Abstract
SummaryObjectiveTo investigate the diagnostic value of abdominal ultrasound in HIV-positive inpatients in a rural African setting.MethodsThis was a prospective case series over 3 months of adult HIV-positive patients with symptoms suggestive of abdominal tuberculosis (TB). Diagnostic ultrasound was performed for all patients: sonographic criteria included abdominal lymph node enlargement (>1.5 cm) and focal splenic lesions; ascites was a supportive finding. Further diagnostic studies, e.g., aspiration or biopsy were not routinely performed. TB treatment was initiated on the basis of clinical and sonographic features. The patients were contacted after 4 months to evaluate the clinical outcome.ResultsOne hundred and eighty adult HIV-positive patients were screened; 30 (16.7%) showed sonographic signs of abdominal TB. The median CD4 count was 78 cells/mm3. Presenting symptoms were weight loss (86.7%), abdominal pain (76.7%), and diarrhea (60%). Abdominal lymph node enlargement was the diagnostic finding in almost all cases (96.7%); hypoechoic lesions of the spleen were seen in 50% and ascites in 73.3%. Follow-up information was available for 25 patients: 24% had died and the remaining 76% reported symptomatic improvement and weight gain.ConclusionsCharacteristic sonographic features of abdominal TB are common in HIV-infected inpatients in a rural African setting. Ultrasound should be introduced into clinical algorithms for the diagnosis of extrapulmonary TB.
Highlights
The convergence of the HIV and tuberculosis (TB) epidemics in Southern Africa has contributed to a significant increase in reported cases of TB and especially of extrapulmonary TB (EPTB).[1]
Three patients were on antiretroviral therapy (ART) at the time of the examination
In our patient series we found that ultrasound is a feasible technique to add weight to a diagnosis of abdominal TB in HIVinfected patients
Summary
The convergence of the HIV and tuberculosis (TB) epidemics in Southern Africa has contributed to a significant increase in reported cases of TB and especially of extrapulmonary TB (EPTB).[1] Abdominal TB is a frequent localization of EPTB in HIV-positive patients.[2] Abdominal symptoms are common at all stages of HIV infection, but at advanced stages of immunosuppression It can be challenging in a setting with limited diagnostics to differentiate between symptoms caused by HIV itself and symptoms related to opportunistic infection or neoplasm.[3] The lack of advanced imaging techniques such as computed tomography (CT) and magnetic resonance imaging (MRI), and the limited use of cytology, histology, and cultures, compel physicians to make treatment decisions based on history, clinical examina-. In the rural district hospital setting, ultrasound is often the most commonly available imaging modality
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