Conference Material > Poster
Niykayo LF, Mahajan R, Sagrado MJ, Ajack YBP, Chol BT, et al.
MSF Paediatric Days 2024. 3 May 2024; DOI:10.57740/CO9XKuY
Conference Material > Poster
Phillip E, Adede J, Onduto S, Ochola C, Simba R, et al.
MSF Paediatric Days 2024. 3 May 2024; DOI:10.57740/w8leOu
Journal Article > ResearchFull Text
BMJ Open. 19 May 2023; Volume 13 (Issue 5); e066937.; DOI:10.1136/bmjopen-2022-066937
Moretó-Planas L, Sagrado MJ, Mahajan R, Gallo J, Biague E, et al.
BMJ Open. 19 May 2023; Volume 13 (Issue 5); e066937.; DOI:10.1136/bmjopen-2022-066937
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.
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.
Journal Article > EditorialFull Text
Pediatr Crit Care Med
. 1 July 2022; Volume 23 (Issue 7); 560-562.; DOI:10.1097/PCC.0000000000002984
Conlon TW, Himebauch AS, Stratta EM, Srinivasan V
Pediatr Crit Care Med
. 1 July 2022; Volume 23 (Issue 7); 560-562.; DOI:10.1097/PCC.0000000000002984
Conference Material > Video
Moreto-Planas L, Sagrado MJ, Mahajan R, Gallo J, Biague E, et al.
MSF Scientific Days International 2022. 7 June 2022; DOI:10.57740/50a1-ba02
Conference Material > Slide Presentation
Moreto-Planas L, Sagrado MJ, Mahajan R, Gallo J, Biague E, et al.
MSF Scientific Days International 2022. 11 May 2022; DOI:10.57740/mpdr-x060
Conference Material > Abstract
Moreto-Planas L, Sagrado MJ, Mahajan R, Gallo J, Biague E, et al.
MSF Scientific Days International 2022. 11 May 2022; DOI:10.57740/b8m1-p572
INTRODUCTION
Tuberculosis (TB) is an important cause of morbidity and mortality in children and over 50% of childhood TB remains undiagnosed every year. As microbiological confirmation is low (<30%), the majority of cases in low and middle-income countries are diagnosed on clinical grounds. Point-of-care ultrasound (POCUS) is a non-invasive bedside tool, and TB-focused POCUS has been validated for diagnosis of TB in adults with HIV. We aimed to describe the performance and findings of TB-focused POCUS for children with presumptive TB at a tertiary care hospital in Guinea- Bissau, a setting with a high burden of HIV, malnutrition and TB.
METHODS
This observational study took place at Simão Mendes hospital in Bissau, from July 2019 to April 2020. Patients aged between 6 months and 15 years with presumptive TB underwent clinical and laboratory assessment, with at least one sample analysed with GeneXpert Ultra, and unblinded clinician-performed POCUS evaluation. POCUS was used to assess for subpleural nodules (SUN’s), lung consolidation, pleural effusion, pericardial effusion, ascites, liver and splenic focal lesions, and abdominal lymph nodes. Presence of any of these signs prompted a POCUS- positive result. Images and clips were evaluated by an expert reviewer and, if discordant, by a second expert reviewer.
ETHICS
This study was approved by the MSF Ethics Review Board (ERB) and by the Guinea-Bissau Ministry of Health ERB.
RESULTS
A total of 139 children were enrolled, with 62 (45%) female and 55 (40%) aged under 5 years. HIV infection and severe acute malnutrition (SAM) were found in 59 (42%) and 83 (60%) of patients, respectively. Confirmation of TB was achieved in 27 (19%); 62 (45%) had unconfirmed TB, and 50 (36%) had unlikely TB. Children with TB were more likely to have a POCUS positive result (83/89; 93%) as compared to children with unlikely TB (17/50; 34%). The most common POCUS signs in TB patients were: lung consolidation (51; 57%), SUN’s (49; 55%), pleural effusion (27; 30%), and focal splenic lesions (25; 28%). In children with confirmed TB (n=27), POCUS sensitivity was 85.2% (95% confidence interval (CI) 67.5-94.1). In those with unlikely TB (n=50), specificity was 66% (95%CI 2.2-77.6). Unlike HIV infection, SAM was associated with higher risk of positive POCUS. Cohen’s kappa coefficient for concordance between field and expert reviewers ranged from 0.6 to 0.9 depending on the POCUS sign, while overall POCUS concordance was 0.8.
CONCLUSION
We found high prevalence of any POCUS sign in children with TB, as compared to children with unlikely TB. POCUS positivity was independent of HIV status, but not of nutritional status. POCUS concordance between field and expert reviewers was moderate to high. TB-focused POCUS could potentially play a supportive role in the diagnosis of TB in children.
CONFLICTS OF INTEREST
None declared.
Tuberculosis (TB) is an important cause of morbidity and mortality in children and over 50% of childhood TB remains undiagnosed every year. As microbiological confirmation is low (<30%), the majority of cases in low and middle-income countries are diagnosed on clinical grounds. Point-of-care ultrasound (POCUS) is a non-invasive bedside tool, and TB-focused POCUS has been validated for diagnosis of TB in adults with HIV. We aimed to describe the performance and findings of TB-focused POCUS for children with presumptive TB at a tertiary care hospital in Guinea- Bissau, a setting with a high burden of HIV, malnutrition and TB.
METHODS
This observational study took place at Simão Mendes hospital in Bissau, from July 2019 to April 2020. Patients aged between 6 months and 15 years with presumptive TB underwent clinical and laboratory assessment, with at least one sample analysed with GeneXpert Ultra, and unblinded clinician-performed POCUS evaluation. POCUS was used to assess for subpleural nodules (SUN’s), lung consolidation, pleural effusion, pericardial effusion, ascites, liver and splenic focal lesions, and abdominal lymph nodes. Presence of any of these signs prompted a POCUS- positive result. Images and clips were evaluated by an expert reviewer and, if discordant, by a second expert reviewer.
ETHICS
This study was approved by the MSF Ethics Review Board (ERB) and by the Guinea-Bissau Ministry of Health ERB.
RESULTS
A total of 139 children were enrolled, with 62 (45%) female and 55 (40%) aged under 5 years. HIV infection and severe acute malnutrition (SAM) were found in 59 (42%) and 83 (60%) of patients, respectively. Confirmation of TB was achieved in 27 (19%); 62 (45%) had unconfirmed TB, and 50 (36%) had unlikely TB. Children with TB were more likely to have a POCUS positive result (83/89; 93%) as compared to children with unlikely TB (17/50; 34%). The most common POCUS signs in TB patients were: lung consolidation (51; 57%), SUN’s (49; 55%), pleural effusion (27; 30%), and focal splenic lesions (25; 28%). In children with confirmed TB (n=27), POCUS sensitivity was 85.2% (95% confidence interval (CI) 67.5-94.1). In those with unlikely TB (n=50), specificity was 66% (95%CI 2.2-77.6). Unlike HIV infection, SAM was associated with higher risk of positive POCUS. Cohen’s kappa coefficient for concordance between field and expert reviewers ranged from 0.6 to 0.9 depending on the POCUS sign, while overall POCUS concordance was 0.8.
CONCLUSION
We found high prevalence of any POCUS sign in children with TB, as compared to children with unlikely TB. POCUS positivity was independent of HIV status, but not of nutritional status. POCUS concordance between field and expert reviewers was moderate to high. TB-focused POCUS could potentially play a supportive role in the diagnosis of TB in children.
CONFLICTS OF INTEREST
None declared.