ArticlePloS one2010
Comparison of a clinical prediction rule and a LAM antigen-detection assay for the rapid diagnosis of TBM in a high HIV prevalence setting.
Article in PloS one, 2010. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers, 5 of them syntheses that pooled it.
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Who cites it
28 citing papers in PubMed, 5 syntheses or guidelines pooled it.
- Prevalence and trends of advanced HIV disease among antiretroviral therapy-naïve and antiretroviral therapy-experienced patients in South Africa between 2010-2021: a systematic review and meta-analysis.BMC infectious diseases · 2023Pooled it
- Diagnostic value of the cerebrospinal fluid lipoarabinomannan assay for tuberculous meningitis: a systematic review and meta-analysis.Frontiers in public health · 2023Pooled it
- Global morbidity and mortality of central nervous system tuberculosis: a systematic review and meta-analysis.Journal of neurology · 2022Pooled it
- Lateral flow urine lipoarabinomannan assay for detecting active tuberculosis in HIV-positive adults.The Cochrane database of systematic reviews · 2016Pooled it
- Systematic review and meta-analysis of antigen detection tests for the diagnosis of tuberculosis.Clinical and vaccine immunology : CVI · 2011Pooled it
- Urinary lipoarabinomannan for gastrointestinal tuberculosis: Another tool in the kit.Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology · 2026Article
- Clinical scoring systems for diagnosing tuberculous meningitis: A systematic review.World journal of critical care medicine · 2026Article
- Sensitivity of Immunodiagnostic Tests in Localized Versus Disseminated Tuberculosis-A Systematic Review of Individual Patient Data.Tropical medicine and infectious disease · 2025Review
- Utility of Cerebrospinal Fluid Unstimulated Interferon-Gamma (IRISA-TB) as a Same-Day Test for Tuberculous Meningitis in a Tuberculosis-Endemic, Resource-Poor Setting.Open forum infectious diseases · 2024Article
- Urinary lipoarabinomannan in individuals with sputum-negative pulmonary tuberculosis.The Indian journal of medical research · 2024Article
- Fujifilm SILVAMP TB LAM Assay on Cerebrospinal Fluid for the Detection of Tuberculous Meningitis in Adults With Human Immunodeficiency Virus.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2021Article
- Challenges in the diagnosis of tuberculous meningitis.Journal of clinical tuberculosis and other mycobacterial diseases · 2020Article
- Decision-making in the diagnosis of tuberculous meningitis.Wellcome open research · 2020Review
- Lateral flow urine lipoarabinomannan assay for detecting active tuberculosis in people living with HIV.The Cochrane database of systematic reviews · 2019Review
- Prospective Cohort Study on Performance of Cerebrospinal Fluid (CSF) Xpert MTB/RIF, CSF Lipoarabinomannan (LAM) Lateral Flow Assay (LFA), and Urine LAM LFA for Diagnosis of Tuberculous Meningitis in Zambia.Journal of clinical microbiology · 2019Article
- Tuberculous meningitis is associated with higher cerebrospinal HIV-1 viral loads compared to other HIV-1-associated meningitides.PloS one · 2018Article
- Mycobacteria-derived biomarkers for tuberculosis diagnosis.The Indian journal of medical research · 2017Review
- Tuberculosis Meningitis.Current infectious disease reports · 2017Review
- Comparison of clinical features and prognostic factors in HIV-negative adults with cryptococcal meningitis and tuberculous meningitis: a retrospective study.BMC infectious diseases · 2017Article
- Reply to "A Word of Caution in Considering the Use of the Lipoarabinomannan Lateral Flow Assay on Cerebrospinal Fluid for Detection of Tuberculous Meningitis".Journal of clinical microbiology · 2016Article
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Authors and funding
7 authors.
Funding
Abstract
BACKGROUND/
objectiveThe diagnosis of tuberculous meningitis (TBM) in resource poor TB endemic environments is challenging. The accuracy of current tools for the rapid diagnosis of TBM is suboptimal. We sought to develop a clinical-prediction rule for the diagnosis of TBM in a high HIV prevalence setting, and to compare performance outcomes to conventional diagnostic modalities and a novel lipoarabinomannan (LAM) antigen detection test (Clearview-TB®) using cerebrospinal fluid (CSF).
methodsPatients with suspected TBM were classified as definite-TBM (CSF culture or PCR positive), probable-TBM and non-TBM.
resultsOf the 150 patients, 84% were HIV-infected (median [IQR] CD4 count = 132 [54; 241] cells/µl). There were 39, 55 and 54 patients in the definite, probable and non-TBM groups, respectively. The LAM sensitivity and specificity (95%CI) was 31% (17;48) and 94% (85;99), respectively (cut-point ≥ 0.18). By contrast, smear-microscopy was 100% specific but detected none of the definite-TBM cases. LAM positivity was associated with HIV co-infection and low CD4 T cell count (CD4<200 vs. >200 cells/µl; p = 0.03). The sensitivity and specificity in those with a CD4<100 cells/µl was 50% (27;73) and 95% (74;99), respectively. A clinical-prediction rule ≥ 6 derived from multivariate analysis had a sensitivity and specificity (95%CI) of 47% (31;64) and 98% (90;100), respectively. When LAM was combined with the clinical-prediction-rule, the sensitivity increased significantly (p<0.001) to 63% (47;68) and specificity remained high at 93% (82;98).
conclusionsDespite its modest sensitivity the LAM ELISA is an accurate rapid rule-in test for TBM that has incremental value over smear-microscopy. The rule-in value of LAM can be further increased by combination with a clinical-prediction rule, thus enhancing the rapid diagnosis of TBM in HIV-infected persons with advanced immunosuppression.
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