Accuracy of Urine LAM TB Antigen Test as an Alternative Method of Pulmonary Tuberculosis Diagnosis; Evidence-based Case Report


Hafizh A Boenjamin,1 Ikrar Syahmar,1 Joseph Prasetyo,1Nadim Marchian,1 Theresia Rini,1 Jamal Zaini2
1Program Pendidikan Dokter Fakultas Kedokteran Universitas Indonesia
2Departemen Pulmonologi dan Kedokteran Respirasi Fakultas Kedokteran Universitas Indonesia, RSUP Persahabatan, Jakarta

Tuberculosis (TB) cases are found in many developing countries, such as Indonesia. The diagnosis of TB still depends on microscopic examination of sputum which has a low accuracy value, while the culture takes a long time. Sputum is often difficult to obtain due to the condition of the disease. In addition, sputum culture isnot yet available on all primary health care services in areas with limited resources. Therefore, a more rapid, inexpensive, easy, and effective diagnostic method is needed not only from the sputum. One of the alternative options is the urinary lipoarbinomannan (LAM) urin antigen test. This report was aimedto determine the accuracy of LAM urin test as an alternative method to diagnose pulmonary TB. The article search is done on three databases: PubMed; Science Direct; and Cochrane. After screening based on inclusion and exclusion criteria, 22 articles were identified. After a detailed reading, only 4 articles were relevant to the clinical question being asked. Four articles were then assessed on the aspects of validity, significance of results, and possible application in clinical conditions. Of the 4 articles assessed, all studies supported for the use of LAM TB urin test in clinical conditions. All studies show low sensitivity and high specificity, along with a positive likelihood ratio above 1. This indicates that LAM urin test cannot be used as a screening tool, but rather it is used as a diagnostic tool. LAM TB urin test is promising to be used as an alternative diagnostic method forpulmonary TB. LAM accuracy was found to be higher in the HIV population. (J Respir Indo. 2017; 37: 157-64)
Keywords: Lipoarabinomannan (LAM), tuberculosis

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