Utility of Point-of-Care Ultrasound in Children with Pulmonary Tuberculosis

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Abstract

Background:

Point-of-care ultrasound (POCUS) detects extra-pulmonary tuberculosis (EPTB) in HIV-infected adults but has not been evaluated in children despite their higher risk of EPTB. This study’s aims were to investigate feasibility of POCUS for EPTB in children, frequency of POCUS findings suggestive of EPTB, and time to sonographic resolution of findings with treatment.

Methods:

This prospective South African cohort study enrolled children with suspected PTB. POCUS for pleural, pericardial or ascitic effusion, abdominal lymphadenopathy, or splenic or hepatic micro-abscesses was performed and repeated at 1, 3 and 6 months of TB treatment. Prevalence of POCUS findings and their association with HIV-infection was investigated in children with confirmed PTB (microbiologically proven), unconfirmed PTB (clinically diagnosed), or unlikely TB (respiratory disease that improved during follow-up without TB treatment).

Results:

Of 232 children [median age 37 months (IQR 18;74)], 39(17%) were HIV-infected. Children with confirmed or unconfirmed PTB had a higher prevalence of POCUS findings than children with unlikely TB [18/58(31%) and 36/119(30%) versus 8/55(15%), p=0.04 and p=0.03, respectively]. Pleural effusion [n=30(13%)] or abdominal lymphadenopathy [n=28(12%)] were the most common findings; splenic micro-abscesses [n=12(5%)] were strongly associated with confirmed PTB. Children co-infected with HIV and TB were more likely than HIV-uninfected children with TB to have abdominal lymphadenopathy [37% versus 10%, p<0.001] or splenic micro-abscesses [23% versus 3%, p<0.001]. Most ultrasound findings resolved by 3 months with appropriate TB treatment.

Conclusions:

POCUS for EPTB in children with PTB is feasible. The high prevalence of findings suggests that POCUS can contribute to timely diagnosis of childhood TB and to monitoring treatment response.

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