Lipoarabinomannan Antigen Assay (TB-LAM) for Diagnosing Pulmonary Tuberculosis in Children with Severe Acute Malnutrition in Mozambique.

BACKGROUND: Tuberculosis (TB) and malnutrition are important causes of morbidity and mortality in children in the developing world. AIMS: To assess the prevalence of pulmonary TB in severely malnourished children and evaluate TB detection using the urine lipoarabinomannan antigen assay (TB-LAM). METHODS: A retrospective analysis was conducted in all pediatric inpatients with severe acute malnutrition at a rural health center in Mozambique, from February to August 2018. All children underwent a physical examination and chest X-ray, and their nasopharyngeal aspirates and stool specimens were studied for mycobacterial culture and subjected to the Xpert MTB/RIF assay. TB-LAM tests were performed on urine. RESULTS: Of 45 included cases, 17 (37.8%) were clinically diagnosed as pulmonary TB. None of these were detected by the Xpert MTB test; 4 (8.9%) nasopharyngeal aspirates were TB-culture positive. Seventeen patients (37.8%)-all clinically diagnosed with TB-tested positive on the TB-LAM, while 23 (51.1%) were negative. In 5 (11.1%), the urine LAM was not done. CONCLUSION: Although our sample size was small, TB was diagnosed and treated in more than a third of included children. The urine TB-LAM test showed a perfect correlation with clinical diagnosis of childhood TB. LAY SUMMARY: Severe acute malnutrition makes children more vulnerable to tuberculosis (TB) infections, but it is difficult to detect TB in children because they cannot always cough up phlegm, which is used in diagnostic processes. This study aimed to find out how many severely malnourished children had TB in Gaza, Mozambique, and to test the accuracy of a less-used diagnostic test: the lipoarabinomannan assay (TB-LAM). Of the 45 severely malnourished children who were admitted to our hospital, 17 were diagnosed with TB by their doctor. The TB-LAM corroborated the clinical diagnosis in all cases, while the other tests (Xpert MTB/RIF assay) and cultures failed to detect most of them. Overall, more than a third of severely malnourished children had TB, and the TB-LAM test-a simple, point-of-care method-was a highly accurate way to diagnose them. While larger studies are needed to confirm these results, our findings suggest that the TB-LAM could vastly improve TB diagnosis in malnourished children.

Mother-to-child transmission of HIV infection and its associated factors in the district of Bilene, Gaza Province-Mozambique.

BACKGROUND: Mother-to-child transmission of HIV infection is a significant problem in Mozambique. This study aims to determine the risk factors associated with mother-to-child transmission of HIV in rural Mozambique. METHODS: Retrospective case-control study in a rural area of Bilene District, on the coast of southern Mozambique, performed from January 2017 to June 2018. The analysis considered the clinical data of HIV exposed children with definitive HIV positive results and their respective infected mothers (cases), and the data of HIV exposed children with definitive HIV negative results and their respective infected mothers (controls) registered in At Risk Child Clinics from 1st January 2017 to 30th June 2018 at the Macia and Praia de Bilene health facilities in Bilene district, Gaza province-Mozambique. RESULTS: Ninety pregnant women with HIV were involved in the study, including 30 who had transmitted the infection to their children and 60 who had not. Statistical analysis, adjusted for maternal age and gestational age at first antenatal care visit, showed that independent risk factors for transmission were gestational age at first visit (adjusted odds ratio [aOR] 1.19, 95% confidence interval [CI] 1.05-1.36), non-adherence to combination antiretroviral therapy (56.7% vs. 5%; aOR 14.12, 95% CI 3.15-63.41); a viral load of 1000 copies/mL or more (90% vs. 5%; aOR: 156, 95% CI 22.91-1,062) and female sex of the neonate (80% vs. 51.7%; aOR: 4.43, 95% CI 1.33-15.87). CONCLUSION: A high viral load and non-adherence to antiretroviral therapy are important predictors of mother-to-child HIV transmission.

Lipoarabinomannan Antigen Assay (TB-LAM) for Diagnosing Pulmonary Tuberculosis in Children with Severe Acute Malnutrition in Mozambique

Tuberculosis (TB) and malnutrition are important causes of morbidity and mortality in children in the developing world. Aims To assess the prevalence of pulmonary TB in severely malnourished children and evaluate TB detection using the urine lipoarabinomannan antigen assay (TB-LAM). Methods A retrospective analysis was conducted in all pediatric inpatients with severe acute malnutrition at a rural health center in Mozambique, from February to August 2018. All children underwent a physical examination and chest X-ray, and their nasopharyngeal aspirates and stool specimens were studied for mycobacterial culture and subjected to the Xpert MTB/RIF assay. TB-LAM tests were performed on urine. Results Of 45 included cases, 17 (37.8%) were clinically diagnosed as pulmonary TB. None of these were detected by the Xpert MTB test; 4 (8.9%) nasopharyngeal aspirates were TB-culture positive. Seventeen patients (37.8%)­all clinically diagnosed with TB­tested positive on the TB-LAM, while 23 (51.1%) were negative. In 5 (11.1%), the urine LAM was not done. Conclusion Although our sample size was small, TB was diagnosed and treated in more than a third of included children. The urine TB-LAM test showed a perfect correlation with clinical diagnosis of childhood TB. LAY SUMMARY Severe acute malnutrition makes children more vulnerable to tuberculosis (TB) infections, but it is difficult to detect TB in children because they cannot always cough up phlegm, which is used in diagnostic processes. This study aimed to find out how many severely malnourished children had TB in Gaza, Mozambique, and to test the accuracy of a less-used diagnostic test: the lipoarabinomannan assay (TB-LAM). Of the 45 severely malnourished children who were admitted to our hospital, 17 were diagnosed with TB by their doctor. The TB-LAM corroborated the clinical diagnosis in all cases, while the other tests (Xpert MTB/RIF assay) and cultures failed to detect most of them. Overall, more than a third of severely malnourished children had TB, and the TB-LAM test­a simple, point-of-care method­was a highly accurate way to diagnose them. While larger studies are needed to confirm these results, our findings suggest that the TB-LAM could vastly improve TB diagnosis in malnourished children.