Ultrasound dynamics during treatment of pulmonary and extra-pulmonary TB

Point-of-care ultrasound (POCUS) offers an accessible tool for TB screening, particularly in resource-limited settings. Data on the longitudinal dynamics of sonographic pulmonary (PTB) and extra-pulmonary TB (EPTB) findings during anti-TB treatment (ATT) for potential therapy monitoring remain limited.

This secondary analysis of a prospective, multi-centre accuracy study of adults with presumed TB at one Indian and three German referral hospitals followed up participants undergoing ATT. Participants underwent lung (LUS) and extra-pulmonary ultrasound for pleural effusions, lymphadenopathy (peripheral, abdominal, internal mammary), ascites, and peritoneal pathology, before and during ATT. LUS findings were calculated as a score and compared between time-points.

71 participants were enrolled from January 2022 to July 2023; most had pulmonary pathology (n = 68) or pleural effusion (n = 33). Median LUS scores declined consistently to 86% after 2-3 months of ATT compared to baseline. After 6-8 months, median LUS score was 47%, suggesting persistence of pathology. Pleural effusion showed improvements after 2-3 months in 30%, and peripheral lymphadenopathy persisted in 33% even after ATT completion.

Sonographic findings in TB typically resolved with ATT but resolution may be incomplete even after 6 months. This study provides evidence supporting the potential role of ultrasound monitoring for the response of TB to ATT.