Bronchoalveolar Lavage Fluid Lipoarabinomannan as a Rapid Rule-Out Tool for Smear-Negative Pulmonary Tuberculosis in a Non-HIV-Predominant, High-Burden Setting: A Prospective Study

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ID: 325834
2026
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Abstract
Abstract Background In high-burden, non-HIV-predominant settings, rapid exclusion of smear-negative pulmonary tuberculosis (TB) is as clinically critical as its confirmation. Delayed diagnosis prolongs empirical anti-TB therapy, defers treatment for alternative etiologies, and compounds socioeconomic burden. Bronchoalveolar lavage fluid (BALF) lipoarabinomannan (LAM) delivers point-of-care results immediately after bronchoscopy, yet its utility as a rule-out biomarker in non-HIV populations remains poorly characterized. Methods We conducted an exploratory prospective study at a tertiary referral center in Bangkok, Thailand (February 2023–February 2024). Adults with clinical and radiographic features of pulmonary TB, negative sputum AFB smear and molecular tests, and a clinical indication for bronchoscopy were enrolled. BALF was tested using the Alere Determine™ TB-LAM Ag lateral flow assay, compared with mycobacterial culture and PCR (Xpert MTB/RIF), supplemented by histopathology when applicable. Results Of 219 participants (99.5% non-HIV; mean age 64 ± 13 years), 24 (11.0%) had confirmed TB. A negative BALF-LAM result carried an NPV of 92.2% (95% CI: 87.1–95.4%), reducing the post-test probability of TB from 11.0% to 8.4% (negative likelihood ratio: 0.74). Sensitivity was 45.8% (95% CI: 25.6–67.2%) and specificity 74.9% (95% CI: 68.2–80.7%). No clinical or radiographic variable was independently associated with false-positive results. Under a composite reference standard including clinical TB (n = 38), NPV remained 84.9% (95% CI: 78.5–89.6%). Conclusions BALF-LAM functions as a reliable, rapid rule-out adjunct for smear-negative pulmonary TB in non-HIV-predominant, high-burden settings. Its high NPV, low cost, and point-of-care availability suggest potential utility within post-bronchoscopy diagnostic algorithms, pending multi-center validation.
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openalex_W7203926100 Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors WARUNYA YOUBUREE, Tananchai Petnak, Chavachol Setthaudom, Porpon Rotjanapan
Journal Open forum infectious diseases
Year 2026
DOI
10.1093/ofid/ofag544
URL
https://doi.org/10.1093/ofid/ofag544
Keywords Keywords not found

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