Stefan Fabian Weber, Peter Wolf, Nils Wetzstein, Claus Küpper-Tetzel, Maria Vehreschild, Isabelle Suárez, Jan Rybniker, Angela Klingmüller, Tim Weber, Maximilian Güttlein, Frank Tobian, Lisa Koeppel, Julia Selena Beck, Rebecca Wolf, Katharina Manten, Stefan Zimmermann, Devasahayam Jesudas Christopher, Felix Herth, Sabine Bélard, Claudia M Denkinger
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引用次数: 0
Abstract
Background: There is limited evidence on point-of-care ultrasound for tuberculosis (TB), but studies suggest high sensitivity, especially for lung ultrasound (LUS). However, insufficient data are available on specificity of the examination and its generalizability to a broader patient population.
Aims: Our study aimed to establish accuracy for lung, chest, and abdominal ultrasound, individually and in combination, for TB diagnosis.
Methods: We conducted a prospective diagnostic accuracy study among consecutive adult out- and inpatients with probable TB in three German referral hospitals. We applied a comprehensive standardized ultrasound protocol. TB diagnosis was established by a microbiological reference standard including polymerase chain reaction and culture.
Results: A total of 102 participants originating from 30 different countries were enrolled. HIV prevalence was 7/99 (7%) and 73/102 (72%) had confirmed TB. TB was limited to the lungs in 15/34 (44%) of refugees and 27/39 (69%) in nonrefugees. Focused assessment with sonography for HIV-associated tuberculosis had a sensitivity of 40% (95% confidence interval [CI], 30-52) and specificity of 55% (95% CI, 38-72). Additional findings, such as small subpleural consolidations on LUS had a high sensitivity (88%; 95% CI, 78-93), but a low specificity (17%; 95% CI, 8-35). Larger consolidations in the lung apices had a sensitivity of 19% (95% CI, 12-30) and a specificity of 97% (95% CI, 83-100).
Conclusions: Our study establishes the first data on LUS performance against a comprehensive reference standard. Overall, our data suggest that ultrasound does not meet the requirements for triage but previously described and novel ultrasound targets in combination could aid in the clinical decision making.Registry: DRKS00026636.
期刊介绍:
Open Forum Infectious Diseases provides a global forum for the publication of clinical, translational, and basic research findings in a fully open access, online journal environment. The journal reflects the broad diversity of the field of infectious diseases, and focuses on the intersection of biomedical science and clinical practice, with a particular emphasis on knowledge that holds the potential to improve patient care in populations around the world. Fully peer-reviewed, OFID supports the international community of infectious diseases experts by providing a venue for articles that further the understanding of all aspects of infectious diseases.