Table 1.
Summary of reported experiences of POCUS assessment of tropical infectious diseases
| Disease (protocol) | Population | Clinical symptoms | US findings | Suggested action | Evidence | Reference |
|---|---|---|---|---|---|---|
| TB (FASH) | Africa (particularly southern Africa), Asia, and South America with high HIV/TB coinfection prevalence | Fever | Enlarged hypoechoic lymph nodes | Do sputum smear exam | Well described and widely used in South Africa | 11–15,127 |
| Weight loss | Micro-abscesses in spleen and/or liver | Start empirical TB treatment | ||||
| Cough | Pleural effusion | Test for HIV if not done previously and treat accordingly | ||||
| Abdominal symptoms (diarrhea, pain, and abdominal distension), shortness of breath | Pericardial effusion | |||||
| Hypotension | Ascites | |||||
| Echinococcosis (FASE) | Sheep farming populations, South America, Middle East, eastern Europe, The Mediterranean, Central Asia, China, east Africa | Symptoms depend on cyst's size, number, and organ affected | Appearance depends on cyst stage (WHO-IWGE) | Stage-specific treatment of liver CE (WHO-IWGE) | FASE implemented in Argentina | 33–36,40,43 |
| Jaundice | CE1: anechoic with double wall | |||||
| Right upper quadrant pain | CE2: honeycomb appearance, adjacent anechoic daughter vesicles contained in the “mother” cyst's wall | |||||
| Most cases have few or no symptoms | CE3a: anechoic with “lily sign” (detached endocyst) | |||||
| CE3b: daughter vesicles within a solid matrix of the “mother” cyst | ||||||
| CE4: inhomogeneous content with visible hypoechoic folded endocyst (“ball of wool” sign) | ||||||
| CE5: same as CE4 with calcified wall | ||||||
| Amebic liver abscess | Worldwide in tropical countries | Fever | Hypoechoic, but not anechoic, round homogenous liver lesion: possible amebic abscess | Start antibiotic e.g., metronidazole treatment | Individual descriptive studies only | 46,48,49 |
| Right upper quadrant abdominal pain | Differentials: | Amebic serology | ||||
| a) Lesion containing gas, irregular shape: possible pyogenic abscess | In imminent rupture, US-guided aspiration | |||||
| b) Central calcification: possible Brucella abscess | Brucella serology | |||||
| c) Noninfectious lesion, e.g., necrotic tumor | ||||||
| Intestinal schistosomiasis | People in contact with fresh water in Africa, southeast Asia, and Brazil | Abdominal pain | Increasingly wide echogenic fibrosis around portal tracts (pattern D–F) | Refer for endoscopy for patterns E + F | WHO guidelines available for population screening | 59,64–70 |
| Intestinal bleeding | “Tortoise back” pattern in Asia | Refer also if pattern D and signs of portal hypertension | ||||
| Malabsorption | Dilated portal and splenic vein and collateral vessels | Treat medically and advise against exposure for other cases | ||||
| Hepatosplenomegaly | Enlarged caudate lobe | |||||
| Fever | Splenomegaly | |||||
| Eosinophilia | Ascites | |||||
| Malnutrition, anemia | ||||||
| Urogenital schistosomiasis | People in contact with fresh water in Egypt and sub-Saharan Africa | Hematuria | Irregular, thickened bladder wall (in fully distended bladder) | Medical treatment | WHO guidelines available for population screening | 58–60 |
| Urinary tract symptoms | Upper urinary tract dilation | Possibly referral for cystoscopy in case of persistence | ||||
| Fever | Bladder polyps and masses | |||||
| Eosinophilia | ||||||
| Malnutrition, anemia | ||||||
| Dyspareunia | ||||||
| Infertility | ||||||
| VHFs (e.g., Dengue, CCHF, Ebola) | Widely prevalent throughout the tropics | Fever | Effusions (pericardial, pleural) and ascites as signs of plasma leakage | Intensified surveillance for patients with negative prognostic signs | Individual descriptive studies only | 84–87,89,90,93 |
| Muscle pain | Gall bladder wall thickening | Changes in fluid replacement therapy in shock | ||||
| Headache | Subcapsular hepatic fluid | Consider vast differential diagnoses | ||||
| Rash | Volume status assessment (IVC, left ventricle, and pulmonary edema) | |||||
| Petechia | ||||||
| Lymphatic filariasis | Sub-Saharan Africa, southeast Asia, and endemic areas of Central and South America | Hydrocele | Dilation of inguinal lymphatic vessels | Scrotal surgery for hyperechoic, complex hydrocele | Individual descriptive studies only | 71,73 |
| Lower limb lymphedema | Filarial dance sign | Conservative treatment with doxycycline and deferred surgery for echo-free hydrocele | ||||
| Echo-free or hyperechoic hydrocele | ||||||
| Thickened scrotal skin | ||||||
| Visceral leishmaniasis | Indian subcontinent, Sudan | Fever | Hepatosplenomegaly | Unclear | Individual descriptive studies only | 79,80 |
| Abdominal pain | Lymph node enlargement | |||||
| Pancytopenia | Nodular splenic lesions (diagnostic accuracy of these findings is currently unclear for diagnosis of visceral leishmaniasis) |
CCHF = Crimean–Congo hemorrhagic fever; CE = cystic echinococcosis; FASE = focused assessment with sonography for echinococcosis; FASH = focused assessment with sonography for HIV-associated TB; HIV = human immunodeficiency virus; IVC = inferior vena cava; POCUS = point-of-care ultrasound; TB = tuberculosis; US = ultrasound; VHFs = viral hemorrhagic fever; VL = visceral leishmaniasis; WHO-IWGE = World Health Organization Informal Working Group on Echinococcosis.