ArticleOpen forum infectious diseases2026
Bronchoalveolar Lavage Fluid Lipoarabinomannan as a Rapid Rule-Out Tool for Smear-Negative Pulmonary Tuberculosis in a Nonhuman Immunodeficiency Virus-Predominant, High-Burden Setting: A Prospective Study.
Article in Open forum infectious diseases, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: In high-burden, nonhuman immunodeficiency virus (HIV)-predominant settings, rapid exclusion of smear-negative pulmonary tuberculosis (TB) is as clinically critical as its confirmation. Delayed diagnosis prolongs empirical anti-TB therapy, defers treatment for alternative etiologies, and compounds socioeconomic burden. Bronchoalveolar lavage fluid (BALF) lipoarabinomannan (LAM) delivers point-of-care results immediately after bronchoscopy, yet its utility as a rule-out biomarker in non-HIV populations remains poorly characterized. Method: We conducted an exploratory prospective study at a tertiary referral center in Bangkok, Thailand (February 2023-February 2024). Adults with clinical and radiographic features of pulmonary TB, negative sputum acid-fast bacilli smear and molecular tests, and a clinical indication for bronchoscopy were enrolled. Bronchoalveolar lavage fluid was tested using the Alere Determine™ TB-LAM Ag lateral flow assay, compared with mycobacterial culture and polymerase chain reaction (Xpert MTB/RIF), supplemented by histopathology when applicable. Results: Of 219 participants (99.5% non-HIV; mean age 64 ± 13 years), 24 (11.0%) had confirmed TB. A negative BALF-LAM result carried a negative predictive value (NPV) of 92.2% (95% confidence interval [CI]: 87.1%-95.4%), reducing the posttest probability of TB from 11.0% to 8.4% (negative likelihood ratio: 0.74). Sensitivity was 45.8% (95% CI: 25.6%-67.2%) and specificity was 74.9% (95% CI: 68.2%-80.7%). No clinical or radiographic variable was independently associated with false-positive results. Under a composite reference standard, including clinical TB (n = 38), NPV remained 84.9% (95% CI: 78.5%-89.6%). Conclusions: Bronchoalveolar lavage fluid lipoarabinomannan functions as a reliable, rapid rule-out adjunct for smear-negative pulmonary TB in non-HIV-predominant, high-burden settings. Its high NPV, low cost, and point-of-care availability suggest potential utility within postbronchoscopy diagnostic algorithms, pending multicenter validation.
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