WHO, 2016. Global Tuberculosis Report 2016. Geneva, Switzerland: World Health Organization.
Purohit M, Mustafa T, 2015. Laboratory diagnosis of extra-pulmonary tuberculosis (EPTB) in resource-constrained setting: state of the art, challenges and the need. J Clin Diagn Res 9: EE01–EE06.
Pawlowski A, Jansson M, Sköld M, Rottenberg ME, Källenius G, 2012. Tuberculosis and HIV co-infection. PLoS Pathog 8: e1002464.
Centers for Disease Control and Prevention C, 2016. TB in Children. Available at: http://www.cdc.gov/tb/topic/populations/tbinchildren/. Accessed October 21, 2016.
Heller T, Wallrauch C, Goblirsch S, Brunetti E, 2012. Focused assessment with sonography for HIV-associated tuberculosis (FASH): a short protocol and a pictorial review. Crit Ultrasound J 4: 21.
van Hoving DJ, Lamprecht HH, Stander M, Vallabh K, Fredericks D, Louw P, Muller M, Malan JJ, 2013. Adequacy of the emergency point-of-care ultrasound core curriculum for the local burden of disease in South Africa. Emerg Med J 30: 312–315.
Heller T, Wallrauch C, Brunetti E, Giordani MT, 2014. Changes of FASH ultrasound findings in TB-HIV patients during anti-tuberculosis treatment. Int J Tuberc Lung Dis 18: 837–839.
Heller T, Mtemang’ombe EA, Huson MA, Heuvelings CC, Belard S, Janssen S, Phiri S, Grobusch MP, 2017. Ultrasound for patients in a high HIV/tuberculosis prevalence setting: a needs assessment and review of focused applications for Sub-Saharan Africa. Int J Infect Dis 56: 229–236.
Riquelme A, Calvo M, Salech F, Valderrama S, Pattillo A, Arellano M, Arrese M, Soza A, Viviani P, Letelier LM, 2006. Value of adenosine deaminase (ADA) in ascitic fluid for the diagnosis of tuberculous peritonitis: a meta-analysis. J Clin Gastroenterol 40: 705–710.
Verma SK, Dubey AL, Singh PA, Tewerson SL, Sharma D, 2008. Adenosine deaminase (ADA) level in tubercular pleural effusion. Lung India 25: 109–110.
Gupta BK, Bharat A, Debapriya B, Baruah H, 2010. Adenosine Deaminase levels in CSF of tuberculous meningitis patients. J Clin Med Res 2: 220–224.
Evans RP, Mourad MM, Dvorkin L, Bramhall SR, 2016. Hepatic and intra-abdominal tuberculosis: 2016 update. Curr Infect Dis Rep 18: 45.
Deveci HS, Kule M, Kule ZA, Habesoglu TE, 2016. Diagnostic challenges in cervical tuberculous lymphadenitis: a review. North Clin Istanb 3: 150–155.
Rathi P, Gambhire P, 2016. Abdominal tuberculosis. J Assoc Physicians India 64: 38–47.
Leonard JM, 2017. Central nervous system tuberculosis. Microbiol Spectr 5.
Centers for Disease Control and Prevention C, 2017. Tuberculosis (TB) Disease: Symptoms & Risk Factors. Available at: https://www.cdc.gov/features/tbsymptoms/index.html. Accessed July 22, 2017.
Debi U, Ravisankar V, Prasad KK, Sinha SK, Sharma AK, 2014. Abdominal tuberculosis of the gastrointestinal tract: revisited. World J Gastroenterol 20: 14831–14840.
Graham SM et al. 2015. Clinical case definitions for classification of intrathoracic tuberculosis in children: an update. Nephrol Dial Transplant 61: S179–S187.
Central TB Division, 2014. TB India 2014: Revised National TB Control Programme. New Delhi, India: Ministry of Health and Family Welfare.
Heller T, Goblirsch S, Bahlas S, Ahmed M, Giordani MT, Wallrauch C, Brunetti E, 2013. Diagnostic value of FASH ultrasound and chest X-ray in HIV-co-infected patients with abdominal tuberculosis. Int J Tuberc Lung Dis 17: 342–344.
Heller T, Goblirsch S, 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 14: e108–e112.
Giordani MT, Brunetti E, Binazzi R, Benedetti P, Stecca C, Goblirsch S, Heller T, 2013. Extrapulmonary mycobacterial infections in a cohort of HIV-positive patients: ultrasound experience from Vicenza, Italy. Infection 41: 409–414.
Bélard S, Heuvelings CC, Banderker E, Bateman L, Andronikou S, Workman L, Grobusch MP, Zar HJ, 2018. Utility of point-of-care ultrasound in children with pulmonary tuberculosis. Ped Inf Dis J (in press).
Lawn SD, Gupta-Wright A, 2016. Detection of lipoarabinomannan (LAM) in urine is indicative of disseminated TB with renal involvement in patients living with HIV and advanced immunodeficiency: evidence and implications. Trans R Soc Trop Med Hyg 110: 180–185.
Heller T, Belard S, Wallrauch C, Carretto E, Lissandrin R, Filice C, Brunetti E, 2015. Patterns of hepatosplenic Brucella abscesses on cross-sectional imaging: a review of clinical and imaging features. Am J Trop Med Hyg 93: 761–766.
Janssen S, Grobusch MP, Heller T, 2013. ‘Remote FASH’ tele-sonography - a novel tool to assist diagnosing HIV-associated extrapulmonary tuberculosis in remote areas. Acta Trop 127: 53–55.
Gounder L, Moodley P, Drain PK, Hickey AJ, Moosa M-YS, 2017. Hepatic tuberculosis in human immunodeficiency virus co-infected adults: a case series of South African adults. BMC Infect Dis 17: 115.
Spalgais S, Jaiswal A, Puri M, Sarin R, Agarwal U, 2013. Clinical profile and diagnosis of extrapulmonary tb in HIV infected patients: routine abdominal ultrasonography increases detection of abdominal tuberculosis. Indian J Tuberc 60: 147–153.
Shivakoti R, Sharma D, Mamoon G, Pham K, 2017. Association of HIV infection with extrapulmonary tuberculosis: a systematic review. Infection 45: 11–21.
Stengel D, Bauwens K, Sehouli J, Nantke J, Ekkernkamp A, 2001. Discriminatory power of 3.5 MHz convex and 7.5 MHz linear ultrasound probes for the imaging of traumatic splenic lesions: a feasibility study. J Trauma 51: 37–43.
Weber SF, 2016. A Prospective and Explorative Analysis of a Standardized Point-of-care Ultrasound-protocol (“FASH”) for Extra-pulmonary Tuberculosis in an Indian Cohort. Kinderklinik der Universitätsmedizin Mainz: Dissertation: Johannes Gutenberg University Mainz.
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Diagnosing extrapulmonary tuberculosis (EPTB) is challenging. Point-of-care ultrasound (POCUS) for human immunodeficiency virus (HIV)-associated EPTB is applied in sub-Saharan Africa. This study aimed at evaluating the applicability of POCUS for diagnosing EPTB in HIV-positive and HIV-negative presumptive tuberculosis (TB) patients in India, a country of moderate relative TB and HIV burden. Presumptive TB patients at Kasturba Hospital, Manipal, India, prospectively underwent POCUS evaluating for pericardial, pleural and ascitic effusion, abdominal lymphadenopathy, and hepatic and splenic microabscesses. Findings were correlated with TB category (confirmed TB, clinical TB, unlikely TB), HIV status, and discharge diagnoses. A total of 425 patients underwent POCUS; 81 (20%) were HIV-positive. POCUS findings were more common in HIV/TB coinfected patients than in HIV-positive patients with unlikely TB (24/40 (60%) versus 9/41 (22%), P < 0.001). Abdominal lymphadenopathy and splenic microabscesses were strongly associated with TB in HIV-positive patients (P = 0.002 and P = 0.001). POCUS findings did not correlate with TB in HIV-negative patients; a third of HIV-negative patients with unlikely TB and POCUS findings had cancer, another third other infectious diseases. Sonographic findings were common in HIV-positive and HIV-negative presumptive TB patients. POCUS was a useful bedside test for the detection of HIV-associated EPTB. In HIV-negative patients, POCUS detected features associated with EPTB but also of malignancy and other infectious diseases.
POCUS ETI Study Group: Manjunath Hande, Rahul Magazine, Aswini K Mohapatra, Barkur A. Shastry, Shubha Sheshadri, Sudha Vidyasagar, Muralidhar Varma, Raviraj V. Acharya, Rama Bhat, Shiva Shankar, Mukhyaprana Prabhu.
Financial support: The work was supported by the DAAD (German Academic Exchange Service) [57210526 to S. F. W.] and the Charité Clinician Scientist Program funded by the Charité Universitätsmedizin Berlin and the Berlin Institute of Health, Berlin, Germany to S. B.
Authors’ addresses: Stefan F. Weber, Department of Pediatrics, University Clinics Mainz, Germany and Department of Pediatrics, RWTH Aachen University, Germany, E-mail: stefanfabianweber@yahoo.de. Kavitha Saravu, Department of Medicine, Kasturba Medical College, Manipal University, Manipal, India and Manipal McGill Center for Infectious Diseases, India, E-mail: kavithasaravu@gmail.com. Tom Heller, Lighthouse Clinics, Lilongwe, Malawi, E-mail: echnatom@web.de. Rajagopal Kadavigere, Department of Radiodiagnosis, Kasturba Medical College, Manipal University, Manipal, India, E-mail: rajarad@gmail.com. Shashidhar Vishwanath, Department of Microbiology, Kasturba Medical College, Manipal University, Manipal, India, E-mail: shashidhar.v@manipal.edu. Stephan Gehring, Department of Pediatrics, University Clinics Mainz, Germany, E-mail: Stephan.gehring@uni-mainz.de. Sabine Bélard, Department of Pediatric Pneumology and Immunology, Charité University Medicine, Berlin, Germany and Berlin Institute of Health, Berlin, Germany, E-mail: sabine.belard@charite.de.
WHO, 2016. Global Tuberculosis Report 2016. Geneva, Switzerland: World Health Organization.
Purohit M, Mustafa T, 2015. Laboratory diagnosis of extra-pulmonary tuberculosis (EPTB) in resource-constrained setting: state of the art, challenges and the need. J Clin Diagn Res 9: EE01–EE06.
Pawlowski A, Jansson M, Sköld M, Rottenberg ME, Källenius G, 2012. Tuberculosis and HIV co-infection. PLoS Pathog 8: e1002464.
Centers for Disease Control and Prevention C, 2016. TB in Children. Available at: http://www.cdc.gov/tb/topic/populations/tbinchildren/. Accessed October 21, 2016.
Heller T, Wallrauch C, Goblirsch S, Brunetti E, 2012. Focused assessment with sonography for HIV-associated tuberculosis (FASH): a short protocol and a pictorial review. Crit Ultrasound J 4: 21.
van Hoving DJ, Lamprecht HH, Stander M, Vallabh K, Fredericks D, Louw P, Muller M, Malan JJ, 2013. Adequacy of the emergency point-of-care ultrasound core curriculum for the local burden of disease in South Africa. Emerg Med J 30: 312–315.
Heller T, Wallrauch C, Brunetti E, Giordani MT, 2014. Changes of FASH ultrasound findings in TB-HIV patients during anti-tuberculosis treatment. Int J Tuberc Lung Dis 18: 837–839.
Heller T, Mtemang’ombe EA, Huson MA, Heuvelings CC, Belard S, Janssen S, Phiri S, Grobusch MP, 2017. Ultrasound for patients in a high HIV/tuberculosis prevalence setting: a needs assessment and review of focused applications for Sub-Saharan Africa. Int J Infect Dis 56: 229–236.
Riquelme A, Calvo M, Salech F, Valderrama S, Pattillo A, Arellano M, Arrese M, Soza A, Viviani P, Letelier LM, 2006. Value of adenosine deaminase (ADA) in ascitic fluid for the diagnosis of tuberculous peritonitis: a meta-analysis. J Clin Gastroenterol 40: 705–710.
Verma SK, Dubey AL, Singh PA, Tewerson SL, Sharma D, 2008. Adenosine deaminase (ADA) level in tubercular pleural effusion. Lung India 25: 109–110.
Gupta BK, Bharat A, Debapriya B, Baruah H, 2010. Adenosine Deaminase levels in CSF of tuberculous meningitis patients. J Clin Med Res 2: 220–224.
Evans RP, Mourad MM, Dvorkin L, Bramhall SR, 2016. Hepatic and intra-abdominal tuberculosis: 2016 update. Curr Infect Dis Rep 18: 45.
Deveci HS, Kule M, Kule ZA, Habesoglu TE, 2016. Diagnostic challenges in cervical tuberculous lymphadenitis: a review. North Clin Istanb 3: 150–155.
Rathi P, Gambhire P, 2016. Abdominal tuberculosis. J Assoc Physicians India 64: 38–47.
Leonard JM, 2017. Central nervous system tuberculosis. Microbiol Spectr 5.
Centers for Disease Control and Prevention C, 2017. Tuberculosis (TB) Disease: Symptoms & Risk Factors. Available at: https://www.cdc.gov/features/tbsymptoms/index.html. Accessed July 22, 2017.
Debi U, Ravisankar V, Prasad KK, Sinha SK, Sharma AK, 2014. Abdominal tuberculosis of the gastrointestinal tract: revisited. World J Gastroenterol 20: 14831–14840.
Graham SM et al. 2015. Clinical case definitions for classification of intrathoracic tuberculosis in children: an update. Nephrol Dial Transplant 61: S179–S187.
Central TB Division, 2014. TB India 2014: Revised National TB Control Programme. New Delhi, India: Ministry of Health and Family Welfare.
Heller T, Goblirsch S, Bahlas S, Ahmed M, Giordani MT, Wallrauch C, Brunetti E, 2013. Diagnostic value of FASH ultrasound and chest X-ray in HIV-co-infected patients with abdominal tuberculosis. Int J Tuberc Lung Dis 17: 342–344.
Heller T, Goblirsch S, 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 14: e108–e112.
Giordani MT, Brunetti E, Binazzi R, Benedetti P, Stecca C, Goblirsch S, Heller T, 2013. Extrapulmonary mycobacterial infections in a cohort of HIV-positive patients: ultrasound experience from Vicenza, Italy. Infection 41: 409–414.
Bélard S, Heuvelings CC, Banderker E, Bateman L, Andronikou S, Workman L, Grobusch MP, Zar HJ, 2018. Utility of point-of-care ultrasound in children with pulmonary tuberculosis. Ped Inf Dis J (in press).
Lawn SD, Gupta-Wright A, 2016. Detection of lipoarabinomannan (LAM) in urine is indicative of disseminated TB with renal involvement in patients living with HIV and advanced immunodeficiency: evidence and implications. Trans R Soc Trop Med Hyg 110: 180–185.
Heller T, Belard S, Wallrauch C, Carretto E, Lissandrin R, Filice C, Brunetti E, 2015. Patterns of hepatosplenic Brucella abscesses on cross-sectional imaging: a review of clinical and imaging features. Am J Trop Med Hyg 93: 761–766.
Janssen S, Grobusch MP, Heller T, 2013. ‘Remote FASH’ tele-sonography - a novel tool to assist diagnosing HIV-associated extrapulmonary tuberculosis in remote areas. Acta Trop 127: 53–55.
Gounder L, Moodley P, Drain PK, Hickey AJ, Moosa M-YS, 2017. Hepatic tuberculosis in human immunodeficiency virus co-infected adults: a case series of South African adults. BMC Infect Dis 17: 115.
Spalgais S, Jaiswal A, Puri M, Sarin R, Agarwal U, 2013. Clinical profile and diagnosis of extrapulmonary tb in HIV infected patients: routine abdominal ultrasonography increases detection of abdominal tuberculosis. Indian J Tuberc 60: 147–153.
Shivakoti R, Sharma D, Mamoon G, Pham K, 2017. Association of HIV infection with extrapulmonary tuberculosis: a systematic review. Infection 45: 11–21.
Stengel D, Bauwens K, Sehouli J, Nantke J, Ekkernkamp A, 2001. Discriminatory power of 3.5 MHz convex and 7.5 MHz linear ultrasound probes for the imaging of traumatic splenic lesions: a feasibility study. J Trauma 51: 37–43.
Weber SF, 2016. A Prospective and Explorative Analysis of a Standardized Point-of-care Ultrasound-protocol (“FASH”) for Extra-pulmonary Tuberculosis in an Indian Cohort. Kinderklinik der Universitätsmedizin Mainz: Dissertation: Johannes Gutenberg University Mainz.
Past two years | Past Year | Past 30 Days | |
---|---|---|---|
Abstract Views | 1526 | 1045 | 740 |
Full Text Views | 763 | 20 | 4 |
PDF Downloads | 375 | 23 | 3 |