@article{Kerkhoff2017,
abstract = {HIV-associated disseminated TB (tuberculosis) has been under-recognised and poorly characterised. Blood culture is the gold-standard diagnostic test, but is expensive, slow, and may under-diagnose TB dissemination. In a cohort of hospitalised HIV patients, we aimed to report the prevalence of TB-blood-culture positivity, performance of rapid diagnostics as diagnostic surrogates, and better characterise the clinical phenotype of disseminated TB. HIV-inpatients were systematically investigated using sputum, urine and blood testing. Overall, 132/410 (32.2{\%}) patients had confirmed TB; 41/132 (31.1{\%}) had a positive TB blood culture, of these 9/41 (22.0{\%}) died within 90-days. In contrast to sputum diagnostics, urine Xpert and urine-lipoarabinomannan (LAM) combined identified 88{\%} of TB blood-culture-positive patients, including 9/9 who died within 90-days. For confirmed-TB patients, half the variation in major clinical variables was captured on two principle components (PCs). Urine Xpert, urine LAM and TB-blood-culture positive patients clustered similarly on these axes, distinctly from patients with localised disease. Total number of positive tests from urine Xpert, urine LAM and MTB-blood-culture correlated with PCs (p {\textless} 0.001 for both). PC1{\&}PC2 independently predicted 90-day mortality (ORs 2.6, 95{\%}CI = 1.3–6.4; and 2.4, 95{\%}CI = 1.3–4.5, respectively). Rather than being a non-specific diagnosis, disseminated TB is a distinct, life-threatening condition, which can be diagnosed using rapid urine-based tests, and warrants specific interventional trials.},
author = {Kerkhoff, Andrew D and Barr, David A and Schutz, Charlotte and Burton, Rosie and Nicol, Mark P and Lawn, Stephen D and Meintjes, Graeme A},
doi = {10.1038/s41598-017-09895-7},
file = {:C$\backslash$:/Users/01462563/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Kerkhoff et al. - 2017 - Disseminated tuberculosis among hospitalised HIV patients in South Africa a common condition that can be rapidl.pdf:pdf},
issn = {2045-2322},
journal = {Scientific Reports},
keywords = {HIV infections,OA,Tuberculosis,fund{\_}not{\_}ack,original},
mendeley-tags = {OA,fund{\_}not{\_}ack,original},
month = {dec},
number = {1},
pages = {10931},
pmid = {28883510},
publisher = {Nature Publishing Group},
title = {{Disseminated tuberculosis among hospitalised HIV patients in South Africa: a common condition that can be rapidly diagnosed using urine-based assays}},
url = {http://www.nature.com/articles/s41598-017-09895-7},
volume = {7},
year = {2017}
}

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Overall, 132/410 (32.2%) patients had confirmed TB; 41/132 (31.1%) had a positive TB blood culture, of these 9/41 (22.0%) died within 90-days. In contrast to sputum diagnostics, urine Xpert and urine-lipoarabinomannan (LAM) combined identified 88% of TB blood-culture-positive patients, including 9/9 who died within 90-days. For confirmed-TB patients, half the variation in major clinical variables was captured on two principle components (PCs). Urine Xpert, urine LAM and TB-blood-culture positive patients clustered similarly on these axes, distinctly from patients with localised disease. Total number of positive tests from urine Xpert, urine LAM and MTB-blood-culture correlated with PCs (p \\textless 0.001 for both). PC1&PC2 independently predicted 90-day mortality (ORs 2.6, 95%CI = 1.3–6.4; and 2.4, 95%CI = 1.3–4.5, respectively). Rather than being a non-specific diagnosis, disseminated TB is a distinct, life-threatening condition, which can be diagnosed using rapid urine-based tests, and warrants specific interventional trials.","author":[{"propositions":[],"lastnames":["Kerkhoff"],"firstnames":["Andrew","D"],"suffixes":[]},{"propositions":[],"lastnames":["Barr"],"firstnames":["David","A"],"suffixes":[]},{"propositions":[],"lastnames":["Schutz"],"firstnames":["Charlotte"],"suffixes":[]},{"propositions":[],"lastnames":["Burton"],"firstnames":["Rosie"],"suffixes":[]},{"propositions":[],"lastnames":["Nicol"],"firstnames":["Mark","P"],"suffixes":[]},{"propositions":[],"lastnames":["Lawn"],"firstnames":["Stephen","D"],"suffixes":[]},{"propositions":[],"lastnames":["Meintjes"],"firstnames":["Graeme","A"],"suffixes":[]}],"doi":"10.1038/s41598-017-09895-7","file":":C$\\$:/Users/01462563/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Kerkhoff et al. - 2017 - Disseminated tuberculosis among hospitalised HIV patients in South Africa a common condition that can be rapidl.pdf:pdf","issn":"2045-2322","journal":"Scientific Reports","keywords":"HIV infections,OA,Tuberculosis,fund_not_ack,original","mendeley-tags":"OA,fund_not_ack,original","month":"dec","number":"1","pages":"10931","pmid":"28883510","publisher":"Nature Publishing Group","title":"Disseminated tuberculosis among hospitalised HIV patients in South Africa: a common condition that can be rapidly diagnosed using urine-based assays","url":"http://www.nature.com/articles/s41598-017-09895-7","volume":"7","year":"2017","bibtex":"@article{Kerkhoff2017,\r\nabstract = {HIV-associated disseminated TB (tuberculosis) has been under-recognised and poorly characterised. Blood culture is the gold-standard diagnostic test, but is expensive, slow, and may under-diagnose TB dissemination. In a cohort of hospitalised HIV patients, we aimed to report the prevalence of TB-blood-culture positivity, performance of rapid diagnostics as diagnostic surrogates, and better characterise the clinical phenotype of disseminated TB. HIV-inpatients were systematically investigated using sputum, urine and blood testing. Overall, 132/410 (32.2{\\%}) patients had confirmed TB; 41/132 (31.1{\\%}) had a positive TB blood culture, of these 9/41 (22.0{\\%}) died within 90-days. In contrast to sputum diagnostics, urine Xpert and urine-lipoarabinomannan (LAM) combined identified 88{\\%} of TB blood-culture-positive patients, including 9/9 who died within 90-days. For confirmed-TB patients, half the variation in major clinical variables was captured on two principle components (PCs). 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