in human immunodeficiency virus-endemic setting. Int J Mycobacteriol [serial online] 2019 [cited 2019 Dec 7];8:413-4. Available from: http://www.ijmyco.org/text.asp?2019/8/4/413/271479



Urine lipoarabinomannan is a new noninvasive laboratory investigation for the diagnosis of tuberculosis.[1] Basically, the lipoarabinomannan is a heat stable biomolecule of the outer cell wall of Mycobacterial organism. This biomolecule is excreted via urine of patients with tuberculosis, and it is proposed as a new biomarker for tuberculosis.[1] In a recent report from Egypt by Mourad et al., the usefulness of urine lipoarabinomannan test for tuberculosis detection was confirmed.[2] Recently, Suwanpimolkul et al. reported on the difference of the diagnostic properties of urine lipoarabinomannan test for patients with and without human immunodeficiency virus (HIV) infection.[3] Here, the authors reappraise on the report of using urine lipoarabinomannan for tuberculosis detection in Thailand, a tropical country which is a known HIV-endemic setting.

The authors developed a clinical mathematical model to assess the expected advantage of urine lipoarabinomannan for tuberculosis detection. The primary data on HIV detection using urine lipoarabinomannan for tuberculosis detection in the previous Thai report were reanalyzed.[3] The path probability analysis is used in the mathematical model calculation. The path probability is calculated by multiplication of detection rate in a path with specific chance in that path. The final estimated detection rate is derived from the summation of all path probabilities. Regarding the primary data, the detection rates for tuberculosis are equal to (16/43) 37.21% and 28.57% (2/7) for patients with and without HIV infection, respectively. The chance or rates of tuberculosis patients with and without HIV infection are equal to 86% and 14%, respectively. According to the path probability analysis [Table 1], the expected detection rate of urine lipoarabinomannan for tuberculosis detection is equal to 36%.
Table 1: Path probability analysis of urine lipoarabinomannan for tuberculosis detection

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Therefore, it can imply that the estimated detection rate of urine lipoarabinomannan for tuberculosis detection regardless of HIV infection background in our setting is equal to 36%. This can show that there is a limited advantage of urine lipoarabinomannan for tuberculosis detection in our setting. This finding is concordant with a previous report by Maes that the test is limited for field usage due to the restriction of use imposed and poor sensitivity.[4] In fact, the limitation of the test levels for differentiating HIV-associated tuberculosis patients is already mentioned in a previous report from Iran.[5] Similar to many new immunodiagnostic tests,[6],[7] the limitation of urine lipoarabinomannan can be hereby demonstrated. The standard diagnostic test for tuberculosis detection is still recommended.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Correia-Neves M, Fröberg G, Korshun L, Viegas S, Vaz P, Ramanlal N, et al. Biomarkers for tuberculosis: The case for lipoarabinomannan. ERJ Open Res 2019;5. pii: 00115-2018.  Back to cited text no. 1
    
2.
Mourad SM, Abdelwahab NH, Abdulla AA, ElDeeb MK, Ali MA. Diagnostic utility of urinary lipoarabinomannan in pulmonary tuberculosis. Egypt J Chest Dis Tuberc 2019;68:159-64.  Back to cited text no. 2
  [Full text]  
3.
Suwanpimolkul G, Kawkitinarong K, Manosuthi W, Sophonphan J, Gatechompol S, Ohata PJ, et al. Utility of urine lipoarabinomannan (LAM) in diagnosing tuberculosis and predicting mortality with and without HIV: Prospective TB cohort from the Thailand big city TB research network. Int J Infect Dis 2017;59:96-102.  Back to cited text no. 3
    
4.
Maes R. Evaluation of the therapeutic, diagnostic, and prognostic means currently applied to counter the surge of tuberculosis. Biomed Biotechnol Res J 2019;3:140-6.  Back to cited text no. 4
  [Full text]  
5.
Tabarsi P, Marjani M, Moniri A, Farnia P, Dizaji MK, Garssen J, et al. Investigation of urine lipoarabinomannan in human immunodeficiency virus patients with or without coinfection with tuberculosis in Iran. Int J Mycobacteriol 2016;5 Suppl 1:S186-7.  Back to cited text no. 5
    
6.
Hassanein HA, Elbadry MI. Selective immunoglobulin M deficiency in an adult with miliary tuberculosis: A clinically interesting coexistence. A case report and review of the literature. Int J Mycobacteriol 2016;5:106-10.  Back to cited text no. 6
  [Full text]  
7.
Patil S, Giribhattanavar P, Patil M, Kumar K. Immunoconfirmation of central nervous system tuberculosis by blotting: A study of 300 cases. Int J Mycobacteriol 2015;4:124-30.  Back to cited text no. 7
  [Full text]  



 
 
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