The Role of Ultrasound in the Diagnosis of Pulmonary Infection Caused by Intracellular, Fungal Pathogens and Mycobacteria: A Systematic Review

Abstract

Background: Lung ultrasound (LUS) is a widely available technique allowing rapid bedside detection of different respiratory disorders. Its reliability in the diagnosis of community-acquired lung infection has been confirmed. However, its usefulness in identifying infections caused by specific and less common pathogens (e.g., in immunocompromised patients) is still uncertain. Methods: This systematic review aimed to explore the most common LUS patterns in infections caused by intracellular, fungal pathogens or mycobacteria. Results: We included 17 studies, reporting a total of 274 patients with M. pneumoniae, 30 with fungal infection and 213 with pulmonary tuberculosis (TB). Most of the studies on M. pneumoniae in children found a specific LUS pattern, mainly consolidated areas associated with diffuse B lines. The typical LUS pattern in TB consisted of consolidation and small subpleural nodes. Only one study on fungal disease reported LUS specific patterns (e.g., indicating “halo sign” or “reverse halo sign”). Conclusions: Considering the preliminary data, LUS appears to be a promising point-of-care tool, showing patterns of atypical pneumonia and TB which seem different from patterns characterizing common bacterial infection. The role of LUS in the diagnosis of fungal disease is still at an early stage of exploration. Large trials to investigate sonography in these lung infections are granted.

Differentiating Viral from Bacterial Pneumonia in Children: The Diagnostic Role of Lung Ultrasound—A Prospective Observational Study

“…In addition to its accuracy in diagnosing pneumonia, LUS has also been shown to be useful in differentiating between bacterial and viral pneumonia in children [ 13 , 14 , 15 ]. This is important because the appropriate treatment for pneumonia depends on the underlying cause, with bacterial pneumonia typically requiring antibiotics and viral pneumonia requiring supportive care [ 4 , 16 ].…”

Lung Ultrasound: A Leading Diagnostic Tool

“…The authors of [4] show how US offers good sensitivity in the detection of pleural abnormalities localized in the costo-phrenic angle (CPA) and how an accurate ultrasound examination of CPA in patients affected by pleural effusion or suspected malignant pleural effusion could assess even millimetric pathological lesions not easily detectable by chest CT scan. In [5], the role of ultrasound in the diagnosis of pulmonary infection, caused by intracellular fungal pathogens or mycobacteria, is analyzed through a systematic review. Lung ultrasound can also be successfully used to examine children [6,7] and newborns [8].…”

“…In most papers reporting damage during lung ultrasound exams, hemorrhages were locally provoked on the lungs of small animals via static long expositions and often by locating the probe directly on the parietal pleura, i.e., by adopting working conditions that are never met in standard lung ultrasound exams. The submitted contributions have demonstrated the solid confidence of physicians to be using a safe [1,3,8,10,13,14] and harmless [8,10,13] imaging device that is free of adverse effects [5] and produces no side effects [12,17]. Computer-aided image analysis is a wide topic ranging from simple algorithms for the detection and counting of vertical artefacts in single-lung US images to convolutional neural networks for an explicit diagnosis of a pathology.…”