title: Abdominal tuberculosis: sonographic diagnosis and treatment response in HIV-positive adults in rural South Africa.
abstract: OBJECTIVE
  To investigate the diagnostic value of abdominal ultrasound in HIV-positive inpatients in a rural African setting.
  
  
  METHODS
  This was a prospective case series over 3 months of adult HIV-positive patients with symptoms suggestive of abdominal tuberculosis (TB). Diagnostic ultrasound was performed for all patients: sonographic criteria included abdominal lymph node enlargement (>1.5cm) and focal splenic lesions; ascites was a supportive finding. Further diagnostic studies, e.g., aspiration or biopsy were not routinely performed. TB treatment was initiated on the basis of clinical and sonographic features. The patients were contacted after 4 months to evaluate the clinical outcome.
  
  
  RESULTS
  One hundred and eighty adult HIV-positive patients were screened; 30 (16.7%) showed sonographic signs of abdominal TB. The median CD4 count was 78 cells/mm(3). Presenting symptoms were weight loss (86.7%), abdominal pain (76.7%), and diarrhea (60%). Abdominal lymph node enlargement was the diagnostic finding in almost all cases (96.7%); hypoechoic lesions of the spleen were seen in 50% and ascites in 73.3%. Follow-up information was available for 25 patients: 24% had died and the remaining 76% reported symptomatic improvement and weight gain.
  
  
  CONCLUSIONS
  Characteristic sonographic features of abdominal TB are common in HIV-infected inpatients in a rural African setting. Ultrasound should be introduced into clinical algorithms for the diagnosis of extrapulmonary TB.
authors.affiliation: Hlabisa Hospital, Hlabisa, KwaZulu-Natal, South Africa.
authors.forename: Tom
authors.initials: T
authors.lastname: Heller
authors.forename: Sam
authors.initials: S
authors.lastname: Goblirsch
authors.forename: Claudia
authors.initials: C
authors.lastname: Wallrauch
authors.forename: Richard
authors.initials: R
authors.lastname: Lessells
authors.forename: Enrico
authors.initials: E
authors.lastname: Brunetti
mesh_terms: D000328:Adult; D001201:Ascites / Q000000981:diagnostic imaging; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000000981:diagnostic imaging; D006801:Humans; D008206:Lymphatic Diseases / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012424:Rural Population; D013019:South Africa; D013154:Spleen / Q000000981:diagnostic imaging; D014385:Tuberculosis, Gastrointestinal / Q000150:complications* / Q000175:diagnosis / Q000000981:diagnostic imaging*; D014463:Ultrasonography; D055815:Young Adult