Abdominal ultrasound for diagnosing abdominal tuberculosis or disseminated tuberculosis with abdominal involvement in HIV-positive individuals

Abstract

BackgroundAccurate diagnosis of tuberculosis in people living with HIV is difficult. HIV‐positive individuals have higher rates of extrapulmonary tuberculosis and the diagnosis of tuberculosis is often limited to imaging results. Ultrasound is such an imaging test that is widely used as a diagnostic tool (including point‐of‐care) in people suspected of having abdominal tuberculosis or disseminated tuberculosis with abdominal involvement.ObjectivesTo determine the diagnostic accuracy of abdominal ultrasound for detecting abdominal tuberculosis or disseminated tuberculosis with abdominal involvement in HIV‐positive individuals.To investigate potential sources of heterogeneity in test accuracy, including clinical setting, ultrasound training level, and type of reference standard.Search methodsWe searched for publications in any language up to 4 April 2019 in the following databases: MEDLINE, Embase, BIOSIS, Science Citation Index Expanded (SCI‐EXPANDED), Social Sciences Citation Index (SSCI), Conference Proceedings Citation Index‐ Science (CPCI‐S), and also ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform to identify ongoing trials.Selection criteriaWe included cross‐sectional, cohort, and diagnostic case‐control studies (prospective and retrospective) that compared the result of the index test (abdominal ultrasound) with one of the reference standards. We only included studies that allowed for extraction of numbers of true positives (TPs), true negatives (TNs), false positives (FPs), and false negatives (FNs). Participants were HIV‐positive individuals aged 15 years and older. A higher‐quality reference standard was the bacteriological confirmation of Mycobacterium tuberculosis from any clinical specimen, and a lower‐quality reference standard was a clinical diagnosis of tuberculosis without microbiological confirmation. We excluded genitourinary tuberculosis.Data collection and analysisFor each study, two review authors independently extracted data using a standardized form. We assessed the quality of studies using a tailored Quality Assessment of Diagnostic Accuracy Studies‐2 (QUADAS‐2) tool. We used the bivariate model to estimate pooled sensitivity and specificity. When studies were few we simplified the bivariate model to separate univariate random‐effects logistic regression models for sensitivity and specificity. We explored the influence of the type of reference standard on the accuracy estimates by conducting separate analyses for each type of reference standard. We assessed the certainty of the evidence using the GRADE approach.Main resultsWe included 11 studies. The risks of bias and concern about applicability were often high or unclear in all domains. We included six studies in the main analyses of any abnormal finding on abdominal ultrasound; five studies reported only individual lesions.The six studies of any abnormal finding were cross‐sectional or cohort studies. Five of these (83%) were conducted in low‐ or middle‐income countries, and one in a high‐income country. The...

Abdominal ultrasound in the diagnostic work-up of visceral leishmaniasis and for detection of complications of spleen aspiration

“…Our study questions the value of abdominal US in VL diagnosis as part of routine care in VL suspect patients. It remains to be further assessed whether the procedure would be useful in HIV patients with suspected VL, as concurrent tuberculosis has been reported to be very common in this group and US could contribute to the diagnosis of disseminated or abdominal tuberculosis [ 23 ]. Comparative studies in Ethiopia and Sudan would also shed light on the discrepancies in findings seen in our and reported studies from Sudan.…”

Utility of circulating cell-free Mycobacterium tuberculosis DNA for the improved diagnosis of abdominal tuberculosis

“…tuberculosis is very low from ascitic fluid [ 3 ], thus a composite reference standard (CRS) was used in the study. The CRS was broadly based on published guidelines and previous categorizations for ATB and comprised of clinical, radiological, microbiological and biochemical findings associated with ATB patients and response to ATT ( Fig 2 ) [ 3 , 22 , 38 ]. Based on the CRS, the patients were categorised into ‘Definite’ ATB, ‘Probable’ ATB, ‘Possible’ ATB and ‘Non-TB’ groups ( Fig 2 ).…”

“…‘Possible’ ATB category (n = 13) included patients who presented with chronic symptoms of ATB with either radiology suggestive of ATB (palpable abdominal mass or omental thickening) or an abnormal chest X-ray (consolidation, calcification or pleural effusion) or presence of other features as described in Fig 2 . [ 3 , 4 , 22 , 38 ]. However, in this group, the information about response to ATT was not available because either the patient got lost to follow up (n = 11) or left against medical advice (n = 2).…”

“…The 'Definite' ATB category included patients who were M. tuberculosis culture-positive (n = 2) and 'Probable' ATB category (n = 16) included patients who were clinically diagnosed as ATB and responded to anti tubercular therapy [3,38] (Fig 2). 'Possible' ATB category (n = 13) included patients who presented with chronic symptoms of ATB with either radiology suggestive of ATB (palpable abdominal mass or omental thickening) or an abnormal chest X-ray (consolidation, calcification or pleural effusion) or presence of other features as described in Fig 2. [ 3,4,22,38]. However, in this group, the information about response to ATT was not available because either the patient got lost to follow up (n = 11) or left against medical advice (n = 2).…”

Ultrasound in managing extrapulmonary tuberculosis: a randomized controlled two-center study

“…In a recent Cochrane metanalysis including HIV-positive adults, FASH signs predicted tuberculosis with a moderate diagnostic performance only. The authors also concluded that ultrasound results should be considered in combination with other tests, such as chest X-ray and Xpert MTB/RIF® only [10]. No randomized controlled trial evaluating sonography for the diagnosis of tuberculosis has been done yet.…”