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Vaezipour N, Fritschi N, Brasier N, Bélard S, Domínguez J, Tebruegge M, Portevin D, Ritz N. Towards Accurate Point-of-Care Tests for Tuberculosis in Children. Pathogens 2022; 11:pathogens11030327. [PMID: 35335651 PMCID: PMC8949489 DOI: 10.3390/pathogens11030327] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/02/2022] [Accepted: 03/03/2022] [Indexed: 12/20/2022] Open
Abstract
In childhood tuberculosis (TB), with an estimated 69% of missed cases in children under 5 years of age, the case detection gap is larger than in other age groups, mainly due to its paucibacillary nature and children’s difficulties in delivering sputum specimens. Accurate and accessible point-of-care tests (POCTs) are needed to detect TB disease in children and, in turn, reduce TB-related morbidity and mortality in this vulnerable population. In recent years, several POCTs for TB have been developed. These include new tools to improve the detection of TB in respiratory and gastric samples, such as molecular detection of Mycobacterium tuberculosis using loop-mediated isothermal amplification (LAMP) and portable polymerase chain reaction (PCR)-based GeneXpert. In addition, the urine-based detection of lipoarabinomannan (LAM), as well as imaging modalities through point-of-care ultrasonography (POCUS), are currently the POCTs in use. Further to this, artificial intelligence-based interpretation of ultrasound imaging and radiography is now integrated into computer-aided detection products. In the future, portable radiography may become more widely available, and robotics-supported ultrasound imaging is currently being trialed. Finally, novel blood-based tests evaluating the immune response using “omic-“techniques are underway. This approach, including transcriptomics, metabolomic, proteomics, lipidomics and genomics, is still distant from being translated into POCT formats, but the digital development may rapidly enhance innovation in this field. Despite these significant advances, TB-POCT development and implementation remains challenged by the lack of standard ways to access non-sputum-based samples, the need to differentiate TB infection from disease and to gain acceptance for novel testing strategies specific to the conditions and settings of use.
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Affiliation(s)
- Nina Vaezipour
- Mycobacterial and Migrant Health Research Group, University Children’s Hospital Basel, Department for Clinical Research, University of Basel, 4056 Basel, Switzerland; (N.V.); (N.F.)
- Infectious Disease and Vaccinology Unit, University Children’s Hospital Basel, University of Basel, 4056 Basel, Switzerland
| | - Nora Fritschi
- Mycobacterial and Migrant Health Research Group, University Children’s Hospital Basel, Department for Clinical Research, University of Basel, 4056 Basel, Switzerland; (N.V.); (N.F.)
| | - Noé Brasier
- Department of Health Sciences and Technology, Institute for Translational Medicine, ETH Zurich, 8093 Zurich, Switzerland;
- Department of Digitalization & ICT, University Hospital Basel, 4031 Basel, Switzerland
| | - Sabine Bélard
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité–Universitätsmedizin Berlin, 13353 Berlin, Germany;
- Institute of Tropical Medicine and International Health, Charité–Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - José Domínguez
- Institute for Health Science Research Germans Trias i Pujol. CIBER Enfermedades Respiratorias, Universitat Autònoma de Barcelona, 08916 Barcelona, Spain;
| | - Marc Tebruegge
- Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London WCN1 1EH, UK;
- Department of Pediatrics, The Royal Children’s Hospital Melbourne, The University of Melbourne, Parkville, VIC 3052, Australia
| | - Damien Portevin
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, 4123 Allschwil, Switzerland;
- University of Basel, 4001 Basel, Switzerland
| | - Nicole Ritz
- Mycobacterial and Migrant Health Research Group, University Children’s Hospital Basel, Department for Clinical Research, University of Basel, 4056 Basel, Switzerland; (N.V.); (N.F.)
- Department of Pediatrics, The Royal Children’s Hospital Melbourne, The University of Melbourne, Parkville, VIC 3052, Australia
- Department of Paediatrics and Paediatric Infectious Diseases, Children’s Hospital, Lucerne Cantonal Hospital, 6000 Lucerne, Switzerland
- Correspondence: ; Tel.: +41-61-704-1212
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Lung Ultrasound Effectively Detects HIV-Associated Interstitial Pulmonary Disease. Int J Infect Dis 2021; 111:204-210. [PMID: 34407479 DOI: 10.1016/j.ijid.2021.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/10/2021] [Accepted: 08/12/2021] [Indexed: 11/20/2022] Open
Abstract
Objectives To prospectively evaluate lung ultrasound in comparison with radiography and computed tomography (CT) for detecting HIV-related lung diseases. Methods Ultrasound examinations in HIV-positive patients were evaluated by three raters; available conventional imaging was evaluated by another rater. Results were compared with each other and the definite diagnosis. Interrater reliability was calculated for each finding. Results Eighty HIV-positive patients received lung ultrasound examinations; 74 received conventional imaging. The overall sensitivity was 97.5% for CT, 90.7% for ultrasound and 78.1% for radiography. The most common diagnoses were Pneumocystis jirovecii pneumonia (21 cases) and bacterial pneumonia (17 cases). The most frequent and sensitive ultrasonographic findings were interstitial abnormalities indicated by B-lines, independent of the aetiology. Interrater reliability was high for interstitial abnormalities (ICC=0.82). The interrater reliability for consolidations and effusion increased during the study (r=0.88 and r=0.37, respectively). Conclusions Ultrasound is a fast, reliable and sensitive point-of-care tool, particularly in detecting interstitial lung disease, which is common in HIV-associated illness. It does not effectively discriminate between different aetiologies. A longer learning period might be required to reliably identify consolidations and effusions.
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Swarts L, Lahri S, van Hoving DJ. The burden of HIV and tuberculosis on the resuscitation area of an urban district-level hospital in Cape Town. Afr J Emerg Med 2021; 11:165-170. [PMID: 33680739 PMCID: PMC7910156 DOI: 10.1016/j.afjem.2020.09.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 06/23/2020] [Accepted: 09/22/2020] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Many patients present to emergency centres with HIV and tuberculosis related emergencies. Little is known about the influence of HIV and tuberculosis on the resuscitation areas of district-level hospitals. The primary objective was to determine the burden of non-trauma patients with HIV and/or tuberculosis presenting to the resuscitation area of Khayelitsha Hospital, Cape Town. METHODS A retrospective analysis was performed on a prospectively collected observational database. A randomly selected 12-week sample of data from the resuscitation area was used. Trauma and paediatric (<13 years) cases were excluded. Patient demographics, HIV and tuberculosis status, disease category, investigations and procedures undertaken, disposition and in-hospital mortality were assessed. HIV and tuberculosis status were determined by laboratory confirmation or from clinical records. Descriptive statistics are presented and comparisons were done using the χ2-test or independent t-test. RESULTS A total of 370 patients were included. HIV prevalence was 38.4% (n = 142; unknown n = 78, 21.1%), tuberculosis prevalence 13.5% (n = 50; unknown n = 233, 63%), and HIV/tuberculosis co-infection 10.8% (n = 40). HIV and tuberculosis were more likely in younger patients (both p < 0.01) and more females were HIV-positive (p < 0.01). Patients with tuberculosis spend 93 min longer in the resuscitation area than those without (p = 0.02). The acuity of patients did not differ by HIV or tuberculosis status.Infectious-related diseases and diseases of the digestive system occurred significantly more in the HIV-positive group, and endocrine-related diseases and diseases of the nervous system in HIV-negative patients.HIV-positive patients received more abdominal ultrasound examinations (p < 0.01), blood cultures (p < 0.01) and intravenous antibiotics (p < 0.01). In-hospital mortality was 17% and was not influenced by HIV status (p = 0.36) or tuberculosis status (p = 0.29). CONCLUSION This study highlights the burden of HIV and tuberculosis on the resuscitation area of a district level hospital. Neither HIV nor tuberculosis status were associated with in-hospital mortality.
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Affiliation(s)
- Lynne Swarts
- Division of Emergency Medicine, Stellenbosch University, Cape Town, South Africa
| | - Sa'ad Lahri
- Division of Emergency Medicine, Stellenbosch University, Cape Town, South Africa
| | - Daniël J. van Hoving
- Division of Emergency Medicine, Stellenbosch University, Cape Town, South Africa
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4
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Fentress M, Ugarte-Gil C, Cervantes M, Rivas D, Moore D, Caliguiri P, Bergman K, Noazin S, Padovani A, Gilman RH. Lung Ultrasound Findings Compared with Chest X-Ray Findings in Known Pulmonary Tuberculosis Patients: A Cross-Sectional Study in Lima, Peru. Am J Trop Med Hyg 2020; 103:1827-1833. [PMID: 32815504 PMCID: PMC7646758 DOI: 10.4269/ajtmh.20-0542] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Lung ultrasound (LUS) is highly portable and has excellent diagnostic accuracy for pneumonia compared with conventional radiography, but the literature on its use in pulmonary tuberculosis (PTB) is limited. This study characterized LUS lesions in patients with PTB and compared them with chest X-ray (CXR) findings. Adult patients in Lima, Peru, with PTB were recruited within 1 week of starting antituberculosis treatment. Comprehensive LUS was performed in all patients at enrollment and assessed for consolidation, small subpleural consolidation (SPC, hypothesized to be a marker of CXR consolidation), cavity, pleural effusion, pathologic B-lines, and miliary pattern. Patient CXRs were digitized and interpreted by a board-certified radiologist. Fifty-one patients were included in the final analysis. Lung ultrasound detected either consolidation or SPC in 96.1% of participants. No significant difference was found between the LUS detection of a composite of consolidation or SPC, and CXR detection of consolidation (96.1% versus 98%, P > 0.99). The proportion of patients with cavity detected by LUS was significantly lower than that detected by CXR (5.9% versus 51%, P < 0.001). Overall, LUS detection of consolidation or SPC may be a sensitive marker for diagnosis of PTB. Lung ultrasound demonstrated poor ability to detect radiographically identified cavity, although previous studies suggest SPC could add specificity for the diagnosis of PTB. Based on its portability and evidence base for diagnosing other pulmonary diseases, LUS may have a role in screening and diagnosis of PTB in areas without ready access to CXR. Further studies should evaluate its diagnostic accuracy in patients with and without PTB.
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Affiliation(s)
- Matthew Fentress
- University of California, Davis, Sacramento, California.,Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Cesar Ugarte-Gil
- London School of Hygiene and Tropical Medicine, London, United Kingdom.,Universidad Peruana Cayetano Heredia, Lima, Peru.,Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | | | | | - David Moore
- London School of Hygiene and Tropical Medicine, London, United Kingdom.,Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | | | - Kevin Bergman
- Contra Costa Family Medicine Residency, University of California - San Francisco, Martinez, California
| | - Sassan Noazin
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | | | - Robert H Gilman
- Associacion Benefica PRISMA, Lima, Peru.,Universidad Peruana Cayetano Heredia, Lima, Peru.,Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
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Zanatta M, Kaminstein D, Cianci V, Altissimo D, Giordani MT. A 32-Year-Old Man Affected by HIV With Fever, Dyspnea, and a Rapid Evolution Toward Multiorgan Failure. Chest 2020; 157:e141-e144. [DOI: 10.1016/j.chest.2019.06.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 04/27/2019] [Accepted: 06/30/2019] [Indexed: 10/24/2022] Open
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Giordani MT, Heller T. Role of ultrasound in the diagnosis of tuberculosis. Eur J Intern Med 2019; 66:27-28. [PMID: 31351765 DOI: 10.1016/j.ejim.2019.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 07/07/2019] [Indexed: 11/24/2022]
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7
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Montuori M, Casella F, Casazza G, Franzetti F, Pini P, Invernizzi C, Torzillo D, Rizzardini G, Galli M, Cogliati C. Lung ultrasonography in pulmonary tuberculosis: A pilot study on diagnostic accuracy in a high-risk population. Eur J Intern Med 2019; 66:29-34. [PMID: 31235198 DOI: 10.1016/j.ejim.2019.06.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 05/15/2019] [Accepted: 06/05/2019] [Indexed: 12/14/2022]
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.
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Affiliation(s)
- M Montuori
- Infectious Diseases Unit, Department of Biomedical and Clinical Sciences "Luigi Sacco" University of Milan, ASST-FBF-Sacco, Italy.
| | - F Casella
- Department of Internal Medicine, ASST-FBF-Sacco, Italy
| | - G Casazza
- Dipartimento di Scienze Biomediche e Cliniche "Luigi Sacco", Università degli Studi di Milano, Italy
| | - F Franzetti
- Infectious Diseases Unit, Department of Biomedical and Clinical Sciences "Luigi Sacco" University of Milan, ASST-FBF-Sacco, Italy
| | - P Pini
- Department of Internal Medicine, ASST-FBF-Sacco, Italy
| | - C Invernizzi
- Department of Internal Medicine, ASST-FBF-Sacco, Italy
| | - D Torzillo
- Department of Internal Medicine, ASST-FBF-Sacco, Italy
| | - G Rizzardini
- First Division of Infectious Diseases, ASST-FBF-Sacco, Milano, Italy
| | - M Galli
- Infectious Diseases Unit, Department of Biomedical and Clinical Sciences "Luigi Sacco" University of Milan, ASST-FBF-Sacco, Italy
| | - C Cogliati
- Department of Internal Medicine, ASST-FBF-Sacco, Italy
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8
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Perspectives on Point-of-Care Ultrasound Use in Pediatric Tropical Infectious Disease. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2019. [DOI: 10.1016/j.cpem.2019.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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9
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Heuvelings CC, Bélard S, Andronikou S, Jamieson-Luff N, Grobusch MP, Zar HJ. Chest ultrasound findings in children with suspected pulmonary tuberculosis. Pediatr Pulmonol 2019; 54:463-470. [PMID: 30632712 DOI: 10.1002/ppul.24230] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Accepted: 12/08/2018] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Chest ultrasound is increasingly used for the diagnosis of pediatric lung disease but there are limited data for its use in pediatric pulmonary tuberculosis (PTB). AIM To describe chest ultrasound findings in children with suspected PTB. METHODS Consecutive children, presenting with suspected PTB to a tertiary children's hospital in Cape Town between July 2014 and March 2016, were enrolled in this cohort study. Children were categorized into three groups based on microbiological and clinical features; confirmed PTB (microbiologically confirmed), unconfirmed PTB (clinical diagnosis only), and unlikely PTB (respiratory disease not due to PTB). A clinician, blinded to categorization, performed chest and mediastinal ultrasound for consolidation, pleural gaps, pleural effusions, B-lines or enlarged mediastinal lymph nodes at enrolment and 1, 3, and 6 months thereafter. Two readers interpreted the ultrasounds independently. RESULTS One hundred seventy children (median age 26.6 months) were enrolled; 40 (24%) confirmed PTB, 85 (50%) unconfirmed PTB, and 45 (26%) unlikely PTB. In children with confirmed PTB, pleural effusion was more common (30% vs 9% in unlikely PTB, P = 0.024), mediastinal lymph nodes were larger (median size 1.5 cm vs 1.0 cm in unlikely PTB, P = 0.027), resolution of consolidation occurred less commonly at 1-month follow-up (24% vs 67% unlikely TB, P = 0.014) and the proportional size reduction of a consolidation was lower (44% vs 80% in unlikely PTB, P = 0.009). Inter-reader agreement was perfect to moderate. CONCLUSION Chest ultrasound identified abnormalities suggestive of PTB with a high inter-reader agreement. Consolidation showed slower resolution in children with confirmed PTB.
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Affiliation(s)
- Charlotte C Heuvelings
- Center of Tropical Medicine and Travel Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.,Department of Paediatrics and Child Health and SA-MRC Unit on Child and Adolescent Health, Red Cross War Memorial Children's Hospital, University of Cape Town, South Africa
| | - Sabine Bélard
- Center of Tropical Medicine and Travel Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.,Department of Paediatrics and Child Health and SA-MRC Unit on Child and Adolescent Health, Red Cross War Memorial Children's Hospital, University of Cape Town, South Africa.,Department of Pediatric Pneumology and Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Savvas Andronikou
- Department of Paediatrics and Child Health and SA-MRC Unit on Child and Adolescent Health, Red Cross War Memorial Children's Hospital, University of Cape Town, South Africa.,Department of Paediatric Radiology, Children's Hospital Philadelphia, Philadelphia, Pennsylvania
| | - Norme Jamieson-Luff
- Department of Paediatrics and Child Health and SA-MRC Unit on Child and Adolescent Health, Red Cross War Memorial Children's Hospital, University of Cape Town, South Africa
| | - Martin P Grobusch
- Center of Tropical Medicine and Travel Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Heather J Zar
- Department of Paediatrics and Child Health and SA-MRC Unit on Child and Adolescent Health, Red Cross War Memorial Children's Hospital, University of Cape Town, South Africa
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Potential Diagnostic Properties of Chest Ultrasound in Thoracic Tuberculosis-A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15102235. [PMID: 30322009 PMCID: PMC6210728 DOI: 10.3390/ijerph15102235] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 09/28/2018] [Accepted: 10/02/2018] [Indexed: 02/01/2023]
Abstract
Background: Chest ultrasound (CUS) has been shown to be a sensitive and specific imaging modality for pneumothorax, pneumonia, and pleural effusions. However, the role of chest ultrasound in the diagnosis of thoracic tuberculosis (TB) is uncertain. We performed a systematic search in the medical literature to better define the potential role and value of chest ultrasound in diagnosing thoracic tuberculosis. Aim: To describe existing literature with regard to the diagnostic value of chest ultrasound in thoracic tuberculosis. Methods: MEDLINE, EMBASE, and Scopus databases were searched for relevant articles. We included studies that used chest ultrasound for the diagnosis or management of any form of thoracic tuberculosis, including pulmonary, pleural, mediastinal, and military forms. Results: We identified five main fields of chest ultrasound application: (1) Detection, characterization, and quantification of TB; (2) detection of residual pleural thickening after evacuation; (3) chest ultrasound-guided needle biopsy; (4) identification of pathologic mediastinal lymph nodes in children; and (5) identification of parenchymal ultrasound patterns. Effusion was also detected, in early stages, with signs of organization in 24–100% of patients. A low to moderate (10–23%), false negative rate was reported for chest ultrasound-guided needle biopsy. CUS was able to identify mediastinal lymph nodes in as many as 67% of patients with negative chest radiography. Conclusions: Very few studies with important methodological limitations analyze the role of chest ultrasound in the diagnosis of TB. The scarce available data suggests potential targets of future diagnostic or feasibility trials, such as the detection of tuberculosis–related pleural effusion, residual pleural thickening, lymphadenopathy, TB parenchymal patterns, or the use of CUS in biopsy guidance.
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Limonta S, Monge E, Montuori M, Morosi M, Galli M, Franzetti F. Lung ultrasound in the management of pneumocystis pneumonia: A case series. Int J STD AIDS 2018; 30:188-193. [PMID: 30236043 DOI: 10.1177/0956462418797872] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Despite the decline in HIV mortality and morbidity, Pneumocystis jirovecii pneumonia (PJP) is still frequently seen, particularly in patients with a low CD4+ cell count. We present a case series where we analyzed the possible role of lung ultrasound (LUS) in the management of PJP in a real-life clinical setting. We describe the ultrasound findings from a consecutive series of six HIV patients hospitalized for PJP, all with a favorable outcome, and evaluated with LUS at admission in our ward and then repeated this once during the hospitalization. Multiple B lines indicating interstitial syndrome were detected at admission in all cases, with a bilateral asymmetric pattern mostly localized in middle and upper lobes. In the follow-up LUS, we noted a substantially improved pattern in all patients, observing a reduction of B lines which correlated with clinical amelioration. One patient at admission and three patients during the follow-up showed lung consolidations with hyperechoic spots inside, that might be typical of the disease. In conclusion, LUS could be a practical and noninvasive imaging tool for supporting diagnosis and treatment response of PJP.
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Affiliation(s)
- Silvia Limonta
- Division of Infectious Diseases, Department of Biomedical and Clinical Sciences, Luigi Sacco Hospital, Università degli Studi di Milano, Milan, Italy
| | - Elisa Monge
- Division of Infectious Diseases, Department of Biomedical and Clinical Sciences, Luigi Sacco Hospital, Università degli Studi di Milano, Milan, Italy
| | - Michele Montuori
- Division of Infectious Diseases, Department of Biomedical and Clinical Sciences, Luigi Sacco Hospital, Università degli Studi di Milano, Milan, Italy
| | - Manuela Morosi
- Division of Infectious Diseases, Department of Biomedical and Clinical Sciences, Luigi Sacco Hospital, Università degli Studi di Milano, Milan, Italy
| | - Massimo Galli
- Division of Infectious Diseases, Department of Biomedical and Clinical Sciences, Luigi Sacco Hospital, Università degli Studi di Milano, Milan, Italy
| | - Fabio Franzetti
- Division of Infectious Diseases, Department of Biomedical and Clinical Sciences, Luigi Sacco Hospital, Università degli Studi di Milano, Milan, Italy
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12
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Giordani MT, Tamarozzi F, Kaminstein D, Brunetti E, Heller T. Point-of-care lung ultrasound for diagnosis of Pneumocystis jirovecii pneumonia: notes from the field. Crit Ultrasound J 2018; 10:8. [PMID: 29666966 PMCID: PMC5904093 DOI: 10.1186/s13089-018-0089-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 04/09/2018] [Indexed: 12/13/2022] Open
Abstract
Background Thoracic ultrasound is helpful to evaluate lung pathology in patients with acute dyspnea. Several studies have demonstrated the efficacy of point-of-care ultrasound in patients with extrapulmonary TB and HIV co-infection. This retrospective, open-label case–control study explores the role of lung ultrasound in the diagnosis of Pneumocystis jirovecii pneumonia (PJP) in HIV-positive patients. In particular, it highlights the potential role of specific sonographic features that may be unique to this population. Methods The record of all HIV-positive patients admitted from 1.1.2013 to 31.6.2017 to the Department of Infectious Diseases and Tropical Medicine of san Bortolo Hospital, Vicenza, Italy, with a discharge diagnosis of acute lung injury (ALI) and who received point-of-care ultrasound of the chest for clinical purposes was included in the analysis. The patients were scanned according with the evidence-based recommendation. Results Of 273 HIV-positive patients whose records were reviewed, 81 (29.6%) were diagnosed with ALI. Complete documentation was available for 24 patients, of which 14 (58.3%) had microbiologically confirmed PJP (PJP+) and 10 (41.7%) had other conditions (PJP−). B-lines, subpleural consolidations, and cystic changes were significantly more frequent in patients with PJP (14/14 vs. 6/10, p = 0.0198; 14/14 vs. 4/10, p = 0.0016; 8/14 vs. 0/10, p = 0.0019, respectively). In particular, B-lines and subpleural consolidations were present in all PJP+ patients in our cohort giving a sensitivity of 100%, but their specificity was low (45 and 60%, respectively). On the contrary, the presence of consolidations with cystic changes had a very high specificity for PJP (100%), but low sensitivity (57%). Pleural effusions and consolidations with linear air bronchograms were not observed in PJP+ patients. Conclusions B-lines, subpleural consolidations, and cystic changes are suggestive of PJP. Lung consolidation with air bronchograms and pleural effusion should prompt suspicion of other etiologies. These findings have the potential to be useful in the daily management of HIV-positive patients in resource-limited settings where other diagnostic tools are rarely available. Electronic supplementary material The online version of this article (10.1186/s13089-018-0089-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maria Teresa Giordani
- Infectious and Tropical Diseases Unit, San Bortolo Hospital, Via Rodolfi 37, 36100, Vicenza, Italy.
| | - Francesca Tamarozzi
- Center for Tropical Diseases, Sacro Cuore-Don Calabria Hospital, Negrar, Verona, Italy
| | - Daniel Kaminstein
- Department of Emergency Medicine and Hospitalist Service, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Enrico Brunetti
- Division of Infectious and Tropical Diseases, University of Pavia, IRCCS S. Matteo Hospital Foundation, Pavia, Italy
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Sodhi KS, Bhalla AS, Mahomed N, Laya BF. Imaging of thoracic tuberculosis in children: current and future directions. Pediatr Radiol 2017; 47:1260-1268. [PMID: 29052772 DOI: 10.1007/s00247-017-3866-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 03/11/2017] [Accepted: 04/09/2017] [Indexed: 12/18/2022]
Abstract
Tuberculosis continues to be an important cause of morbidity and mortality worldwide. It is the leading cause of infection-related deaths worldwide. Children are amongst the high-risk groups for developing tuberculosis and often pose a challenge to the clinicians in making a definitive diagnosis. The newly released global tuberculosis report from World Health Organization reveals a 50% increase in fatality from tuberculosis in children. Significantly, diagnostic and treatment algorithms of tuberculosis for children differ from those of adults. Bacteriologic confirmation of the disease is often difficult in children; hence radiologists have an important role to play in early diagnosis of this disease. Despite advancing technology, the key diagnostic imaging modalities for primary care and emergency services, especially in rural and low-resource areas, are chest radiography and ultrasonography. In this article, we discuss various diagnostic imaging modalities used in diagnosis and treatment of tuberculosis and their indications. We highlight the use of US as point-of-care service along with mediastinal US and rapid MRI protocols, especially in mediastinal lymphadenopathy and thoracic complications. MRI is the ideal modality in high-resource areas when adequate infrastructure is available. Because the prevalence of tuberculosis is highest in lower-resource countries, we also discuss global initiatives in low-resource settings.
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Affiliation(s)
- Kushaljit Singh Sodhi
- Department of Radiodiagnosis & Imaging, Post Graduate Institute of Medical Education & Research (PGIMER), Sector-12, Chandigarh, 160012, India.
| | - Ashu S Bhalla
- Department of Radiodiagnosis, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Nasreen Mahomed
- Department of Radiology, Rahima Moosa Mother and Child Hospital, University of Witwatersrand, Johannesburg, South Africa
| | - Bernard F Laya
- Institute of Radiology, St. Luke's Medical Center-Global City, Taguig City, Philippines
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14
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Aston SJ. Pneumonia in the developing world: Characteristic features and approach to management. Respirology 2017; 22:1276-1287. [PMID: 28681972 DOI: 10.1111/resp.13112] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 04/26/2017] [Accepted: 04/27/2017] [Indexed: 01/22/2023]
Abstract
Community-acquired pneumonia (CAP) is a common cause of morbidity and mortality in adults worldwide, but its epidemiology varies markedly by region. Whilst in high-income countries, the predominant burden of CAP is in the elderly and those with chronic cardiovascular and pulmonary co-morbidity, CAP patients in low-income settings are often of working age and, in sub-Saharan Africa, frequently HIV-positive. Although region-specific aetiological data are limited, they are sufficient to highlight major trends: in high-burden settings, tuberculosis (TB) is a common cause of acute CAP; Gram-negative pathogens such as Klebsiella pneumoniae are regionally important; and HIV-associated opportunistic infections are common but difficult to diagnose. These differences in epidemiology and aetiological profile suggest that modified approaches to diagnosis, severity assessment and empirical antimicrobial therapy of CAP are necessary, but tailored individualized management approaches are constrained by limitations in the availability of radiological and laboratory diagnostic services, as well as medical expertise. The widespread introduction of the Xpert MTB/RIF platform represents a major advance for TB diagnosis, but innovations in rapid diagnostics for other opportunistic pathogens are urgently needed. Severity assessment tools (e.g. CURB65) that are used to guide early management decisions in CAP have not been widely validated in low-income settings and locally adapted tools are required. The optimal approach to initial antimicrobial therapy choices such as the need to provide early empirical cover for atypical bacteria and TB remain poorly defined. Improvements in supportive care such as correcting hypoxaemia and intravenous fluid management represent opportunities for substantial reductions in mortality.
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Affiliation(s)
- Stephen J Aston
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK.,Tropical and Infectious Diseases Unit, Royal Liverpool University Hospital, Liverpool, UK
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15
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Agostinis P, Copetti R, Lapini L, Badona Monteiro G, N'Deque A, Baritussio A. Chest ultrasound findings in pulmonary tuberculosis. Trop Doct 2017; 47:320-328. [PMID: 28541140 DOI: 10.1177/0049475517709633] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
In resource-limited countries, the diagnosis of pulmonary tuberculosis (TB) is based on clinical findings, chest radiography and the demonstration of acid-fast bacilli in sputum. Few data are available on the use of ultrasound (US) to diagnose pulmonary TB. Chest US was performed in patients with lung TB from a rural African setting, to look for signs of the disease and to clarify the role US may have in the diagnosis of pulmonary TB. Sixty adult patients diagnosed with lung TB underwent chest US. All patients had abnormal findings. The most frequent was a subpleural nodule (SUN), which was mostly multiple and also found in radiologically normal areas. Other findings were lung consolidations, cavitations, miliary patterns made of miniature SUNs, and pleural and pericardial effusions. Chest US is a complementary tool in evaluating patients with suspected lung TB in resource-limited settings where the disease has high prevalence.
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Affiliation(s)
- Paolo Agostinis
- 1 Department of Medicine, Ospedale San Antonio Abate Tolmezzo, Italy
| | | | - Laura Lapini
- 3 Department of Infectious Diseases, Ospedale San Donato Arezzo, Italy
| | | | - Augusto N'Deque
- 5 Medical Ward, Hospital do Mal de Hansen Cumura, Guinea Bissau
| | - Aldo Baritussio
- 6 Department of Medicine, University of Padova, Padova, Italy
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16
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Gharahbaghian L, Anderson KL, Lobo V, Huang RW, Poffenberger CM, Nguyen PD. Point-of-Care Ultrasound in Austere Environments. Emerg Med Clin North Am 2017; 35:409-441. [DOI: 10.1016/j.emc.2016.12.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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17
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Trovato FM, Catalano D, Trovato GM. Thoracic ultrasound: An adjunctive and valuable imaging tool in emergency, resource-limited settings and for a sustainable monitoring of patients. World J Radiol 2016; 8:775-784. [PMID: 27721940 PMCID: PMC5039673 DOI: 10.4329/wjr.v8.i9.775] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 07/11/2016] [Accepted: 08/01/2016] [Indexed: 02/06/2023] Open
Abstract
Imaging workup of patients referred for elective assessment of chest disease requires an articulated approach: Imaging is asked for achieving timely diagnosis. The concurrent or subsequent use of thoracic ultrasound (TUS) with conventional (chest X-rays-) and more advanced imaging procedures (computed tomography and magnetic resonance imaging) implies advantages, limitations and actual problems. Indeed, despite TUS may provide useful imaging of pleura, lung and heart disease, emergency scenarios are currently the most warranted field of application of TUS: Pleural effusion, pneumothorax, lung consolidation. This stems from its role in limited resources subsets; actually, ultrasound is an excellent risk reducing tool, which acts by: (1) increasing diagnostic certainty; (2) shortening time to definitive therapy; and (3) decreasing problems from blind procedures that carry an inherent level of complications. In addition, paediatric and newborn disease are particularly suitable for TUS investigation, aimed at the detection of congenital or acquired chest disease avoiding, limiting or postponing radiological exposure. TUS improves the effectiveness of elective medical practice, in resource-limited settings, in small point of care facilities and particularly in poorer countries. Quality and information provided by the procedure are increased avoiding whenever possible artefacts that can prevent or mislead the achievement of the correct diagnosis. Reliable monitoring of patients is possible, taking into consideration that appropriate expertise, knowledge, skills, training, and even adequate equipment’s suitability are not always and everywhere affordable or accessible. TUS is complementary imaging procedure for the radiologist and an excellent basic diagnostic tool suitable to be shared with pneumologists, cardiologists and emergency physicians.
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18
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Bélard S, Tamarozzi F, Bustinduy AL, Wallrauch C, Grobusch MP, Kuhn W, Brunetti E, Joekes E, Heller T. Point-of-Care Ultrasound Assessment of Tropical Infectious Diseases--A Review of Applications and Perspectives. Am J Trop Med Hyg 2016; 94:8-21. [PMID: 26416111 PMCID: PMC4710450 DOI: 10.4269/ajtmh.15-0421] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 08/18/2015] [Indexed: 12/28/2022] Open
Abstract
The development of good quality and affordable ultrasound machines has led to the establishment and implementation of numerous point-of-care ultrasound (POCUS) protocols in various medical disciplines. POCUS for major infectious diseases endemic in tropical regions has received less attention, despite its likely even more pronounced benefit for populations with limited access to imaging infrastructure. Focused assessment with sonography for HIV-associated TB (FASH) and echinococcosis (FASE) are the only two POCUS protocols for tropical infectious diseases, which have been formally investigated and which have been implemented in routine patient care today. This review collates the available evidence for FASH and FASE, and discusses sonographic experiences reported for urinary and intestinal schistosomiasis, lymphatic filariasis, viral hemorrhagic fevers, amebic liver abscess, and visceral leishmaniasis. Potential POCUS protocols are suggested and technical as well as training aspects in the context of resource-limited settings are reviewed. Using the focused approach for tropical infectious diseases will make ultrasound diagnosis available to patients who would otherwise have very limited or no access to medical imaging.
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Affiliation(s)
- Sabine Bélard
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Pediatric Pneumology and Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany; Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, World Health Organization Collaborating Centre for Clinical Management of Cystic Echinococcosis, University of Pavia, Pavia, Italy; Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St. George's University of London, London, United Kingdom; Department of Medicine, Klinikum Muenchen-Perlach, Munich, Germany; Center for Operational Medicine, Medical College Georgia, Georgia Regents University, Augusta, Georgia; Division of Infectious and Tropical Diseases, University of Pavia/IRCCS San Matteo Hospital Foundation, Pavia, Italy; Department of Radiology, The Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom
| | - Francesca Tamarozzi
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Pediatric Pneumology and Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany; Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, World Health Organization Collaborating Centre for Clinical Management of Cystic Echinococcosis, University of Pavia, Pavia, Italy; Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St. George's University of London, London, United Kingdom; Department of Medicine, Klinikum Muenchen-Perlach, Munich, Germany; Center for Operational Medicine, Medical College Georgia, Georgia Regents University, Augusta, Georgia; Division of Infectious and Tropical Diseases, University of Pavia/IRCCS San Matteo Hospital Foundation, Pavia, Italy; Department of Radiology, The Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom
| | - Amaya L Bustinduy
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Pediatric Pneumology and Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany; Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, World Health Organization Collaborating Centre for Clinical Management of Cystic Echinococcosis, University of Pavia, Pavia, Italy; Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St. George's University of London, London, United Kingdom; Department of Medicine, Klinikum Muenchen-Perlach, Munich, Germany; Center for Operational Medicine, Medical College Georgia, Georgia Regents University, Augusta, Georgia; Division of Infectious and Tropical Diseases, University of Pavia/IRCCS San Matteo Hospital Foundation, Pavia, Italy; Department of Radiology, The Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom
| | - Claudia Wallrauch
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Pediatric Pneumology and Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany; Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, World Health Organization Collaborating Centre for Clinical Management of Cystic Echinococcosis, University of Pavia, Pavia, Italy; Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St. George's University of London, London, United Kingdom; Department of Medicine, Klinikum Muenchen-Perlach, Munich, Germany; Center for Operational Medicine, Medical College Georgia, Georgia Regents University, Augusta, Georgia; Division of Infectious and Tropical Diseases, University of Pavia/IRCCS San Matteo Hospital Foundation, Pavia, Italy; Department of Radiology, The Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom
| | - Martin P Grobusch
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Pediatric Pneumology and Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany; Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, World Health Organization Collaborating Centre for Clinical Management of Cystic Echinococcosis, University of Pavia, Pavia, Italy; Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St. George's University of London, London, United Kingdom; Department of Medicine, Klinikum Muenchen-Perlach, Munich, Germany; Center for Operational Medicine, Medical College Georgia, Georgia Regents University, Augusta, Georgia; Division of Infectious and Tropical Diseases, University of Pavia/IRCCS San Matteo Hospital Foundation, Pavia, Italy; Department of Radiology, The Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom
| | - Walter Kuhn
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Pediatric Pneumology and Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany; Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, World Health Organization Collaborating Centre for Clinical Management of Cystic Echinococcosis, University of Pavia, Pavia, Italy; Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St. George's University of London, London, United Kingdom; Department of Medicine, Klinikum Muenchen-Perlach, Munich, Germany; Center for Operational Medicine, Medical College Georgia, Georgia Regents University, Augusta, Georgia; Division of Infectious and Tropical Diseases, University of Pavia/IRCCS San Matteo Hospital Foundation, Pavia, Italy; Department of Radiology, The Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom
| | - Enrico Brunetti
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Pediatric Pneumology and Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany; Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, World Health Organization Collaborating Centre for Clinical Management of Cystic Echinococcosis, University of Pavia, Pavia, Italy; Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St. George's University of London, London, United Kingdom; Department of Medicine, Klinikum Muenchen-Perlach, Munich, Germany; Center for Operational Medicine, Medical College Georgia, Georgia Regents University, Augusta, Georgia; Division of Infectious and Tropical Diseases, University of Pavia/IRCCS San Matteo Hospital Foundation, Pavia, Italy; Department of Radiology, The Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom
| | - Elizabeth Joekes
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Pediatric Pneumology and Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany; Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, World Health Organization Collaborating Centre for Clinical Management of Cystic Echinococcosis, University of Pavia, Pavia, Italy; Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St. George's University of London, London, United Kingdom; Department of Medicine, Klinikum Muenchen-Perlach, Munich, Germany; Center for Operational Medicine, Medical College Georgia, Georgia Regents University, Augusta, Georgia; Division of Infectious and Tropical Diseases, University of Pavia/IRCCS San Matteo Hospital Foundation, Pavia, Italy; Department of Radiology, The Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom
| | - Tom Heller
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Pediatric Pneumology and Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany; Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, World Health Organization Collaborating Centre for Clinical Management of Cystic Echinococcosis, University of Pavia, Pavia, Italy; Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St. George's University of London, London, United Kingdom; Department of Medicine, Klinikum Muenchen-Perlach, Munich, Germany; Center for Operational Medicine, Medical College Georgia, Georgia Regents University, Augusta, Georgia; Division of Infectious and Tropical Diseases, University of Pavia/IRCCS San Matteo Hospital Foundation, Pavia, Italy; Department of Radiology, The Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom
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19
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Hunter L, Bélard S, Janssen S, van Hoving DJ, Heller T. Miliary tuberculosis: sonographic pattern in chest ultrasound. Infection 2015; 44:243-6. [PMID: 26661658 DOI: 10.1007/s15010-015-0865-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Accepted: 11/28/2015] [Indexed: 12/16/2022]
Abstract
Miliary tuberculosis (TB) is characterized by a multitude of small nodular opacities on chest radiography. Despite ultrasound of the chest gaining wider acceptance as a diagnostic tool of lung infections, sonographic changes of pulmonary miliary TB have not yet been reported. Here, we describe B-lines and comet-tail artifacts disseminated throughout multiple lung areas and a pattern of sub-pleural granularity as consistent changes seen in lung ultrasound of ten patients with pulmonary miliary TB diagnosed by chest radiography.
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Affiliation(s)
- L Hunter
- Khayelitsha District Hospital, Cape Town, South Africa
| | - S Bélard
- Department of Pediatric Pneumology and Immunology, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - S Janssen
- Clinical Infectious Disease Research Initiative (CIDRI), Institute of Infectious Disease and Molecular Medicine, Cape Town, South Africa
| | - D J van Hoving
- Division of Emergency Medicine, Stellenbosch University, Cape Town, South Africa
| | - T Heller
- Department of Medicine, Klinikum Muenchen-Perlach, Munich, Germany
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