Point-of-Care Ultrasound for Extrapulmonary Tuberculosis in India: A Prospective Cohort Study in HIV-Positive and HIV-Negative Presumptive Tuberculosis Patients

Stefan F. Weber Department of Pediatrics, University Clinics, Mainz, Germany;
Department of Pediatrics, RWTH Aachen University, Aachen, Germany;

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Kavitha Saravu Department of Medicine, Kasturba Medical College, Manipal University, Manipal, India;
Manipal McGill Center for Infectious Diseases, Manipal, India;

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Tom Heller Lighthouse Clinics, Lilongwe, Malawi;

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Rajagopal Kadavigere Department of Radiodiagnosis, Kasturba Medical College, Manipal University, Manipal, India;

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Shashidhar Vishwanath Department of Microbiology, Kasturba Medical College, Manipal University, Manipal, India;

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Stephan Gehring Department of Pediatrics, University Clinics, Mainz, Germany;

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Sabine Bélard Department of Pediatric Pneumology and Immunology, Charité University Medicine, Berlin, Germany;
Berlin Institute of Health, Berlin, Germany

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and POCUS ETI Study Group Department of Pediatrics, University Clinics, Mainz, Germany;
Department of Pediatrics, RWTH Aachen University, Aachen, Germany;
Department of Medicine, Kasturba Medical College, Manipal University, Manipal, India;
Manipal McGill Center for Infectious Diseases, Manipal, India;
Lighthouse Clinics, Lilongwe, Malawi;
Department of Radiodiagnosis, Kasturba Medical College, Manipal University, Manipal, India;
Department of Microbiology, Kasturba Medical College, Manipal University, Manipal, India;
Department of Pediatric Pneumology and Immunology, Charité University Medicine, Berlin, Germany;
Berlin Institute of Health, Berlin, Germany

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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.

Author Notes

Address correspondence to Kavitha Saravu, Department of Medicine, Kasturba Medical College, Madhav Nagar, Manipal University, Manipal, Karnataka, India. E-mail: kavithasaravu@gmail.com

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.

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