{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T18:09:08Z","timestamp":1785434948338,"version":"3.56.0"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,2,20]],"date-time":"2025-02-20T00:00:00Z","timestamp":1740009600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cell. Infect. Microbiol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Traditional lipoarabinomannan tests have limited sensitivity in HIV-negative individuals. Our aims were to compare chemiluminescence-based LAM (AIMLAM) and other diagnostic modalities in HIV-negative patients and to explore whether lymphocyte counts impact the sensitivity and costs of AIMLAM.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This is a prospective, cross-sectional, diagnostic accuracy study. Participants underwent testing with sputum acid-fast bacilli, sputum culture, GeneXpert, and AIMLAM. Their diagnostic efficiency and cost-effectiveness alone or under different lymphocyte count categories was evaluated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Using MRS as a reference, the sensitivities of different diagnostic methods were as follows: sputum smear 27.43%, sputum culture 45.13%, GeneXpert 74.34%, and AIMLAM 71.68%. Patients with lymphocyte counts &amp;lt;0.8 \u00d7 10<jats:sup>9<\/jats:sup>\/L were significantly more likely to have a positive AIMLAM result (OR = 9.431, 95% CI: 2.659\u201333.447, <jats:italic>P<\/jats:italic> = 0.001). The sensitivity of AIMLAM in patients with lymphocyte counts &amp;lt;0.8 \u00d7 10<jats:sup>9<\/jats:sup>\/L reached 93.02%. The overall cost of AIMLAM to detect a positive TB case was $129.82, lower than sputum culture ($136.10) and GeneXpert ($180.27). For patients with lymphocyte counts &amp;lt;0.8 \u00d7 10<jats:sup>9<\/jats:sup>\/L, the cost of AIMLAM was further reduced to $67.84 (a 47.74% decrease), which was lower than GeneXpert ($111.65) and sputum culture ($94.28).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>AIMLAM showed promising diagnostic performance in HIV-negative patients. Stratifying patients using lymphocyte cell counting lifted the sensitivity and lowered the cost of LAM, offering a novel diagnostic strategy for tuberculosis in resource-limited settings.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcimb.2025.1498651","type":"journal-article","created":{"date-parts":[[2025,2,20]],"date-time":"2025-02-20T06:39:25Z","timestamp":1740033565000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["A new strategy improving TB diagnosis: stratified urine LAM test based on lymphocyte counts"],"prefix":"10.3389","volume":"15","author":[{"given":"Hongzhi","family":"Li","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xian","family":"Gao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dandan","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhe","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,2,20]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12879-014-0675-0","article-title":"Cost-effectiveness of point-of-care digital chest-x-ray in HIV patients with pulmonary mycobacterial infections in Nigeria","volume":"14","author":"Aliyu","year":"2014","journal-title":"BMC Infect. 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