by Bélard, Sabine, MD; Heuvelings, Charlotte C., MD; Heller, Tom, MD; Andronikou, Savvas, PhD; Grobusch, Martin P., FRCP; Zar, Heather J., PhD
To be published in The Pediatric Infectious Disease Journal, May 2019.
Childhood pulmonary tuberculosis (PTB) is difficult to diagnose because clinical presentation is nonspecific, and microbiologic confirmation is only achieved in a minority of children. Imaging therefore plays an important diagnostic role. However, current imaging tools are limited by sensitivity and specificity, as well as availability and/or feasibility in children. The standard radiologic study in childhood tuberculosis (TB) is chest radiograph, which can show parenchymal disease or pleural effusion but may not accurately detect mediastinal lymphadenopathy, has poor interreader agreement and may not be affordable in resource-poor, highly endemic settings. Computed tomography (CT) may certainly demonstrate lymphadenopathy more often and may be more accurate for parenchymal disease, but it is not the “standard” technique because of radiation exposure and cost. CT or magnetic resonance imaging is even less accessible and require sedation in young children. New imaging approaches are urgently needed to improve diagnosis of childhood TB, and ultrasound emerges as promising noninvasive and cheap point-of-care tool. Authors focused on point-of-care ultrasound (POCUS) for detection of extra-pulmonary tuberculosis (EPTB) because children are vulnerable to develop disseminated forms of TB.