利福布汀脂质阿拉伯甘露聚糖抗原检测（TB-LAM）在莫桑比克用于诊断严重急性营养不良的儿童肺结核。
Lipoarabinomannan Antigen Assay (TB-LAM) for Diagnosing Pulmonary Tuberculosis in Children with Severe Acute Malnutrition in Mozambique.
机构信息
Department of General Medicine, Macia Health Center, Gaza, Mozambique 0000.
Elizabeth Glaser Pediatric AIDS Foundation, Maputo, Mozambique 0000.
出版信息
J Trop Pediatr. 2021 Jul 2;67(3). doi: 10.1093/tropej/fmaa072.
BACKGROUND
Tuberculosis (TB) and malnutrition are important causes of morbidity and mortality in children in the developing world.
AIMS
To assess the prevalence of pulmonary TB in severely malnourished children and evaluate TB detection using the urine lipoarabinomannan antigen assay (TB-LAM).
METHODS
A retrospective analysis was conducted in all pediatric inpatients with severe acute malnutrition at a rural health center in Mozambique, from February to August 2018. All children underwent a physical examination and chest X-ray, and their nasopharyngeal aspirates and stool specimens were studied for mycobacterial culture and subjected to the Xpert MTB/RIF assay. TB-LAM tests were performed on urine.
RESULTS
Of 45 included cases, 17 (37.8%) were clinically diagnosed as pulmonary TB. None of these were detected by the Xpert MTB test; 4 (8.9%) nasopharyngeal aspirates were TB-culture positive. Seventeen patients (37.8%)-all clinically diagnosed with TB-tested positive on the TB-LAM, while 23 (51.1%) were negative. In 5 (11.1%), the urine LAM was not done.
CONCLUSION
Although our sample size was small, TB was diagnosed and treated in more than a third of included children. The urine TB-LAM test showed a perfect correlation with clinical diagnosis of childhood TB.
LAY SUMMARY
Severe acute malnutrition makes children more vulnerable to tuberculosis (TB) infections, but it is difficult to detect TB in children because they cannot always cough up phlegm, which is used in diagnostic processes. This study aimed to find out how many severely malnourished children had TB in Gaza, Mozambique, and to test the accuracy of a less-used diagnostic test: the lipoarabinomannan assay (TB-LAM). Of the 45 severely malnourished children who were admitted to our hospital, 17 were diagnosed with TB by their doctor. The TB-LAM corroborated the clinical diagnosis in all cases, while the other tests (Xpert MTB/RIF assay) and cultures failed to detect most of them. Overall, more than a third of severely malnourished children had TB, and the TB-LAM test-a simple, point-of-care method-was a highly accurate way to diagnose them. While larger studies are needed to confirm these results, our findings suggest that the TB-LAM could vastly improve TB diagnosis in malnourished children.
背景
在发展中国家，结核病（TB）和营养不良是导致儿童发病和死亡的重要原因。
目的
评估严重营养不良儿童中肺结核的患病率，并评估尿液脂阿拉伯甘露聚糖抗原检测（TB-LAM）在结核病检测中的作用。
方法
对 2018 年 2 月至 8 月莫桑比克农村卫生中心所有严重急性营养不良的儿科住院患者进行回顾性分析。所有儿童均接受体格检查和胸部 X 线检查，并对其鼻咽抽吸物和粪便标本进行分枝杆菌培养和 Xpert MTB/RIF 检测。TB-LAM 检测尿液。
结果
45 例纳入病例中，17 例（37.8%）临床诊断为肺结核。Xpert MTB 检测均未检出；4 例（8.9%）鼻咽抽吸物结核培养阳性。17 例（37.8%）患者——所有临床诊断为 TB 的患者 TB-LAM 检测均为阳性，而 23 例（51.1%）为阴性。5 例（11.1%）未进行尿液 LAM 检测。
结论
尽管我们的样本量较小，但纳入的患儿中超过三分之一被诊断和治疗。尿液 TB-LAM 检测与儿童结核病的临床诊断具有完美的相关性。
简述
严重急性营养不良使儿童更容易感染结核病（TB），但由于儿童不能经常咳出痰液，这是诊断过程中使用的一种方法，因此难以在儿童中检测到 TB。本研究旨在了解莫桑比克 Gaza 地区有多少严重营养不良的儿童患有 TB，并测试一种不太常用的诊断测试：脂阿拉伯甘露聚糖检测（TB-LAM）的准确性。在我院住院的 45 例严重营养不良的儿童中，有 17 例被医生诊断为 TB。TB-LAM 在所有病例中均与临床诊断相符，而其他检测（Xpert MTB/RIF 检测）和培养未能检测出其中大部分。总体而言，超过三分之一的严重营养不良儿童患有 TB，而 TB-LAM 检测——一种简单的即时检测方法——是诊断他们的一种高度准确的方法。虽然需要更大规模的研究来证实这些结果，但我们的发现表明，TB-LAM 可以极大地改善营养不良儿童的 TB 诊断。
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