Background. Although sputum smears are the gold standard for diagnosis of tuberculosis, sensitivity in HIV/TB coinfection cases is low, indicating a need for alternative methods. Urine is being increasingly evaluated. Materials and Methods. A novel method for detecting Mycobacterium tuberculosis (MTB) in synthetic urine using a combined IMS/ATP assay was evaluated. Preliminary work established standard ATP conditions and the sensitivity and specificity of the MTB antibody. Eighty-four blinded samples in four replicate assays were evaluated for the presence of MTB using labeled immunomagnetic beads for capture. Beads were separated, washed, and resuspended in broth and added to a microtiter plate. Bioluminescent output was measured and signal-to-noise ratios were calculated. All samples were plated on Middlebrook 7H10 agar or trypticase soy agar to determine limit of detection and recoveries. Results and Conclusions. MTB was distinguished from common bacteriuria isolates and other nontarget bacteria by its ATP results. IMS/ATP successfully detected 19 of 28 samples of MTB in synthetic urine with a limit of detection of 104？CFU/ml. Sensitivity and specificity were 67.9% and 82.1%, respectively. This assay offers a possible rapid screening method for HIV-positive patients with suspected coinfection to improve MTB diagnosis. 1. Introduction There are over 8 million new cases of tuberculosis (TB) annually, with increasing incidence in areas where HIV is prevalent [1]. In 2009, there were 9.4 million new TB cases, with 1.1 million among HIV-positive individuals [2]. Sputum smear microscopy remains the standard for diagnosis. However, sensitivity varies even among HIV-negative patients, with an average sensitivity of less than 60%, and is as low as 20% for patients with HIV/TB coinfection [3]. This is further complicated by an inability to produce sputum among HIV-positive individuals [4–6]. In addition to smear-negative pulmonary TB, HIV-positive individuals tend to have abnormal chest X-rays and clinical presentations, so diagnosis and treatment are often delayed [3, 6, 7]. Furthermore, the sputum procedure is limited in diagnosing extrapulmonary infection, which is more common among patients in this group [3, 8, 9]. The impact of smear-negative disease on diagnostics is significant; even nucleic acid amplification tests such as the Gen-Probe MTD and Roche Amplicor MTB, which have sensitivities greater than 95% in smear-positive cases, have reduced sensitivities of 40–77% in smear-negative cases [3, 10]. Extrapulmonary TB and disseminated disease are more
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