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Lung ultrasonography in pulmonary tuberculosis: A pilot study on diagnostic accuracy in a high-risk population

      Highlights

      • Lung ultrasound is a transportable, low cost, bedside diagnostic tool.
      • Lung ultrasound has potential but unstudied role in pulmonary tuberculosis diagnosis.
      • Apical consolidations and subpleural nodules are correlated with tuberculosis diagnosis.
      • Apical consolidations and subpleural nodules show good diagnostic accuracy for tuberculosis.

      Abstract

      Objectives

      The validity of lung ultrasound (LUS) in the diagnosis of interstitial or focal lung pathologies is well documented, we assessed its accuracy in the diagnosis of pulmonary tuberculosis (PTB).

      Methods

      Sonographic signs suggestive of PTB and their diagnostic accuracy were evaluated in patients admitted with clinical suspicion of PTB. Consolidations, subpleural nodules, pleural thickenings or irregularities and pleural effusion were assessed. LUS signs significantly associated with PTB in the univariate analysis (p < .05) were entered in a multivariate logistic regression model.

      Results

      PTB was confirmed in 51 out of 102 patients. Multiple consolidations (OR 3.54, 95%CI 1.43–8.78), apical consolidations (OR 9.65, 95%CI 3.02–30.78), superior quadrant consolidations (OR 4.01, 95%CI 1.76–9.14), and subpleural nodules (OR 5.29, 95%CI 2.27–12.33) were significantly associated with PTB diagnosis. Apical consolidation (OR 9.67, 95%CI 2.81–33.25, p 0.003) and subpleural nodules (OR 5.30, 95%CI 2.08–13.52, p 0.005) retained a significant association in a multivariate model, with an overall accuracy of 0.799.

      Conclusions

      Our data suggest a possible role of LUS in the diagnosis of PTB, a high burden pathological condition for which the delay in diagnosis still represents a critical point in the control of the disease.

      Keywords

      Abbreviations:

      TB (Tuberculosis), PTB (Pulmonary tuberculosis), WHO (World Health Organization), CXR (Chest X-Ray), LUS (Lung ultrasonography), CT (Computed tomography), TST (Tuberculin Skin Test), HIV (Human immunodeficiency virus), US (Ultrasound), LR+ (Likelihood ratio), LR- (Negative likelihood ratio), PPV (Positive predictive value), NPV (Negative predictive value), CI (Confidence intervals), OR (Odds ratios), ROC (Receiver-operating characteristic)
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      Linked Article

      • Role of ultrasound in the diagnosis of tuberculosis
        European Journal of Internal MedicineVol. 66
        • Preview
          Tuberculosis (TB) is one of the most important infectious diseases affecting a sobering 10 million people worldwide per year and causing 1.6 million deaths annually [1]. The large majority of cases are seen in Sub-Saharan Africa and in other low-and-middle-income countries (LMIC) with strained health systems. The search for affordable diagnostic tools is therefore a pressing topic for these countries. Over the past years, increasing migration also brought TB patients to Europe, requiring European hospitals and physicians to diagnose a disease [2], which used to be considered either “historical” or “tropical.”
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