Point-of-care ultrasound for tuberculosis diagnosis in children: a Médecins Sans Frontières cross-sectional study in Guinea-Bissau
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 ag...
| Main Authors: | , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2023-05-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/13/5/e066937.full |
| _version_ | 1797823568523821056 |
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| author | Laura Moreto-Planas Sakib Burza Raman Mahajan Sabine Bélard Candida Medina María José Sagrado Jonathan Gallo Evelize Biague Ramiro Gonçalves Pablo Nuozzi Merce Rocaspana Jamila Vieira Fonseca Miguel Camará Adi Nadimpalli Beatriz Alonso Augusto E Llosa Lotje Heuvelings Israel Molina Lisa C Ruby Erin Stratta |
| author_facet | Laura Moreto-Planas Sakib Burza Raman Mahajan Sabine Bélard Candida Medina María José Sagrado Jonathan Gallo Evelize Biague Ramiro Gonçalves Pablo Nuozzi Merce Rocaspana Jamila Vieira Fonseca Miguel Camará Adi Nadimpalli Beatriz Alonso Augusto E Llosa Lotje Heuvelings Israel Molina Lisa C Ruby Erin Stratta |
| author_sort | Laura Moreto-Planas |
| collection | DOAJ |
| description | 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.Trial registration number NCT05364593. |
| first_indexed | 2024-03-13T10:24:54Z |
| format | Article |
| id | doaj.art-80d69fee90ff4f339e199ad04b7260a1 |
| institution | Directory Open Access Journal |
| issn | 2044-6055 |
| language | English |
| last_indexed | 2024-03-13T10:24:54Z |
| publishDate | 2023-05-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj.art-80d69fee90ff4f339e199ad04b7260a12023-05-19T14:00:06ZengBMJ Publishing GroupBMJ Open2044-60552023-05-0113510.1136/bmjopen-2022-066937Point-of-care ultrasound for tuberculosis diagnosis in children: a Médecins Sans Frontières cross-sectional study in Guinea-BissauLaura Moreto-Planas0Sakib Burza1Raman Mahajan2Sabine Bélard3Candida Medina4María José Sagrado5Jonathan Gallo6Evelize Biague7Ramiro Gonçalves8Pablo Nuozzi9Merce Rocaspana10Jamila Vieira Fonseca11Miguel Camará12Adi Nadimpalli13Beatriz Alonso14Augusto E Llosa15Lotje Heuvelings16Israel Molina17Lisa C Ruby18Erin Stratta19Medecins Sans Frontieres, New Delhi, Delhi, IndiaMédecins Sans Frontières, New Delhi, IndiaMédecins Sans Frontières, New Delhi, India1 Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, Center of Tropical Medicine and Travel Medicine, University of Amsterdam, Amsterdam, The NetherlandsNational HIV Programme, Ministry of Health, Bissau, Guinea-BissauMedical Department, Médecins Sans Frontières, Barcelona, SpainMedecins Sans Frontières, Bissau, Guinea-BissauMedecins Sans Frontières, Bissau, Guinea-BissauMedecins Sans Frontières, Bissau, Guinea-BissauMedecins Sans Frontières, Bissau, Guinea-BissauMedical Department, Médecins Sans Frontières, Barcelona, SpainSimão Mendes Hospital, Bissau, Guinea-BissauNational Tuberculosis Program, Bissau, Guinea-BissauMedecins Sans Frontières, New York City, New York, USAMedical Department, Médecins Sans Frontières, Barcelona, SpainMedical Department, Médecins Sans Frontières, Barcelona, SpainAmsterdam, NetherlandsDepartment of Infectious Diseases, Vall d’Hebron Hospital Universitari, Barcelona, SpainDepartment of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, Berlin, GermanyMedecins Sans Frontières, New York City, New York, USAObjective 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.Trial registration number NCT05364593.https://bmjopen.bmj.com/content/13/5/e066937.full |
| spellingShingle | Laura Moreto-Planas Sakib Burza Raman Mahajan Sabine Bélard Candida Medina María José Sagrado Jonathan Gallo Evelize Biague Ramiro Gonçalves Pablo Nuozzi Merce Rocaspana Jamila Vieira Fonseca Miguel Camará Adi Nadimpalli Beatriz Alonso Augusto E Llosa Lotje Heuvelings Israel Molina Lisa C Ruby Erin Stratta Point-of-care ultrasound for tuberculosis diagnosis in children: a Médecins Sans Frontières cross-sectional study in Guinea-Bissau BMJ Open |
| title | Point-of-care ultrasound for tuberculosis diagnosis in children: a Médecins Sans Frontières cross-sectional study in Guinea-Bissau |
| title_full | Point-of-care ultrasound for tuberculosis diagnosis in children: a Médecins Sans Frontières cross-sectional study in Guinea-Bissau |
| title_fullStr | Point-of-care ultrasound for tuberculosis diagnosis in children: a Médecins Sans Frontières cross-sectional study in Guinea-Bissau |
| title_full_unstemmed | Point-of-care ultrasound for tuberculosis diagnosis in children: a Médecins Sans Frontières cross-sectional study in Guinea-Bissau |
| title_short | Point-of-care ultrasound for tuberculosis diagnosis in children: a Médecins Sans Frontières cross-sectional study in Guinea-Bissau |
| title_sort | point of care ultrasound for tuberculosis diagnosis in children a medecins sans frontieres cross sectional study in guinea bissau |
| url | https://bmjopen.bmj.com/content/13/5/e066937.full |
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