Doctors With Africa CUAMM, Yirol, South Sudan.
Infectious Diseases, University of Bari, Bari, Italy.
BMJ Open. 2019 Apr 2;9(4):e027179. doi: 10.1136/bmjopen-2018-027179.
Our cross-sectional study aimed at evaluating the diagnostic performance of Focused Assessment with Sonography for HIV-associated tuberculosis (FASH) to detect extrapulmonary tuberculosis in extremely resource-limited settings, with visceral leishmaniasis as a differential diagnosis with overlapping sonographic feature.
Cross-sectional study.
Voluntary Counselling and Testing Centre (VCT) of Yirol Hospital, South Sudan.
From May to November 2017, 252 HIV-positive patients out of 624 newly admitted to VCT Centre were registered for antiretroviral treatment. According to the number of trained doctors available to practise ultrasound (US) scan, a sample of 100 patients were screened using the FASH protocol.
Following a full clinical examination, each patient was scanned with a portable US scanner in six different positions for pleural, pericardial, ascitic effusion, abdominal lymphadenopathy and hepatic/splenic microabscesses, according to the FASH protocol. A k39 antigen test for visceral leishmaniasis was also performed on patients with lymphadenopathy and/or splenomegaly. All demographic, clinical and HIV data, as well as FASH results and therapy adjustments, were recorded following the examination.
The FASH protocol allowed the detection of pathological US findings suggestive of tuberculosis in 27 out of the 100 patients tested. Overall, FASH results supported tuberculosis treatment indication for 16 of 21 patients, with the treatment being based exclusively on FASH findings in half of them (8 patients). The group of FASH-positive patients had a significantly higher proportion of patients with CD4 count below 0.2 x10/L (n=22, 81%) as compared with FASH-negative patients (n=35, 48%) (p=0.003). Moreover, 48% (n=13) of FASH-positive patients had CD4 below 100 cells/mm. All patients tested had a negative result on k39 antigen test.
FASH was found to be a relevant diagnostic tool to detect signs of tuberculosis. Further research is needed to better define a patient profile suitable for investigation and also considering diagnostic accuracy.
本横断面研究旨在评估超声引导下重点评估（FASH）在极度资源有限环境下诊断 HIV 相关性肺结核（TB）的诊断性能，同时将内脏利什曼病作为具有重叠超声特征的鉴别诊断。
横断面研究。
南苏丹伊罗尔医院自愿咨询检测中心（VCT）。
2017 年 5 月至 11 月，624 名新入 VCT 中心的 HIV 阳性患者中，有 252 名符合抗逆转录病毒治疗标准。根据可进行超声（US）扫描的医生人数，100 名患者采用 FASH 方案进行了筛查。
在进行全面临床检查后，根据 FASH 方案，每位患者均使用便携式 US 扫描仪在六个不同位置进行胸膜、心包、腹水、腹部淋巴结病和肝/脾微脓肿扫描。对有淋巴结病和/或脾肿大的患者进行利什曼原虫 k39 抗原检测。所有人口统计学、临床和 HIV 数据，以及 FASH 结果和治疗调整，均在检查后记录。
在 100 名接受测试的患者中，FASH 方案检测到 27 例提示结核病的病理性超声发现。总体而言，FASH 结果支持 21 例患者中的 16 例进行结核病治疗，其中有 8 例（50%）完全基于 FASH 结果进行治疗。FASH 阳性患者中 CD4 计数低于 0.2 x10/L 的患者比例明显高于 FASH 阴性患者（n=22，81%比 n=35，48%）（p=0.003）。此外，FASH 阳性患者中有 48%（n=13）的 CD4 计数低于 100 个细胞/mm。所有接受检测的患者的利什曼原虫 k39 抗原检测结果均为阴性。
FASH 是一种可用于检测结核病征象的有价值的诊断工具。需要进一步研究以更好地确定适合调查的患者特征，并考虑诊断准确性。
