Abdominal tuberculosis: sonographic diagnosis and treatment response in HIV-positive adults in rural South Africa

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• 作者：Tom Heller ; Sam Goblirsch ; Claudia Wallrauch ; Richard Lessells ; Enrico Brunetti
• 关键词：Ultrasound ; TB ; HIV
• 刊名：International Journal of Infectious Diseases
• 出版年：2010
• 出版时间：September 2010
• 年：2010
• 卷：14
• 期：Supplement 3
• 页码：e108-e112
• 全文大小：181 K

文摘

Summary

Objective

To investigate the diagnostic value of abdominal ultrasound in HIV-positive inpatients in a rural African setting.

Methods

This 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.

Results

One 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.

Conclusions

Characteristic 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.