Urinary Lipoarabinomannan (LAM) in HIV sero-negative miliary tuberculosis patients

Tuberculosis (TB) is the leading cause of death from infectious diseases worldwide next to COVID. Miliary presentation is a form of TB that can cause 100% mortality without treatment. Due to lack of a gold standard test, a systematic approach of high index of clinical suspicion and efforts at demonstrating Mycobacterium tuberculosis is imperative to early treatment initiation and mortality reduction. This study is designed to find the diagnostic value of urinary LAM using cage nanotechnology a new class of sandwich ELISA technique in HIV sero-negative miliary PTB patients.

This is a case-control study done in a tertiary care hospital. Fifty HIV sero-negative patients with clinical presentation of miliary TB and fifty asymptomatic individuals as controls were enrolled. Mean urinary LAM value among the miliary TB patients was 1.82 ± 0.45 mg/L and control group was 0.48 ± 0.18 mg/L. Miliary TB patients had urinary LAM sensitivity and specificity of 98% and 96%.

The patients with urinary LAM values between 0.48 and 1.88 mg/L are most likely to have miliary TB. Patients with urinary LAM value of >1.88 mg/L will be likely to have microbiologically confirmed miliary TB and urinary LAM values less than 0.48 mg/L are less likely to have microbiologically confirmed miliary TB.