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Abstracts of Poster and e-Poster Presentations
PA-455 Bedside ultrasound for the diagnosis of tuberculosis in HIV-positive infants hospitalized with severe pneumonia
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  1. Muhammad Sidat1,
  2. Gil Muvale2,
  3. Mohammad Salgado3,
  4. Cátia Domingos4,
  5. Suraia Liasse4,
  6. Uneisse Cassia1,
  7. Celda Mavume3,
  8. Jahit Sacarlal1,
  9. Alfeu Passanduca1,
  10. Amir Seni3,5,
  11. Kajal Chhaganlal5,
  12. Joseph Borrell6,
  13. Shannon Richardson6,
  14. Elisa Lopez7,
  15. Olivier Marcy8,
  16. Álvaro Ballesteros9,
  17. Alfredo Tagarro9,10,11,
  18. Cinta Moraleda9,12,
  19. Pablo Rojo9,12,13,
  20. W Chris Buck1,6
  1. 1Universidade Eduardo Mondlane Faculdade de Medicina, Mozambique
  2. 2Hospital Geral da Polana Caniço, Mozambique
  3. 3Hospital Central de Beira, Mozambique
  4. 4Hospital Central de Maputo, Mozambique
  5. 5Universidade Católica de Moçambique Faculdade de Ciências de Saúde, Mozambique
  6. 6University of California Los Angeles David Geffen School of Medicine, USA
  7. 7ISGlobal, Hospital Clínic – Universitat de Barcelona, Spain
  8. 8University of Bordeaux, Inserm U1219, IRD EMR271, France
  9. 9Foundation for Biomedical Research of the Hospital Universitario 12 de Octubre-Hospital 12 de Octubre Health Research Institute (i+12), Spain
  10. 10Universidad Europea de Madrid, Spain
  11. 11Servicio Madrileño de Salud (SERMAS), Infanta Sofia University Hospital, Spain
  12. 12Servicio Madrileño de Salud (SERMAS), 12 de Octubre University Hospital-Paediatric Unit for Research and Clinical Trials (UPIC), Spain
  13. 13Universidad Complutense, Spain

Abstract

Background Tuberculosis (TB) diagnosis is challenging in children, particularly in infants, contributing to high TB-related mortality. Up to 30% of infants with pulmonary TB have concurrent extrapulmonary disease, with findings that can frequently be detected with ultrasound. A protocol of focused assessment with sonography for HIV-associated TB (FASH) at six abdominal and thoracic positions has shown promise for diagnosis in children and adults, but few infants have been included in published studies.

Methods EMPIRICAL (#NCT03915366) is a randomized, controlled trial funded by EDCTP (RIA2017MC-2013) recruiting HIV-positive infants <12 months hospitalized with severe pneumonia without current/past TB diagnosis or exposure. All participants have Xpert Ultra (stool, nasopharyngeal aspirate) and urine LAM testing, and in an ongoing blinded diagnostic ancillary study at 5 hospitals in Mozambique, FASH is performed. An interim descriptive analysis was done for participants no longer active in the trial as of April 2023.

Results For the 39 participants included, the median age was 3 months (IQR:3.17–5.13), 48.7% were female, and the median CD4% was 13% (IQR:9.90–17.55). There was ≥1 positive FASH finding in 10/39 (25.6%); all had pericardial effusion 10/39 (25.6%), with focal splenic lesions and ascites also noted in 2/39 (5.1%) and 1/39 (2.6%), respectively. No participants had pleural effusion, focal liver lesions, or abdominal lymphadenopathy. In participants with laboratory-confirmed TB, 42.9% (3/7) had ≥1 positive FASH finding. There were 2 positive FASH findings in 7.6% (3/39) participants, of whom 66.7% (2/3) had laboratory-confirmed TB.

Conclusion Positive FASH findings were frequent in HIV-positive infants hospitalized with severe pneumonia and even more common in the subset of participants with laboratory-confirmed TB, with pericardial effusion noted on all positive FASH exams. Future analysis will attempt to define which abnormalities on FASH exam are most predictive of TB disease and assess the use of FASH to monitor TB treatment response.

https://doi.org/10.1136/bmjgh-2023-EDC.207

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