Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2010 May;16(3):262-70.
doi: 10.1097/MCP.0b013e328337f23a.

Urine for the diagnosis of tuberculosis: current approaches, clinical applicability, and new developments

Jonathan Peter  1 , Clare Green, Michael Hoelscher, Peter Mwaba, Alimuddin Zumla, Keertan Dheda
Affiliations
Review

Urine for the diagnosis of tuberculosis: current approaches, clinical applicability, and new developments

Jonathan Peter et al. Curr Opin Pulm Med. 2010 May.

Abstract

Purpose of review: Urine is increasingly being investigated as a convenient clinical sample for the identification of mycobacterial products for the diagnosis of tuberculosis. The available literature on mycobacterial lipoarabinomannan (LAM) and urine mycobacterial DNA is reviewed.

Recent findings: The available data, despite being extracted from heterogeneous clinical populations and different clinical subgroups, indicate that urine LAM has little diagnostic utility in unselected tuberculosis suspects; however, test characteristics improve in HIV-infected patients, particularly those with advanced immunosuppression (CD4 cell count <200 cells/microl). Methodologies for urine PCR for detection of mycobacterial DNA vary across studies and focus is on standardizing assays with respect to specimen collection, assay design, and processing methodology.

Summary: Both the urine LAM and PCR for mycobacterial DNA are being evaluated in different geographical settings. Urine LAM currently offers little utility for the diagnosis of tuberculosis in unselected populations. However, urine LAM appears promising as a diagnostic tool in HIV-infected patients with CD4 cell counts less than 200 cells/microl in different clinical settings. Further developmental studies are required to enhance the performance of the assays, and their usefulness over sputum microscopy in HIV-infected patients with advanced immunosuppression requires definition in large cohort studies.

PubMed Disclaimer

Figures

Figure 1
Figure 1. Annotated diagram illustrating the passage of mycobacterial DNA and lipoarabinomannan antigen from infection site to urine
LAM, lipoarabinomannan.
Figure 2
Figure 2. Putative clinical algorithm for the diagnostic work-up of outpatients and inpatients with suspected tuberculosis* in either a primary care clinic or referral hospital in a resource-poor high-tuberculosis burden and high-HIV prevalence setting
This suggested algorithm will require prospective validation. LAM, lipoarabinomannan; TB, tuberculosis.
See this image and copyright information in PMC

References

    1. WHO. Global tuberculosis control: surveillance, planning, financing: WHO report 2009. World Health Organisation; Geneva: 2009.
    1. Harries AD, Hargreaves NJ, Kemp J, et al. Deaths from tuberculosis in sub-Saharan African countries with a high prevalence of HIV-1. Lancet. 2001;357:1519–1523. - PubMed
    1. Garcia GF, Moura AS, Ferreira CS, Rocha MO. Clinical and radiographic features of HIV-related pulmonary tuberculosis according to the level of immunosuppression. Rev Soc Bras Med Trop. 2007;40:622–626. - PubMed
    1. Davies PD, Pai M. The diagnosis and misdiagnosis of tuberculosis. Int J Tuberc Lung Dis. 2008;12:1226–1234. - PubMed
    1. Dheda K, Smit RZ, Badri M, Pai M. T-cell interferon-gamma release assays for the rapid immunodiagnosis of tuberculosis: clinical utility in high-burden vs. low-burden settings. Curr Opin Pulm Med. 2009;15:188–200. - PubMed

Publication types