High sensitivity of ultrasound for the diagnosis of tuberculosis in adults in South Africa: A proof-of-concept study

Matthew Fentress; Patricia C Henwood; Priya Maharaj; Mohammed Mitha; Dilshaad Khan; Philip Caligiuri; Aaron S Karat; Stephen Olivier; Anita Edwards; Dirhona Ramjit; Nokwanda Ngcobo; Emily B Wong; Alison D Grant

doi:10.1371/journal.pgph.0000800

High sensitivity of ultrasound for the diagnosis of tuberculosis in adults in South Africa: A proof-of-concept study

PLOS Glob Public Health. 2022 Oct 6;2(10):e0000800. doi: 10.1371/journal.pgph.0000800. eCollection 2022.

Authors

Matthew Fentress¹, Patricia C Henwood², Priya Maharaj³, Mohammed Mitha³, Dilshaad Khan³, Philip Caligiuri^{4

5}, Aaron S Karat¹, Stephen Olivier⁶, Anita Edwards⁶, Dirhona Ramjit⁶, Nokwanda Ngcobo⁶, Emily B Wong^{6

7}, Alison D Grant^{1

8

9}

Affiliations

¹ TB Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom.
² Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America.
³ Department of Pulmonology and Critical Care, Inkosi Albert Luthuli Central Hospital, Durban, South Africa.
⁴ Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah, United States of America.
⁵ Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah, United States of America.
⁶ Africa Health Research Institute, KwaZulu-Natal, South Africa.
⁷ Division of Infectious Diseases, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America.
⁸ Africa Health Research Institute, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, KwaZulu-Natal, South Africa.
⁹ School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.

Abstract

Background: There are limited data on the performance characteristics of ultrasound for the diagnosis of pulmonary tuberculosis in both HIV-positive and HIV-negative persons. The objective of this proof-of-concept study was to determine the sensitivity and specificity of ultrasound for the diagnosis of tuberculosis in adults.

Methods: Comprehensive thoracic and focused abdominal ultrasound examinations were performed by trained radiologists and pulmonologists on adults recruited from a community multimorbidity survey and a primary healthcare clinic in KwaZulu-Natal Province, South Africa. Sputum samples were systematically collected from all participants. Sensitivity and specificity of ultrasound to detect tuberculosis were calculated compared to a reference standard of i) bacteriologically-confirmed tuberculosis, and ii) either bacteriologically-confirmed or radiologic tuberculosis.

Results: Among 92 patients (53 [58%] male, mean age 41.9 [standard deviation 13.7] years, 49 [53%] HIV positive), 34 (37%) had bacteriologically-confirmed tuberculosis, 8 (9%) had radiologic tuberculosis with negative bacteriologic studies, and 50 (54%) had no evidence of active tuberculosis. Ultrasound abnormalities on either thoracic or abdominal exams were detected in 31 (91%) participants with bacteriologic tuberculosis and 27 (54%) of those without tuberculosis. Sensitivity and specificity of any ultrasound abnormality for bacteriologically-confirmed tuberculosis were 91% (95% confidence interval [CI] 76%-98%) and 46% (95% CI 32%-61%). Sensitivity and specificity of any ultrasound abnormality for either bacteriologically-confirmed or radiologic tuberculosis were 86% (95% CI 71%-95%) and 46% (95% CI 32%-61%). Overall performance did not appear to differ markedly between participants with and without HIV.

Conclusion: A comprehensive ultrasound scanning protocol in adults in a high TB burden setting had high sensitivity but low specificity to identify bacteriologically-confirmed tuberculosis.

Copyright: © 2022 Fentress et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Grants and funding

This work was supported, in whole or in part, by the Bill & Melinda Gates Foundation (Grant Number OPP1212544). AG and EW are the PI and co-PI, respectively, for this grant. The funders were involved in the design of the study, but had no role in data collection, data analysis, decision to publish or preparation of the manuscript. Under the grant conditions of the Foundation, a Creative Commons Attribution 4.0 Generic License has already been assigned to the Author Accepted Manuscript version that might arise from this submission.