Volume 82, Issue 3
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



In Africa, human immunodeficiency virus (HIV)–associated extrapulmonary tuberculosis (TB) is common and poses diagnostic difficulties. Ultrasound is useful to find suggestive signs such as effusions or abdominal lymphadenopathy. Because trained radiologists are scarce in resource-poor settings, even this simple and relatively inexpensive diagnostic tool is frequently unavailable to patients in district hospitals in sub-Saharan Africa. We developed a focused protocol for assessment with sonography for HIV/TB and trained physicians in a rural district hospital in South Africa. In this pilot study, high levels of confidence in identifying specific signs were rapidly achieved and ultrasound was introduced into routine clinical practice.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. World Health Organization, 2009. Global Tuberculosis Control: Epidemiology, Strategy, Financing: WHO Report 2009. Geneva: World Health Organization. [Google Scholar]
  2. Kang'ombe CT, Harries AD, Ito K, Clark T, Nyirenda TE, Aldis W, Nunn PP, Semba RD, Salaniponi FM, , 2004. Long-term outcome in patients registered with tuberculosis in Zomba, Malawi: mortality at 7 years according to initial HIV status and type of TB. Int J Tuberc Lung Dis 8: 829836. [Google Scholar]
  3. World Health Organization, 2007. Improving the Diagnosis and Treatment of Smear-Negative Pulmonary and Extrapulmonary Tuberculosis among Adults and Adolescents. Recommendations for HIV-Prevalent and Resource-Constrained Settings. Geneva: World Health Organization. [Google Scholar]
  4. Sinkala E, Gray S, Zulu I, Mudenda V, Zimba L, Vermund SH, Drobniewski F, Kelly P, , 2009. Clinical and ultrasonographic features of abdominal tuberculosis in HIV positive adults in Zambia. BMC Infect Dis 9: 44.[Crossref] [Google Scholar]
  5. Ma OJ, Mateer JR, Ogata M, Kefer MP, Wittmann D, Aprahamian C, , 1995. Prospective analysis of a rapid trauma ultrasound examination performed by emergency physicians. J Trauma 38: 879885.[Crossref] [Google Scholar]
  6. Mateer J, Plummer D, Heller M, Olson D, Jehle D, Overton D, Gussow L, , 1994. Model curriculum for physician training in emergency ultrasonography. Ann Emerg Med 23: 95102.[Crossref] [Google Scholar]
  7. Welz T, Hosegood V, Jaffar S, Bätzing-Feigenbaum J, Herbst K, Newell ML, , 2007. Continued very high prevalence of HIV infection in rural KwaZulu-Natal, South Africa: a population-based longitudinal study. AIDS 21: 14671472.[Crossref] [Google Scholar]
  8. Altman DG, , 1991. Practical Statistics for Medical Research. First edition. London: Chapman and Hall, 403407. [Google Scholar]
  9. Luzze H, Elliott AM, Joloba ML, Odida M, Oweka-Onyee J, Nakiyingi J, Quigley M, Hirsch C, Mugerwa RD, Okwera A, Johnson JL, , 2001. Evaluation of suspected tuberculous pleurisy: clinical and diagnostic findings in HIV-1-positive and HIV-negative adults in Uganda. Int J Tuberc Lung Dis 5: 746753. [Google Scholar]
  10. Reuter H, Burgess LJ, Doubell AF, , 2005. Epidemiology of pericardial effusions at a large academic hospital in South Africa. Epidemiol Infect 133: 393399.[Crossref] [Google Scholar]
  11. Heller T, Goblirsch Wallrauch C, Lessells R, Brunetti E, 2010. Abdominal tuberculosis: sonographic diagnosis and treatment response in HIV-positive adults in rural South Africa. Int J Infect Dis (in press). [Google Scholar]
  12. Bussmann H, Koen E, Arhin-Tenkorang D, Munyadzwe G, Troeger J, , 2001. Feasibility of an ultrasound service on district health care level in Botswana. Trop Med Int Health 6: 10231031.[Crossref] [Google Scholar]
  13. Shah SP, Epino H, Bukhman G, Umulisa I, Dushimiyimana J, Reichman A, Noble VE, , 2009. Impact of the introduction of ultrasound service in a limited resource setting: rural Rwanda 2008. BMC Int Health Hum Rights 9: 4.[Crossref] [Google Scholar]
  14. World Health Organization, 1998. Training in diagnostic ultrasound: essentials, principles and standards. Report of a WHO study group. World Health Organ Tech Rep Ser 875: i46. [Google Scholar]
  15. Ferraioli G, Meloni MF, , 2007. Sonographic training program at a district hospital in a developing country: work in progress. AJR Am J Roentgenol 189: W119W122.[Crossref] [Google Scholar]
  16. Zhou XH, Obuchowski NA, McClish DK, , 2002. Statistical Methods in Diagnostic Medicine. First edition. New York: Wiley Interscience, 359366.[Crossref] [Google Scholar]

Data & Media loading...

  • Received : 16 Sep 2009
  • Accepted : 21 Nov 2009
  • Published online : 05 Mar 2010

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error