The sound of TB: role of lung ultrasound in the diagnosis and follow-up of pulmonary tuberculosis in resource limited settings.

Francesco Di Gennaro

Lung Ultrasound (LUS) could be an useful tool for the diagnosis of pulmonary TB in resource limited settings. No studies are yet available on the role of lung ultrasound in the diagnosis and management of pulmonary tuberculosis.
Study Objectives
The main goal is to establish potential recurrent LUS patterns in patients with pulmonary TB;
Secondary goals are: to compare the diagnostic accuracy of LUS versus chest X ray (CXR) regarding TB infiltrates and pleural effusions; to assess potential changes in ultrasound patterns after a complete cycle of anti TB treatment; to compare the effectiveness of LUS versus CXR in co-infected TB-HIV positive patients versus HIV-negative subjects
Patients and methods
Only newly diagnosed pulmonary TB patients will be eligible to be enrolled into the study.
Chest radiography and lung ultrasound will be performed at the following timepoints:
-T0, baseline, defined as the first visit, within one month of the start of therapy; -T1 defined as two months after the start of therapy; -T2 defined as the end of therapy for pulmonary TB; -T3, six month after the end of therapy.
LUS will be performed using a 2 to 5 MHz convex probe. Ultrasound images will be performed by first investigator of study and two experts in the lung ultrasound field will indipendently review a the ultrasound images.
A previously validated simplified CXR report method 2 will be used. The ultrasound pattern will be defined for a given region of interest according to the score validated by Bouhemad et al 3.

Our study aims to validate this approach for the diagnosis of pulmonary TB. We believe that LUS could be an useful tool for improving the detection rate of new TB cases and for the monitoring of TB treatment in resource limited settings.

1 Lewandowski CM, Co-investigator N, Lewandowski CM. WHO Glocal tuberculosis report 2015. Eff Br mindfulness Interv acute pain Exp An Exam Individ Differ 2015; 1: 1689–99.
2 Ralph AP, Ardian M, Wiguna A, et al. A simple, valid, numerical score for grading chest x-ray severity in adult smear-positive pulmonary tuberculosis. Thorax 2010; 65: 863–9.
3 Bouhemad B, Brisson H, Le-Guen M, Arbelot C, Lu Q, Rouby JJ. Bedside ultrasound assessment of positive end-expiratory pressure-induced lung recruitment. Am J Respir Crit Care Med 2011; 183: 341–7.

Simone Agnello
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