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)To read this article in full you will need to make a payment
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References
- Global tuberculosis report.2018
- Time delays in diagnosis of pulmonary tuberculosis: a systematic review of literature.2009https://doi.org/10.1186/1471-2334-9-91
- Diagnostics for pulmonary tuberculosis.Postgrad Med J. 2016; 92: 187-193https://doi.org/10.1136/postgradmedj-2015-133278
- Systematic screening for active tuberculosis : Principles and recommendations.World Health Organization, 2013
- Clinical review: bedside lung ultrasound in critical care practice.Crit Care. 2007; 11: 205https://doi.org/10.1186/cc5668
- Training in diagnostic ultrasound: essentials, principles and standards.in: Report of a WHO Study Group. World Health Organ Tech Rep Ser. 1998 (875:i-46; back cover)
- Occult traumatic pneumothorax: diagnostic accuracy of lung ultrasonography in the emergency department.Chest. 2008; 133: 204-211https://doi.org/10.1378/chest.07-1595
- Ultrasound in the assessment of pulmonary fibrosis in connective tissue disorders: correlation with high-resolution computed tomography.J Rheumatol. 2012; 39: 1641-1647https://doi.org/10.3899/jrheum.120104
- International evidence-based recommendations for point-of-care lung ultrasound.Intensive Care Med. 2012; 38: 577-591https://doi.org/10.1007/s00134-012-2513-4
- Lung ultrasound in the diagnosis and follow-up of community-acquired pneumonia: a prospective, multicenter, diagnostic accuracy study.Chest. 2012; 142: 965-972https://doi.org/10.1378/chest.12-0364
- Potential diagnostic properties of chest ultrasound in thoracic tuberculosis-a systematic review.Int J Environ Res Public Health. 2018; 15https://doi.org/10.3390/ijerph15102235
- Review article: use of ultrasound in the developing world.Int J Emerg Med. 2011; 472https://doi.org/10.1186/1865-1380-4-72
- Chest ultrasonography in patients with HIV: a case series and review of the literature.Infection. 2016; 44: 1-10https://doi.org/10.1007/s15010-015-0780-z
- Chest ultrasound findings in pulmonary tuberculosis.Trop Dr. 2017; 47: 320-328https://doi.org/10.1177/0049475517709633
- Controlling tuberculosis in the United States. Recommendations from the American Thoracic Society, CDC, and the Infectious Diseases Society of America.MMWR Recomm Reports Morb Mortal Wkly Report Recomm Reports. 2005; 54: 1-81
- Radiographic Manifestations of Tuberculosis: A Primer for Clinicians.San Francisco, Francis J. Curry National Tuberculosis Center2019 (2nd Edition)
- WHO WHO | definitions and reporting framework for tuberculosis. 2015
- Application of ultrasonography in the diagnosis of infectious diseases in resource-limited settings.Curr Infect Dis Rep. 2016; 186https://doi.org/10.1007/s11908-015-0512-7
- Ultrasound for patients in a high HIV/tuberculosis prevalence setting: a needs assessment and review of focused applications for Sub-Saharan Africa.Int J Infect Dis. 2017; 56: 229-236https://doi.org/10.1016/j.ijid.2016.11.001
AIDE-MEMOIRE for Diagnostic Imaging Services 1999.
- WHO's new end TB strategy.Lancet. 2015; 385: 1799-1801https://doi.org/10.1016/S0140-6736(15)60570-0
- Miliary tuberculosis: sonographic pattern in chest ultrasound.Infection. 2016; 44: 243-246https://doi.org/10.1007/s15010-015-0865-8
- Chest ultrasound findings in children with suspected pulmonary tuberculosis.Pediatr Pulmonol. 2019; https://doi.org/10.1002/ppul.24230
- Ultrasound-guided aspiration biopsy of small peripheral pulmonary nodules.Chest. 1992; 101: 926-930https://doi.org/10.1378/chest.101.4.926
Article info
Publication history
Published online: June 22, 2019
Received in revised form:
May 15,
2019
Received:
February 1,
2019
Identification
Copyright
© 2019 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
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- Role of ultrasound in the diagnosis of tuberculosisEuropean Journal of Internal MedicineVol. 66
- PreviewTuberculosis (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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