Detection of Mycobacterial Lipoarabinomannan with A Monoclonal Antibody Qualitative ELISA in Urine of Tuberculous Meningitis Patients
Abstract
BACKGROUND: Tuberculous meningitis is the most severe manifestation of tuberculosis. The diagnostic approach of tuberculous meningitis is difficult. Combination of clinical, laboratory and radiological criteria were used in diagnostic approach of tuberculous meningitis. Urinary mycobacterial lipoarabinomannan (LAM) antigen detection is a promising diagnostic tool. Detection of mycobacterial antigen in concentrated urine sample is predicted to improve the positivity rate of the qualitative enzyme-linked immunosorbent assay (ELISA) diagnostic tool. The purpose of this study is to examine the detection ability of a monoclonal antibody qualitative ELISA in concentrated and unconcentrated urine of tuberculous meningitis patients.
METHODS: This research is a descriptive, crosssectionally designed. The study was conducted in the Clinical Pathology Department laboratory of Dr. Hasan Sadikin Hospital, in July-October 2014. A total of 27 patients diagnosed as tuberculous meningitis patients were included and the subjects were classified into possible and probable criteria according to consensus criteria. The subjects were classified as definite if the cerebrospinal fluid culture was positive for Mycobacterial tuberculosis growth. The subjects were examined for the presence of LAM in unconcentrated and concentrated urine with a monoclonal antibody qualitative ELISA method.
RESULTS: Unconcentrated urinary LAM examination positivity was 0% while in concentrated urine was 14.8%. The positivity of concentrated urinary LAM were higher among the definite criteria group.
CONCLUSION: Concentrating urine sample increase the positivity rate of urinary LAM detection with ELISA method as high as 14.8%. The urinary antigen detection is higher among the definite tuberculous meningitis patients.
KEYWORDS: LAM, concentrated urine, tuberculous meningitis, qualitative ELISA
Full Text:
PDFReferences
Eurosurveillance editorial team WHO. Global tuberculosis report 2013. 18th ed. Floyd K, Raviglione M, Baddeley A, Dean A, Dias HM, Falzon D, et al., editors. Geneva: WHO Press; 2013, PMID.
Vitoria M, Granich R, Gilks CF, Gunneberg C, Hosseini M, Were W, et al. The global fight against HIV/AIDS, tuberculosis, and malaria: current status and future perspectives. Am J Clin Pathol. 2009; 131: 844-8, CrossRef.
Grange JM, Zumla A. The global emergency of tuberculosis: what is the cause? The journal of the Royal Society for the Promotion of Health. 2002; 122: 78-81, CrossRef.
Raviglione MC, O'Brien RJ. Tuberculosis. In: Fauci AS, Dennis L, Kasper M, Longo DL, Braunwald E, Hauser SL, et al., editors. Harrison's Principles of Internal Medicine. 17th ed. New York: McGraw-Hill; 2008, NLMID.
Marais S, Thwaites G, Schoeman JF, Torok ME, Misra UK, Prasad K, et al. Tuberculous meningitis: a uniform case definition for use in clinical research. Lancet Infect Dis. 2010; 10: 803-12, CrossRef.
Karakousis PC, Bishai WR, Dorman SE. Mycobacterium tuberculosis cell envelope lipids and the host immune response. Cell Microbiol. 2004; 6: 105-16, CrossRef.
Hunter SW, Gaylord H, Brennan PJ. Structure and antigenicity of the phosphorylated lipopolysaccharide antigens from the leprosy and tubercle bacilli. J Biol Chem. 1986; 261: 12345-51, PMID.
Beattya WL, Rhoadesa ER, Ullricha HJ, Chatterjeec D, Heuserb JE, Russell DG. Trafficking and release of mycobacterial lipids. Traffic. 2000; 1: 235-47, CrossRef.
Minion J, Leung E, Talbot E, Dheda K, Pai M, Menzies D. Diagnosing tuberculosis with urine lipoarabinomannan: systematic review and meta-analysis. Eur Respir J. 2011; 38: 1398-405, CrossRef.
Wood R, Racow K, Lawn SD, Bekker LG, Middelkoop K, Vogt M, et al. Lipoarabinomannan in urine during tuberculosis treatment: association with host and pathogen factors and mycobacteriuria. BMC Infect Dis. 2012; 12: 1-11, CrossRef.
Tuuminen T. Urine as a specimen to diagnose infections in twenty-first century: focus on analytical accuracy. Front Immunol. 2012; 3: 1-6, CrossRef.
Peter J, Green C, Hoelscher M, Mwaba P, Zumla A, Dheda K. Urine for the diagnosis of tuberculosis: current approaches, clinical applicability, and new developments. Curr Opin Pulm Med. 2010; 16: 262-70, CrossRef.
Sarkar P, Biswas D, Sindhwani G, Rawat J, Kotwal A, Kakati B. Application of lipoarabinomannan antigen in tuberculosis diagnostics: current evidence. Postgrad Med J. 2014; 90: 155-63, CrossRef.
Lawn SD, Kerkhoff AD, Vogt M, Wood R. Diagnostic accuracy of a low-cost, urine antigen, point-of-care screening assay for HIV-associated pulmonary tuberculosis before antiretroviral therapy: a descriptive study. Lancet Infect Dis. 2012; 12: 201-9, CrossRef.
Rustandi D. Gambaran pemeriksaan antigen lipoarabinomannan metode enzyme linked immunosorbent assay pada urin anak penderita tuberkulosis [Thesis]. Bandung: Universitas Padjajaran; 2011.
Dheda K, Davids V, Lenders L, Roberts T, Meldau R, Ling D, et al. Clinical utility of a commercial LAM-ELISA assay for TB diagnosis in HIV-infected patients using urine and sputum samples. PloS One. 2010; 5: e9848, CrossRef.
Wheat LJ, Kohler RB, Tewari RP. Diagnosis of disseminated histoplasmosis by detection of histoplasma capsulatum antigen in serum and urine specimens. N Engl J Med. 1986; 314: 83-8, CrossRef.
Srinivasan A, Kleiman MB, Debelenko L, Stokes DC, De Vincenzo J, Wheat JL. False-negative histoplasma antigen in acute pulmonary histoplasmosis: the value of urinary concentration by ultrafiltration and heat denaturation of serum proteins in detection of histoplasma antigen. Pediatr Infect Dis J. 2009; 28: 447-9, CrossRef.
Dominguez J, Blanco S, Rodrigo C, Azuara M, Gali N, Mainou A, et al. Usefulness of urinary antigen detection by an immunochromatographic test for diagnosis of pneumococcal pneumonia in children. J Clin Microbiol. 2003; 41: 2161-3, CrossRef.
Marcos MA, Jimenez de Anta MT, de la Bellacasa JP, Gonzalez J, Martinez E, Garcia E, et al. Rapid urinary antigen test for diagnosis of pneumococcal community-acquired pneumonia in adults. Eur Respir J. 2003; 21: 209-14, CrossRef.
Guerrero C, Toldos CM, Yague G, Ramirez C, Rodriguez T, Segovia M. Comparison of diagnostic sensitivities of three assays (Bartels enzyme immunoassay [EIA], Biotest EIA, and Binax NOW immunochromatographic test) for detection of Legionella pneumophila serogroup 1 antigen in urine. J Clin Microbiol. 2004; 42: 467-8, CrossRef.
Savolainen L, Kantele A, Sandboge B, Siren M, Valleala H, Tuompo R, et al. Modification of clearview tuberculosis (TB) enzyme-linked immunosorbent assay for TB patients not infected with HIV. Clin Vaccine Immunol. 2013; 20: 1479-82, CrossRef.
Boehme C, Molokova E, Minja F, Geis S, Loscher T, Maboko L, et al. Detection of mycobacterial lipoarabinomannan with an antigen-capture ELISA in unprocessed urine of Tanzanian patients with suspected tuberculosis. Trans R Soc Trop Med Hyg. 2005; 99: 893-900, CrossRef.
Ganiem AR, Parwati I, Wisaksana R, van der Zanden A, van de Beek D, Sturm P, et al. The effect of HIV infection on adult meningitis in Indonesia: a prospective cohort study. AIDS. 2009; 23: 2309-16, CrossRef.
Reither K, Saathoff E, Jung J, Minja LT, Kroidl I, Saad E, et al. Low sensitivity of a urine LAM-ELISA in the diagnosis of pulmonary tuberculosis. BMC Infect Dis. 2009; 9: 141, CrossRef.
Lemassu A, Daffe M. Structural features of the exocellular polysaccharides of Mycobacterium tuberculosis. Biochem J. 1994; 297 (Pt 2): 351-7, CrossRef.
Chatterjee D, Lowell K, Rivoire B, McNeil MR, Brennan PJ. Lipoarabinomannan of mycobacterium tuberculosis. J Biol Chem. 1992; 267: 6234-9, PMID.
Briken V, Porcelli SA, Besra GS, Kremer L. Mycobacterial lipoarabinomannan and related lipoglycans: from biogenesis to modulation of the immune response. Mol Microbiol. 2004; 53: 391-403, CrossRef.
Strohmeier GR, Fenton MJ. Roles of lipoarabinomannan in the pathogenesis of tuberculosis. Microbes Infect. 1999; 1: 709-17, CrossRef.
Armbruster DA, Pry T. Limit of blank, limit of detection and limit of quantitation. Clin Biochem Rev. 2008; 29 (Suppl 1): S49-52, PMID.
Christenson RH, Studenberg SD, Beck-Davis S, Sedor FA. Digoxin-like immunoreactivity eliminated from serum by centrifugal ultrafiltration before fluorescence polarization immunoassay of digoxin. Clin Chem. 1987; 33: 606-8, PMID.
DOI: https://doi.org/10.18585/inabj.v8i1.9
Copyright (c) 2016 The Prodia Education and Research Institute
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Indexed by:
The Prodia Education and Research Institute
