High sensitivity of ultrasound for the diagnosis of tuberculosis in adults in South Africa: A proof-of-concept study.

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

Publication/Presentation Date

1-1-2022

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.

Volume

2

Issue

10

First Page

0000800

Last Page

0000800

ISSN

2767-3375

Published In/Presented At

Fentress, M., Henwood, P. C., Maharaj, P., Mitha, M., Khan, D., Caligiuri, P., Karat, A. S., Olivier, S., Edwards, A., Ramjit, D., Ngcobo, N., Wong, E. B., & Grant, A. D. (2022). High sensitivity of ultrasound for the diagnosis of tuberculosis in adults in South Africa: A proof-of-concept study. PLOS global public health, 2(10), e0000800. https://doi.org/10.1371/journal.pgph.0000800

Disciplines

Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods

PubMedID

36962607

Department(s)

Administration and Leadership

Document Type

Article