Dataset Information

Sonography to Rule Out Tuberculosis in Sub-Saharan Africa: A Prospective Observational Study.

ABSTRACT:

Background

Patients with suspected tuberculosis are often overtreated with antituberculosis drugs. We evaluated the diagnostic value of the focused assessment with sonography for HIV-associated tuberculosis (FASH) in rural Tanzania.

Methods

In a prospective cohort study, the frequency of FASH signs was compared between patients with confirmed tuberculosis and those without tuberculosis. Clinical and laboratory examination, chest x-ray, Xpert MTB/RIF assay, and culture from sputum, sterile body fluids, lymph node aspirates, and Xpert MTB/RIF urine assay was done.

Results

Of 191 analyzed patients with a 6-month follow-up, 52.4% tested positive for human immunodeficiency virus, 21.5% had clinically suspected pulmonary tuberculosis, 3.7% had extrapulmonary tuberculosis, and 74.9% had extrapulmonary and pulmonary tuberculosis. Tuberculosis was microbiologically confirmed in 57.6%, probable in 13.1%, and excluded in 29.3%. Ten of eleven patients with splenic or hepatic hypoechogenic lesions had confirmed tuberculosis. In a univariate model, abdominal lymphadenopathy was significantly associated with confirmed tuberculosis. Pleural- and pericardial effusion, ascites, and thickened ileum wall lacked significant association. In a multiple regression model, abnormal chest x-ray (odds ratio [OR] = 6.19; 95% confidence interval [CI], 1.96-19.6; P < .002), ≥1 FASH-sign (OR = 3.33; 95% CI, 1.21-9.12; P = .019), and body temperature (OR = 2.48; 95% CI, 1.52-5.03; P = .001 per °C increase) remained associated with tuberculosis. A combination of ≥1 FASH sign, abnormal chest x-ray, and temperature ≥37.5°C had 99.1% sensitivity (95% CI, 94.9-99.9), 35.2% specificity (95% CI, 22.7-49.4), and a positive and negative predictive value of 75.2% (95% CI, 71.3-78.7) and 95.0% (95% CI, 72.3-99.3).

Conclusions

The absence of FASH signs combined with a normal chest x-ray and body temperature <37.5°C might exclude tuberculosis.

SUBMITTER: Ndege R

PROVIDER: S-EPMC6483805 | biostudies-literature | 2019 Apr

REPOSITORIES: biostudies-literature

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Publications

Sonography to Rule Out Tuberculosis in Sub-Saharan Africa: A Prospective Observational Study.

Ndege Robert R Weisser Maja M Elzi Luigia L Diggelmann Flavia F Bani Farida F Gingo Winfrid W Sikalengo George G Mapesi Herry H Mchomvu Elisante E Kamwela Lujeko L Mnzava Dorcas D Battegay Manuel M Reither Klaus K Paris Daniel H DH Rohacek Martin M

Open forum infectious diseases 20190425 4

<h4>Background</h4>Patients with suspected tuberculosis are often overtreated with antituberculosis drugs. We evaluated the diagnostic value of the focused assessment with sonography for HIV-associated tuberculosis (FASH) in rural Tanzania.<h4>Methods</h4>In a prospective cohort study, the frequency of FASH signs was compared between patients with confirmed tuberculosis and those without tuberculosis. Clinical and laboratory examination, chest x-ray, Xpert MTB/RIF assay, and culture from sputum, ...[more]

PMID: 31041350

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Dataset Information

Sonography to Rule Out Tuberculosis in Sub-Saharan Africa: A Prospective Observational Study.

Background

Methods

Results

Conclusions

Publications

Sonography to Rule Out Tuberculosis in Sub-Saharan Africa: A Prospective Observational Study.

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