High Sensitivity of Ultrasound for the Diagnosis of Tuberculosis in Adults in South Africa: A Proof-of-concept Study

Overview

Journal PLOS Glob Public Health

Specialty Public Health

Date 2023 Mar 24

PMID 36962607

Authors

Matthew Fentress

Patricia C Henwood

Priya Maharaj

Mohammed Mitha

Dilshaad Khan

Philip Caligiuri

Aaron S Karat

Stephen Olivier

Anita Edwards

Dirhona Ramjit

Nokwanda Ngcobo

Emily B Wong

Alison D Grant

Affiliations

Soon will be listed here.

Abstract

Background: There are limited data on the performance characteristics of ultrasound for the diagnosis of pulmonary tuberculosis in both HIV-positive and HIV-negative persons. The objective of this proof-of-concept study was to determine the sensitivity and specificity of ultrasound for the diagnosis of tuberculosis in adults.

Methods: Comprehensive thoracic and focused abdominal ultrasound examinations were performed by trained radiologists and pulmonologists on adults recruited from a community multimorbidity survey and a primary healthcare clinic in KwaZulu-Natal Province, South Africa. Sputum samples were systematically collected from all participants. Sensitivity and specificity of ultrasound to detect tuberculosis were calculated compared to a reference standard of i) bacteriologically-confirmed tuberculosis, and ii) either bacteriologically-confirmed or radiologic tuberculosis.

Results: Among 92 patients (53 [58%] male, mean age 41.9 [standard deviation 13.7] years, 49 [53%] HIV positive), 34 (37%) had bacteriologically-confirmed tuberculosis, 8 (9%) had radiologic tuberculosis with negative bacteriologic studies, and 50 (54%) had no evidence of active tuberculosis. Ultrasound abnormalities on either thoracic or abdominal exams were detected in 31 (91%) participants with bacteriologic tuberculosis and 27 (54%) of those without tuberculosis. Sensitivity and specificity of any ultrasound abnormality for bacteriologically-confirmed tuberculosis were 91% (95% confidence interval [CI] 76%-98%) and 46% (95% CI 32%-61%). Sensitivity and specificity of any ultrasound abnormality for either bacteriologically-confirmed or radiologic tuberculosis were 86% (95% CI 71%-95%) and 46% (95% CI 32%-61%). Overall performance did not appear to differ markedly between participants with and without HIV.

Conclusion: A comprehensive ultrasound scanning protocol in adults in a high TB burden setting had high sensitivity but low specificity to identify bacteriologically-confirmed tuberculosis.

Citing Articles

Comparative effectiveness of chest ultrasound, chest X-ray and computer-aided diagnostic (CAD) for tuberculosis diagnosis in low-resource setting: study protocol for a cross-sectional study from Ethiopia.

Guido G, Nigussa W, Cotugno S, Kenate Sori B, Bobbio F, Gulo B Front Public Health. 2024; 12:1476866.

PMID: 39691654 PMC: 11650444. DOI: 10.3389/fpubh.2024.1476866.

Diagnostic Accuracy of Lung and Abdominal Ultrasound for Tuberculosis in a German Multicenter Cohort of Patients With Presumed Tuberculosis Disease.

Weber S, Wolf P, Wetzstein N, Kupper-Tetzel C, Vehreschild M, Suarez I Open Forum Infect Dis. 2024; 11(12):ofae651.

PMID: 39691283 PMC: 11651151. DOI: 10.1093/ofid/ofae651.

References

Agostinis P, Copetti R, Lapini L, Badona Monteiro G, NDeque A, Baritussio A . Chest ultrasound findings in pulmonary tuberculosis. Trop Doct. 2017; 47(4):320-328. DOI: 10.1177/0049475517709633. View

Griesel R, Cohen K, Mendelson M, Maartens G . Abdominal Ultrasound for the Diagnosis of Tuberculosis Among Human Immunodeficiency Virus-Positive Inpatients With World Health Organization Danger Signs. Open Forum Infect Dis. 2019; 6(4):ofz094. PMC: 6469434. DOI: 10.1093/ofid/ofz094. View

Heller T, Wallrauch C, Goblirsch S, Brunetti E . Focused assessment with sonography for HIV-associated tuberculosis (FASH): a short protocol and a pictorial review. Crit Ultrasound J. 2012; 4(1):21. PMC: 3554543. DOI: 10.1186/2036-7902-4-21. View

Bigio J, Kohli M, Shyam Klinton J, Maclean E, Gore G, Small P . Diagnostic accuracy of point-of-care ultrasound for pulmonary tuberculosis: A systematic review. PLoS One. 2021; 16(5):e0251236. PMC: 8104425. DOI: 10.1371/journal.pone.0251236. View

Llamas-Alvarez A, Tenza-Lozano E, Latour-Perez J . Accuracy of Lung Ultrasonography in the Diagnosis of Pneumonia in Adults: Systematic Review and Meta-Analysis. Chest. 2016; 151(2):374-382. DOI: 10.1016/j.chest.2016.10.039. View

van Cleeff M, Kivihya-Ndugga L, Meme H, Odhiambo J, Klatser P . The role and performance of chest X-ray for the diagnosis of tuberculosis: a cost-effectiveness analysis in Nairobi, Kenya. BMC Infect Dis. 2005; 5:111. PMC: 1326228. DOI: 10.1186/1471-2334-5-111. View

Wong E, Olivier S, Gunda R, Koole O, Surujdeen A, Gareta D . Convergence of infectious and non-communicable disease epidemics in rural South Africa: a cross-sectional, population-based multimorbidity study. Lancet Glob Health. 2021; 9(7):e967-e976. PMC: 8220132. DOI: 10.1016/S2214-109X(21)00176-5. View

Fehr J, Konigorski S, Olivier S, Gunda R, Surujdeen A, Gareta D . Computer-aided interpretation of chest radiography reveals the spectrum of tuberculosis in rural South Africa. NPJ Digit Med. 2021; 4(1):106. PMC: 8253848. DOI: 10.1038/s41746-021-00471-y. View

Bobbio F, Di Gennaro F, Marotta C, Kok J, Akec G, Norbis L . Focused ultrasound to diagnose HIV-associated tuberculosis (FASH) in the extremely resource-limited setting of South Sudan: a cross-sectional study. BMJ Open. 2019; 9(4):e027179. PMC: 6500283. DOI: 10.1136/bmjopen-2018-027179. View

10.

Lienhardt C, Zumla A, Gebreselassie N, Frick M, Gray G, Kasaeva T . Tuberculosis research and development: seeding the future. Lancet Respir Med. 2018; 6(4):242-244. DOI: 10.1016/S2213-2600(18)30050-X. View

11.

Ye X, Xiao H, Chen B, Zhang S . Accuracy of Lung Ultrasonography versus Chest Radiography for the Diagnosis of Adult Community-Acquired Pneumonia: Review of the Literature and Meta-Analysis. PLoS One. 2015; 10(6):e0130066. PMC: 4479467. DOI: 10.1371/journal.pone.0130066. View

12.

Chavez M, Shams N, Ellington L, Naithani N, Gilman R, Steinhoff M . Lung ultrasound for the diagnosis of pneumonia in adults: a systematic review and meta-analysis. Respir Res. 2014; 15:50. PMC: 4005846. DOI: 10.1186/1465-9921-15-50. View

13.

Den Boon S, White N, van Lill S, Borgdorff M, Verver S, Lombard C . An evaluation of symptom and chest radiographic screening in tuberculosis prevalence surveys. Int J Tuberc Lung Dis. 2006; 10(8):876-82. View

14.

Van Hoving D, Kenge A, Maartens G, Meintjes G . Point-of-Care Ultrasound Predictors for the Diagnosis of Tuberculosis in HIV-Positive Patients Presenting to an Emergency Center. J Acquir Immune Defic Syndr. 2020; 83(4):415-423. DOI: 10.1097/QAI.0000000000002279. View

15.

Urbanowski M, Ordonez A, Ruiz-Bedoya C, Jain S, Bishai W . Cavitary tuberculosis: the gateway of disease transmission. Lancet Infect Dis. 2020; 20(6):e117-e128. PMC: 7357333. DOI: 10.1016/S1473-3099(20)30148-1. View

16.

Harris M, Qi A, Jeagal L, Torabi N, Menzies D, Korobitsyn A . A systematic review of the diagnostic accuracy of artificial intelligence-based computer programs to analyze chest x-rays for pulmonary tuberculosis. PLoS One. 2019; 14(9):e0221339. PMC: 6719854. DOI: 10.1371/journal.pone.0221339. View

17.

Fentress M, Ugarte-Gil C, Cervantes M, Rivas D, Moore D, Caliguiri P . Lung Ultrasound Findings Compared with Chest X-Ray Findings in Known Pulmonary Tuberculosis Patients: A Cross-Sectional Study in Lima, Peru. Am J Trop Med Hyg. 2020; 103(5):1827-1833. PMC: 7646758. DOI: 10.4269/ajtmh.20-0542. View

18.

van Hoving D, Griesel R, Meintjes G, Takwoingi Y, Maartens G, Ochodo E . Abdominal ultrasound for diagnosing abdominal tuberculosis or disseminated tuberculosis with abdominal involvement in HIV-positive individuals. Cochrane Database Syst Rev. 2019; 9:CD012777. PMC: 6766789. DOI: 10.1002/14651858.CD012777.pub2. View

19.

Siddiqi K, Lambert M, Walley J . Clinical diagnosis of smear-negative pulmonary tuberculosis in low-income countries: the current evidence. Lancet Infect Dis. 2003; 3(5):288-96. DOI: 10.1016/s1473-3099(03)00609-1. View

20.

Fentress M, Henwood P, Maharaj P, Mitha M, Khan D, Jackpersad R . Thoracic ultrasound for TB diagnosis in adults and children. Public Health Action. 2022; 12(1):3-6. PMC: 8908869. DOI: 10.5588/pha.21.0072. View