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Journal Article > Research

Point-of-care ultrasound for tuberculosis diagnosis in children: a Médecins Sans Frontières cross-sectional study in Guinea-Bissau

Moretó-Planas L, Sagrado MJ, Mahajan R, Gallo J, Biague E, Gonçalves R, Nuozzi P, Rocaspana M, Fonseca JV, Medina C, Camará M, Nadimpalli A, Alonso B, Llosa AE, Heuvelings L, Burza S, Molina I, Ruby LC, Stratta EM, Bélard S
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Abstract
OBJECTIVE
Description of tuberculosis (TB)-focused point-of-care ultrasound (POCUS) findings for children with presumptive TB.

DESIGN
Cross-sectional study (July 2019 to April 2020).

SETTING
Simão Mendes hospital in Bissau, a setting with high TB, HIV, and malnutrition burdens.

PARTICIPANTS
Patients aged between 6 months and 15 years with presumptive TB.

INTERVENTIONS
Participants underwent clinical, laboratory and unblinded clinician-performed POCUS assessments, to assess subpleural nodules (SUNs), lung consolidation, pleural and pericardial effusion, abdominal lymphadenopathy, focal splenic and hepatic lesions and ascites. Presence of any sign prompted a POCUS positive result. Ultrasound images and clips were evaluated by expert reviewers and, in case of discordance, by a second reviewer. Children were categorised as confirmed TB (microbiological diagnosis), unconfirmed TB (clinical diagnosis) or unlikely TB. Ultrasound findings were analysed per TB category and risk factor: HIV co-infection, malnutrition and age.

RESULTS
A total of 139 children were enrolled, with 62 (45%) women and 55 (40%) aged <5 years; 83 (60%) and 59 (42%) were severely malnourished (SAM) and HIV-infected, respectively. TB confirmation occurred in 27 (19%); 62 (45%) had unconfirmed TB and 50 (36%) had unlikely TB. Children with TB were more likely to have POCUS-positive results (93%) compared with children with unlikely TB (34%). Common POCUS signs in patients with TB were: lung consolidation (57%), SUNs (55%) and pleural effusion (30%), and focal splenic lesions (28%). In children with confirmed TB, POCUS sensitivity was 85% (95% CI) (67.5% to 94.1%). In those with unlikely TB, specificity was 66% (95% CI 52.2% to 77.6%). Unlike HIV infection and age, SAM was associated with a higher POCUS-positivity. Cohen’s kappa coefficient for concordance between field and expert reviewers ranged from 0.6 to 0.9.

CONCLUSIONS
We found a high prevalence of POCUS signs in children with TB compared with children with unlikely TB. POCUS-positivity was dependent on nutritional status but not on HIV status or age. TB-focused POCUS could potentially play a supportive role in the diagnosis of TB in children.
Countries
Guinea-Bissau
Subject Area
tuberculosispediatrics
DOI
10.1136/bmjopen-2022-066937
Published Date
19-May-2023
PubMed ID
37208138
Languages
English
Journal
BMJ Open
Volume / Issue / Pages
Volume 13, Issue 5, Pages e066937
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