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. Author manuscript; available in PMC: 2020 May 1.
Published in final edited form as: Pediatr Infect Dis J. 2019 May;38(5):e110. doi: 10.1097/INF.0000000000002243

Point-of-Care Ultrasound for Pulmonary and Extra-Pulmonary Tuberculosis in Children

Sabine Bélard 1,2,3,4, Charlotte C Heuvelings 1,2, Tom Heller 5, Savvas Andronikou 1,6, Martin P Grobusch 2, Heather J Zar 1
PMCID: PMC6467491  NIHMSID: NIHMS1511778  PMID: 30985549

To the Editors,

We read with interest the letter by Buonsenso et al. [1] on their experience on lung ultrasound for pulmonary tuberculosis (PTB) in children in response to our study of point-of-care ultrasound (POCUS) in children. The authors indicate that POCUS of the lung is limited with regard to PTB. However, our article addresses POCUS for identification of concurrent extra-pulmonary tuberculosis (EPTB) in children with PTB [2], but does not address lung ultrasound in children with PTB.

Childhood PTB is difficult to diagnose because clinical presentation is non-specific and microbiologic confirmation is only achieved in a minority of children. Imaging therefore plays an important diagnostic role. However, current imaging tools are limited by sensitivity and specificity, as well as availability and/or feasibility in children. The standard radiologic study in childhood TB is chest X-ray (CXR), which can show parenchymal disease or pleural effusion but may not accurately detect mediastinal lymphadenopathy, has poor inter-reader agreement, and may not be affordable in resource-poor, highly endemic settings [3–5]. Computed tomography (CT) may certainly demonstrate lymphadenopathy more often, and may be more accurate for parenchymal disease, but it is not the ‘standard’ technique due to radiation exposure and cost. CT or magnetic resonance imaging are even less accessible and require sedation in young children. New imaging approaches are urgently needed to improve diagnosis of childhood TB; and ultrasound emerges as promising non-invasive and cheap point-of-care tool.

Our work focused on POCUS for detection of extra-pulmonary tuberculosis (TB) because children are vulnerable to develop disseminated forms of TB. POCUS for EPTB was found to be valuable in the diagnostic work-up of HIV/TB co-infected adults who may also develop disseminated forms of TB [6–8]. We showed that concurrent EPTB as detected by POCUS, i.e. abdominal lymphadenopathy, pleural or pericardial effusion, or splenic micro-abscesses, was prevalent in almost a third of children with PTB in South Africa, and that follow-up POCUS for EPTB was very useful for monitoring treatment response [2].

In their letter, Buonsenso et al. [1] report lung ultrasound and CT findings from nine pediatric TB cases from Sierra Leone (whether these cases had confirmed or unconfirmed PTB is not reported) and conclude that lung POCUS has limitations. We do not share their skepticism with regard to ultrasound for PTB, because in children, PTB often presents with lung consolidation that may extend to the periphery, and because ultrasound is better than CXR in detecting small consolidation [9].

Acknowledgments

Source of Funding: NIH RO1 HD058971, MRC South Africa, NRF South Africa. SB and CCH were funded by a Marie Curie People grant and SB is currently participant in the BIH-Charité Clinician Scientist Program funded by Charité – Universitätsmedizin Berlin and the Berlin Institute of Health. HZ is funded by the MRC South Africa.

Footnotes

Conflict of Interests: The authors have no conflicts of interest relevant to this article to disclose.

References

  • 1.Buonsenso D, Pezza L, and Valentini P, Utility of Point-of-care Ultrasound in Children With Pulmonary Tuberculosis. Pediatr Infect Dis J, 2018. 37(11): p. e280–e281. [DOI] [PubMed] [Google Scholar]
  • 2.Belard S, et al. , Utility of Point-of-care Ultrasound in Children With Pulmonary Tuberculosis. Pediatr Infect Dis J, 2018. 37(7): p. 637–642. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 3.Pedrazzoli D, et al. , Can tuberculosis patients in resource-constrained settings afford chest radiography? Eur Respir J, 2017. 49(3). [DOI] [PubMed] [Google Scholar]
  • 4.Swingler GH, et al. , Diagnostic accuracy of chest radiography in detecting mediastinal lymphadenopathy in suspected pulmonary tuberculosis. Arch Dis Child, 2005. 90(11): p. 1153–6. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 5.Berteloot L, et al. , Value of chest X-ray in TB diagnosis in HIV-infected children living in resource-limited countries: the ANRS 12229-PAANTHER 01 study. Int J Tuberc Lung Dis, 2018. 22(8): p. 844–850. [DOI] [PubMed] [Google Scholar]
  • 6.Heller T, et al. , Focused assessment with sonography for HIV-associated tuberculosis (FASH): a short protocol and a pictorial review. Crit Ultrasound J, 2012. 4(1): p. 21. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 7.van Hoving DJ, et al. , Adequacy of the emergency point-of-care ultrasound core curriculum for the local burden of disease in South Africa. Emerg Med J, 2013. 30(4): p. 312–5. [DOI] [PubMed] [Google Scholar]
  • 8.Weber SF, et al. , Point-of-Care Ultrasound for Extrapulmonary Tuberculosis in India: A Prospective Cohort Study in HIV-Positive and HIV-Negative Presumptive Tuberculosis Patients. Am J Trop Med Hyg, 2018. 98(1): p. 266–273. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 9.Shah VP, Tunik MG, and Tsung JW, Prospective evaluation of point-of-care ultrasonography for the diagnosis of pneumonia in children and young adults. JAMA Pediatr, 2013. 167(2): p. 119–25. [DOI] [PubMed] [Google Scholar]

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