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JAIDS,  Aug 2009  Infectious Disease Journal Club 17 September 2007 Dr Preneshni Naicker
Introduction ,[object Object],[object Object],[object Object],[object Object],[object Object]
LAM (Lipoarabinomannan) ,[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Aim ,[object Object]
Materials and Methods ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Laboratory testing ,[object Object],[object Object],[object Object],[object Object],[object Object]
TB diagnostic categories Confirmed TB —M. tuberculosis cultured from any site, or   microscopical examination of any specimen revealing   AFB or granuloma(s) in the absence of a culture positive   for any Mycobacteria. Possible TB —no culture positive for M. tuberculosis, and   presence of clinical response to empiric TB treatment as   defined by subjective report of improvement in cough,   weight loss, and/or fever at 2-month follow-up. Not TB —cultures negative for M. tuberculosis, and   1 of the   following: (a) alternative definitive microbiological   diagnosis, (b) clinical improvement in the absence of   TB treatment, and (c) failure to respond to empiric TB   treatment. Indeterminate —failure to meet criteria for any of the above   diagnostic categories
Results
 
 
 
 
 
 
 
 
 
Disease categorizations
 
 
 
LAM test performance
LAM performance by HIV status
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],71% 50-100 85% < 50 56% 100-150 14% 150-200 55% > 200 LAM sensitivity CD4 Count
Factors associated with a positive LAM ,[object Object],[object Object],[object Object],[object Object]
U-LAM compared with Sputum Smear Microscopy
Discussion ,[object Object],[object Object],[object Object],[object Object],[object Object]
Comparison of LAM test performance 100% 38% (All) 67% (CD4 <50) Lawn 2009 Cape Town -  52% HIV + TBcul + Corbett 2003 Harare Unaffected by HIV status 99% 80.3% Boehme 2005 Tanzania Specificity Sensitivity
Limitations ,[object Object],[object Object]
Conclusions ,[object Object],[object Object]

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Urinary LAM

  • 1. JAIDS, Aug 2009 Infectious Disease Journal Club 17 September 2007 Dr Preneshni Naicker
  • 2.
  • 3.
  • 4.
  • 5.
  • 6.
  • 7.
  • 8.
  • 9.
  • 10. TB diagnostic categories Confirmed TB —M. tuberculosis cultured from any site, or microscopical examination of any specimen revealing AFB or granuloma(s) in the absence of a culture positive for any Mycobacteria. Possible TB —no culture positive for M. tuberculosis, and presence of clinical response to empiric TB treatment as defined by subjective report of improvement in cough, weight loss, and/or fever at 2-month follow-up. Not TB —cultures negative for M. tuberculosis, and  1 of the following: (a) alternative definitive microbiological diagnosis, (b) clinical improvement in the absence of TB treatment, and (c) failure to respond to empiric TB treatment. Indeterminate —failure to meet criteria for any of the above diagnostic categories
  • 12.  
  • 13.  
  • 14.  
  • 15.  
  • 16.  
  • 17.  
  • 18.  
  • 19.  
  • 20.  
  • 22.  
  • 23.  
  • 24.  
  • 26. LAM performance by HIV status
  • 27.
  • 28.
  • 29.
  • 30. U-LAM compared with Sputum Smear Microscopy
  • 31.
  • 32. Comparison of LAM test performance 100% 38% (All) 67% (CD4 <50) Lawn 2009 Cape Town - 52% HIV + TBcul + Corbett 2003 Harare Unaffected by HIV status 99% 80.3% Boehme 2005 Tanzania Specificity Sensitivity
  • 33.
  • 34.