TITLE:
Significant Improvement in Tuberculosis Diagnosis by Detection of the Wall Lipoarabinomannan from Mycobacterium tuberculosis in Central African Republic (CAR)
AUTHORS:
Christian Diamant Mossoro-Kpinde, Honorat Nouzoukem, Marcel Mbeko Simaleko, Nina Esther Ngoyi Ontsira, Hermione Dahlia Mossoro-Kpinde, Irenee Galendji, Henri Diemer, Gérard Grésenguet
KEYWORDS:
Tuberculosis Diagnosis, TB-LAM, Acid-Fast Bacilli Microscopy, HIV/AIDS, Central African Republic
JOURNAL NAME:
Open Journal of Medical Microbiology,
Vol.12 No.3,
August
15,
2022
ABSTRACT: Background and Objective: Tuberculosis is one
of the leading causes of morbi-mortality, especially in developing countries,
due to delayed diagnosis and management. The goal of this study is to assess
the contribution of lipoarabinomannan (LAM) in improving tuberculosis (TB) diagnosis
in the Central African Republic (C.A.R.). Methods: We conducted a
retrospective study at the Regional University Hospital of Bria. The records of
patients hospitalized, tested by Determine® TB LAM Ag (Alere,
Medical Co, LTD, Chiba, Japan) immunochromatographic
test for the detection of LAM in urine, associated or not with acid-fast
bacilli (AFB) research by Ziehl-Neelsen stain, were selected from August
to October 2020. Results: During this study, 152 files were selected.
Among them, there were 50.0% of children aged 14 or less (≤14 years: 33.6% + 16.4%) and 50.0% of adults represented. Patients living in the displaced
person camp represented a larger group (65.1%) than those in the other 2 sites.
There were seventy-four patients (i.e. 48.7%) who did not benefit from screening for AFB. For the other seventy-eight (i.e. 51.3%), there were 17.1% positive results for the search of AFB. However, among
the 152 patients, there was a positive HIV serology in 30.9% of cases (i.e. 47 out of 152) and a positive Determine® TB LAM Ag in 38.2% of cases (i.e. 58 out of 152). It appears that
Determine® TB LAM Ag was significantly more able to diagnose tuberculosis than AFB (p 0.003). The 58 patients diagnosed with TB LAM included 20 children who
could not provide sputum and HIV-infected
patients (p 0.03). Conclusion: The results of this study showed that the microscopy for AFB made it possible to make the diagnosis
of tuberculosis in 17.1% of patients against 38.2% for the Alere Determine® TB LAM Ag test. This result highlights the need for routine use of LAM
detection to improve the diagnosis of tuberculosis. The conduct of a subsequent
study combining Xpert MTB/RIF would improve the diagnosis of tuberculosis using
all 3 tests.