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

Abstract

Introduction Abdominal ultrasound (US) is increasingly used in the diagnostic work-up of infectious diseases, but studies on its diagnostic value in visceral leishmaniasis (VL) are lacking. US could help to identify complications of spleen aspiration (SA). We aimed to assess the diagnostic value of US and the evolution of findings after VL treatment; the incidence and degree of splenic injury; and the pain perceived during SA. Methodology/result We conducted a cross-sectional prospective study at the Leishmaniasis Research and Treatment Center, Gondar, Ethiopia between Oct 2017 and Dec 2018. We enrolled VL suspects undergoing tissue aspiration; US were conducted before and after SA, and at the end of VL treatment. Splenic injury was graded using the American association of surgery trauma injury scale (grade 1–4). The pain perceived during SA was graded using a visual analogue scale. Out of 392 VL suspects, 192 (49%) were confirmed VL cases. The median age was 25 years (IQR 21–30). Massive splenomegaly and hepatomegaly were the most common US findings. Splenic nodules were seen in 3.7% of the 190 VL cases and 1.5% of the 197 non-VL cases. Ascites was more common in VL (16.4%) than in non-VL cases (9.1%). The frequency of US abnormalities decreased with treatment. None of the US findings had sufficient sensitivity and specificity to justify its use as a diagnostic test. US detected splenic injury in four of the 318 patients who had post-SA US. All four patients remained clinically stable. Pain was perceived as moderate or severe in 51% of patients. Conclusion The diagnostic value of abdominal US for VL was low but found useful to detect subclinical splenic injury. SA caries a risk of splenic injury and was perceived painful by most. Further research on less invasive diagnostic tools is needed.

Task shifting for point of care ultrasound in primary healthcare in low- and middle-income countries-a systematic review

“…The study from Morocco on POCUS screening for cystic echinococcosis (CE) 22 an infectious disease with a primarily imaging-based diagnosis, 86 proved not only feasible and successful in identifying the disease, but is a good example that POCUS can also support the implementation of disease control activities. POCUS for the detection of urogenital schistosomiasis, 49 POCUS to guide management of severe malaria, 87 POCUS for early detection of vascular leakage in severe dengue 88 and POCUS for visceral leishmaniasis 89,90 FAST: focused assessment with sonography for trauma, FASH: focused assessment with sonography for HIV-associated tuberculosis, FASE: focused assessment with sonography for echinococcosis.…”

Comments and illustrations of the WFUMB CEUS liver guidelines: Rare focal liver lesion – infectious parasitic, fungus

“…In addition to observations of lymphadenopathy, small hypoechoic lesions are often detected in the spleen [78,79,81,[94][95][96][97][98][99][100]. Focal liver lesions are extremely rare [101]. Bükte et al report a case of visceral leishmaniasis with such lesions [97].…”

Utility of chest imaging in the diagnosis and management of patients with visceral leishmaniasis: A systematic review

“…21 A study conducted in Ethiopia reported that there is no evidence to support the routine use of abdominal US in the management of VL except to detect subclinical complications of splenic aspiration. 29 However, previous studies have given limited attention to chest imaging findings, which are not uncommon, with a sparse attempt to review the diagnostic yield of specimens from the identified lesions. To the best of our knowledge, this is the first systematic review done on this subject.…”

“… 9 Tissue sampling, especially splenic aspiration, can lead to serious complications in inexperienced hands. 20 , 28 , 29 Clinical findings in VL are nonspecific 12 , 16 and immunosuppressed patients, AIDS patients, transplant recipients, and children with primary immunodeficiency can have atypical presentations. 18 – 20 These all add to a complex diagnosis of VL.…”

“… 27 In the case of VL, studies have elaborated the abdominal US findings taking into account typical features of the disease. 28 – 30 One study showed that abdominal US findings, hepatosplenomegaly, lymph node enlargement, and nodular splenic lesions, have unclear diagnostic accuracy. 21 A study conducted in Ethiopia reported that there is no evidence to support the routine use of abdominal US in the management of VL except to detect subclinical complications of splenic aspiration.…”