Welcome we are pleased to announce that our hospital started tb diagnosis with a urine test called Lateral Flow urine lipoarabinomannan(LF-LAM) test
what is LF-LAM test?
Even though this test is under study for the last 2 decades since 1997G.C at that time it is not become supported in clinical practice but now it is accepted and currently, it resolved the challenge for the diagnosis of Active Tuberculosis, especially among Human Immuno Deficiency Virus (HIV) Patients, cases for extrapulmonary test finding and in seriously ill and children who had been unable to expectorate sputum.
In the previous era, most diagnosis for tuberculosis is dependent on a sputum sample test, and in this diagnosis expectorating sputum is mandatory, which is difficult to obtain in critical patient and have low sensitivity in immunocompromised patients, patients with disseminated TB, and children, delaying treatment initiation.
Lipoarabinomannan (LAM) is the only WHO-endorsed TB biomarker that can be detected in urine, an easily collected sample and the result take approximately 15 to 20 minute which makes treatment initiation early. A clinician can take the result of the LAM test as confirmatory for tuberculosis and he can start treatment.
note;
it is not a replacement for other diagnostic methods or clinician judgment,
it is also not used for patients without TB symptoms and
it is also not used for HIV patients with an unknown CD4, or with a CD4 > 100 cells/mm3.and
it is also not used for children and adolescents who are able to provide a sputum sample, so these patients can give the sputum sample and a molecular test should have to be done
LF-LAM result
The problem associated with this assay is the lack of sensitivity and it does not provide any information on drug resistance, but it is fast, especially in urgent conditions where rapid diagnosis is important for patients
let us see the WHO recommendation for the use of this test
All patients with the diagnosis of active TB in HIV-positive adults, adolescents, and children for;
1. Inpatient/patient admitted to the ward
with signs and symptoms of TB with advanced HIV disease or who are seriously ill, or with a CD4<200 cells/mm3, irrespective of signs and symptoms of TB.
2. Outpatients:
who: have signs and symptoms of TB; are seriously ill, or have a CD4 <100 cells/mm3 irrespective of signs and symptoms of TB.
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