Case Report

Alere Determine-tuberculosis lipoarabinomannan positivity in disseminated non-tuberculous mycobacteria: An illustrative case series

Riana Greyling, Graeme Meintjes, Bianca Sossen
Southern African Journal of HIV Medicine | Vol 23, No 1 | a1369 | DOI: https://doi.org/10.4102/sajhivmed.v23i1.1369 | © 2022 Riana Greyling, Graeme Meintjes, Bianca Sossen | This work is licensed under CC Attribution 4.0
Submitted: 03 January 2022 | Published: 04 April 2022

About the author(s)

Riana Greyling, Matthew Goniwe Clinic, Cape Town City Health Department, Cape Town, South Africa
Graeme Meintjes, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; and, Wellcome Center for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
Bianca Sossen, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa


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Abstract

Introduction: In outpatients, the World Health Organization recommends that the urine Alere Determine-tuberculosis lipoarabinomannan (AlereLAM) should be used to support the diagnosis of tuberculosis (TB) in people living with HIV (PLHIV) with CD4 counts ≤ 100 cells/µL or with signs of being ‘seriously ill’. There is a risk of a false-positive AlereLAM in disseminated non-tuberculous mycobacterial (NTM) infections and it may be difficult to differentiate a single infection (either Mycobacterium tuberculosis or NTM) from dual infection.

Patient presentation: We report three patients, enrolled in an operational study assessing AlereLAM use in an outpatient setting, who had advanced HIV (all CD4 < 20 cells/µL) and strongly positive (grade 4+) AlereLAM results in whom Mycobacterium avium or kansasii were later cultured from blood or urine and sputum.

Management and outcome: Based on positive AlereLAM results, all three were initiated on TB treatment. One died before NTM infection was detected. Two were managed for dual infection (TB and NTM) but died within two years.

Conclusion: Tuberculosis remains a leading cause of death and a disproportionate number of these deaths occur in PLHIV. Tuberculous treatment should be initiated based on a positive AlereLAM result, and this should be followed by additional testing to confirm the diagnosis of TB and to obtain drug susceptibility results. In those not responding to TB treatment where the only positive result was an AlereLAM, an alternative or additional diagnosis of NTM infection should be considered, particularly in patients with a very low CD4 count.


Keywords

tuberculosis; Lipoarabinomannan; ambulatory; outpatient; point-of-care; urine; HIV; diagnostic

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