Ultrasononography in Managing Extrapulmonary Tuberculosis: A Randomized, Controlled, Parallel, Superiority,...

Area of Science:

• Medical Diagnostics
• Infectious Diseases
• Public Health

Background:

• Extrapulmonary tuberculosis (TB) diagnosis and management remain challenging, often relying on empirical treatment.
• Accurate diagnosis is crucial for effective patient management and preventing disease progression.

Purpose of the Study:

• To evaluate if extended focused assessment with sonography for HIV and tuberculosis (eFASH), combined with other tests, could enhance the correct management of patients with suspected extrapulmonary TB.
• To assess the impact of the eFASH-guided algorithm on diagnostic accuracy and treatment initiation.

Main Methods:

• A randomized controlled trial was conducted in Tanzania involving adults with suspected extrapulmonary TB.
• Participants were randomized to either an eFASH-based intervention or routine care, with both groups receiving standard diagnostic tests.
• The intervention group followed a management algorithm incorporating eFASH, microbiology, adenosine deaminase (ADA), and chest radiography results.

Main Results:

• The primary outcome, proportion of correctly managed patients, showed no significant difference between the intervention (93%) and control (92%) groups (OR, 1.14; P = .68).
• The intervention group had a higher proportion of participants with definite tuberculosis (35%) compared to the control group (24%).
• No procedure-associated adverse events were reported during the trial.

Conclusions:

• Extended focused assessment with sonography for HIV and tuberculosis (eFASH) did not significantly improve the proportion of correctly managed patients with suspected extrapulmonary TB.
• The eFASH approach, however, was associated with an increased proportion of patients diagnosed with definite tuberculosis.