Abdominal Tuberculosis: Sonographic Diagnosis and Treatment Response in HIV-positive Adults in Rural South Africa

Overview

Journal Int J Infect Dis

Publisher Elsevier

Specialty Infectious Diseases

Date 2010 Apr 6

PMID 20363170

Citations 26

Authors

Tom Heller

Sam Goblirsch

Claudia Wallrauch

Richard Lessells

Enrico Brunetti

Affiliations

Soon will be listed here.

Abstract

Objective: To investigate the diagnostic value of abdominal ultrasound in HIV-positive inpatients in a rural African setting.

Methods: This was a prospective case series over 3 months of adult HIV-positive patients with symptoms suggestive of abdominal tuberculosis (TB). Diagnostic ultrasound was performed for all patients: sonographic criteria included abdominal lymph node enlargement (>1.5cm) and focal splenic lesions; ascites was a supportive finding. Further diagnostic studies, e.g., aspiration or biopsy were not routinely performed. TB treatment was initiated on the basis of clinical and sonographic features. The patients were contacted after 4 months to evaluate the clinical outcome.

Results: One hundred and eighty adult HIV-positive patients were screened; 30 (16.7%) showed sonographic signs of abdominal TB. The median CD4 count was 78 cells/mm(3). Presenting symptoms were weight loss (86.7%), abdominal pain (76.7%), and diarrhea (60%). Abdominal lymph node enlargement was the diagnostic finding in almost all cases (96.7%); hypoechoic lesions of the spleen were seen in 50% and ascites in 73.3%. Follow-up information was available for 25 patients: 24% had died and the remaining 76% reported symptomatic improvement and weight gain.

Conclusions: Characteristic sonographic features of abdominal TB are common in HIV-infected inpatients in a rural African setting. Ultrasound should be introduced into clinical algorithms for the diagnosis of extrapulmonary TB.

Citing Articles

Surgical Management of Complicated Abdominal Tuberculosis: The First Systematic Review-New Treatments for an Ancient Disease and the State of the Art.

Di Buono G, Amato G, Barletta G, Romano G, Adelfio N, Geraci G J Clin Med. 2024; 13(16).

PMID: 39201035 PMC: 11355769. DOI: 10.3390/jcm13164894.

"Sponge pattern" of the spleen: a rarely described high-frequency ultrasound pattern in HIV-positive patients.

Heller T, Taccari F, Rambiki K, Kumwenda T, Brunetti E, Wallrauch C Ultrasound J. 2023; 15(1):6.

PMID: 36735108 PMC: 9898479. DOI: 10.1186/s13089-022-00297-z.

Mini-laparoscopy as a diagnostic tool for abdominal tuberculosis: a retrospective series of 29 cases.

Brehm T, Ndzedzeka-Volz N, Wehmeyer M, Christner M, Clauditz T, Hubener P Surg Endosc. 2022; 37(3):1830-1837.

PMID: 36229559 PMC: 9560738. DOI: 10.1007/s00464-022-09703-y.

Extrapulmonary tuberculosis mortality according to clinical and point of care ultrasound features in Mozambique.

Nacarapa E, Munyangaju I, Osorio D, Zindoga P, Mutaquiha C, Jose B Sci Rep. 2022; 12(1):16675.

PMID: 36198860 PMC: 9534934. DOI: 10.1038/s41598-022-21153-z.

Task shifting for point of care ultrasound in primary healthcare in low- and middle-income countries-a systematic review.

Abrokwa S, Ruby L, Heuvelings C, Belard S EClinicalMedicine. 2022; 45:101333.

PMID: 35284806 PMC: 8904233. DOI: 10.1016/j.eclinm.2022.101333.

References

Dos Santos R, Scheid K, Willers D, Goldani L . Comparative radiological features of disseminated disease due to Mycobacterium tuberculosis vs non-tuberculosis mycobacteria among AIDS patients in Brazil. BMC Infect Dis. 2008; 8:24. PMC: 2270846. DOI: 10.1186/1471-2334-8-24. View

Tshibwabwa E, Mwaba P, Zumla A . Four-year study of abdominal ultrasound in 900 Central African adults with AIDS referred for diagnostic imaging. Abdom Imaging. 2000; 25(3):290-6. DOI: 10.1007/s002610000035. View

Brunetti E, Brigada R, Poletti F, Maiocchi L, Garlaschelli A, Gulizia R . The current role of abdominal ultrasound in the clinical management of patients with AIDS. Ultraschall Med. 2006; 27(1):20-33. DOI: 10.1055/s-2005-858649. View

Bussmann H, Koen E, Munyadzwe G, Troeger J . Feasibility of an ultrasound service on district health care level in Botswana. Trop Med Int Health. 2001; 6(12):1023-31. DOI: 10.1046/j.1365-3156.2001.00807.x. View

Wallrauch C, Heller T, Lessells R, Kekana M, Barnighausen T, Newell M . High uptake of HIV testing for tuberculosis patients in an integrated primary health care HIV/TB programme in rural KwaZulu-Natal. S Afr Med J. 2010; 100(3):146-7. DOI: 10.7196/samj.3898. View

Obajimi M, Atalabi M, Ogbole G, Adeniji-Sofoluwe A, Agunloye A, Adekanmi A . Abdominal ultrasonography in HIV/AIDS patients in southwestern Nigeria. BMC Med Imaging. 2008; 8:5. PMC: 2275264. DOI: 10.1186/1471-2342-8-5. View

Martinez-Noguera A, Montserrat E, Maideu J, Sabate J . Abdominal ultrasound findings of disseminated tuberculosis in AIDS. J Clin Ultrasound. 1997; 25(1):1-6. DOI: 10.1002/(sici)1097-0096(199701)25:1<1::aid-jcu1>3.0.co;2-m. View

Ma O, Mateer J, Ogata M, Kefer M, Wittmann D, Aprahamian C . Prospective analysis of a rapid trauma ultrasound examination performed by emergency physicians. J Trauma. 1995; 38(6):879-85. DOI: 10.1097/00005373-199506000-00009. View

Welz T, Hosegood V, Jaffar S, Batzing-Feigenbaum J, Herbst K, Newell M . Continued very high prevalence of HIV infection in rural KwaZulu-Natal, South Africa: a population-based longitudinal study. AIDS. 2007; 21(11):1467-72. DOI: 10.1097/QAD.0b013e3280ef6af2. View

10.

Iliyasu Z, Babashani M . Prevalence and predictors of tuberculosis coinfection among HIV-seropositive patients attending the Aminu Kano Teaching Hospital, northern Nigeria. J Epidemiol. 2009; 19(2):81-7. PMC: 3924118. DOI: 10.2188/jea.je20080026. View

11.

Heller T, Wallrauch C, Lessells R, Goblirsch S, Brunetti E . Short course for focused assessment with sonography for human immunodeficiency virus/tuberculosis: preliminary results in a rural setting in South Africa with high prevalence of human immunodeficiency virus and tuberculosis. Am J Trop Med Hyg. 2010; 82(3):512-5. PMC: 2829920. DOI: 10.4269/ajtmh.2010.09-0561. View

12.

Emby D, Hunter M . The value of ultrasound in the HIV-infected patient with a fever of undetermined origin. S Afr Med J. 2002; 92(8):566. View

13.

OKeefe E, Wood R, Van Zyl A, Cariem A . Human immunodeficiency virus-related abdominal pain in South Africa. Aetiology, diagnosis and survival. Scand J Gastroenterol. 1998; 33(2):212-7. DOI: 10.1080/00365529850166978. View

14.

Murdoch D, Venter W, Feldman C, Van Rie A . Incidence and risk factors for the immune reconstitution inflammatory syndrome in HIV patients in South Africa: a prospective study. AIDS. 2008; 22(5):601-10. DOI: 10.1097/QAD.0b013e3282f4a607. View

15.

Cassani F, Costigliola P, Zoli M, Baffoni L, Dentale N, Ricchi E . Abdominal lymphadenopathy detected by ultrasonography in HIV-1 infection: prevalence and significance. Scand J Infect Dis. 1993; 25(2):221-5. DOI: 10.3109/00365549309008488. View

16.

Sinkala E, Gray S, Zulu I, Mudenda V, Zimba L, Vermund S . Clinical and ultrasonographic features of abdominal tuberculosis in HIV positive adults in Zambia. BMC Infect Dis. 2009; 9:44. PMC: 2678139. DOI: 10.1186/1471-2334-9-44. View

17.

Malik A, Saxena N . Ultrasound in abdominal tuberculosis. Abdom Imaging. 2003; 28(4):574-9. DOI: 10.1007/s00261-002-0061-z. View

18.

Mutevedzi P, Lessells R, Heller T, Barnighausen T, Cooke G, Newell M . Scale-up of a decentralized HIV treatment programme in rural KwaZulu-Natal, South Africa: does rapid expansion affect patient outcomes?. Bull World Health Organ. 2010; 88(8):593-600. PMC: 2908968. DOI: 10.2471/BLT.09.069419. View