Diagnostic Accuracy of Sonographic Signs of Extrapulmonary Tuberculosis and Treatment Response Monitoring in HIV-Positive and -Negative Populations

Robert Ndege; Farida  Bani; Omary Ngome; Mohamed Sasamalo; Dorcas Mnzava; Fiona Vanobberghen; Daniel  Paris; Maja Weisser; Martin Rohacek

doi:10.5826/tuj.2026.18222

Authors

Robert Ndege Biomedical Research and Clinical Trials Department, Ifakara Health Institute, Ifakara, Tanzania; Department of Medicine, Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland; St. Francis Regional Referral Hospital, Ifakara, Tanzania https://orcid.org/0000-0002-1253-8970
Farida Bani Biomedical Research and Clinical Trials Department, Ifakara Health Institute, Ifakara, Tanzania; St. Francis Regional Referral Hospital, Ifakara, Tanzania
Omary Ngome Biomedical Research and Clinical Trials Department, Ifakara Health Institute, Ifakara, Tanzania
Mohamed Sasamalo Biomedical Research and Clinical Trials Department, Ifakara Health Institute, Ifakara, Tanzania
Dorcas Mnzava Biomedical Research and Clinical Trials Department, Ifakara Health Institute, Ifakara, Tanzania
Fiona Vanobberghen Department of Medicine, Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland
Daniel H Paris Department of Medicine, Swiss Tropical and Public Health Institute, Allshwil, Switzerland; University of Basel, Basel, Switzerland
Maja Weisser Biomedical Research and Clinical Trials Department, Ifakara Health Institute, Ifakara, Tanzania; Department of Medicine, Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland; Division of Infectious Diseases, University Hospital Basel, Basel, Switzerland
Martin Rohacek Biomedical Research and Clinical Trials Department, Ifakara Health Institute, Ifakara, Tanzania; Department of Medicine, Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland; St. Francis Regional Referral Hospital, Ifakara, Tanzania

Keywords:

eFASH, FASH, ultrasound, extrapulmonary tuberculosis, treatment monitoring

Abstract

Background

Diagnosis and monitoring of extrapulmonary tuberculosis (EPTB) remains challenging. Ultrasound such as the extended focused assessment for HIV-associated tuberculosis (eFASH) protocol might improve diagnosis and monitoring of treatment responses. This study determined the diagnostic accuracy of eFASH for EPTB and its value in monitoring EPTB treatment response compared with clinical signs and symptoms.

Methods

We performed a post-hoc analysis of a trial assessing eFASH impact on management of adults with suspected EPTB. Participants who had baseline and follow-up ultrasound examinations were included. We assessed the diagnostic accuracy of eFASH and compared the evolution of eFASH and clinical signs and symptoms in participants with definite EPTB, stratified by favorable treatment outcomes at 6 months.

Results

In 296 included participants (95 with definite EPTB, 201 with no definite EPTB), the most common eFASH signs were pleural effusion (47%) and pulmonary B-lines with subpleural granular artefacts (34%). Pleural effusion was the only sign that persisted beyond 6 months. eFASH had a sensitivity of 93.7% (95% CI, 86.8-97.6) and a specificity of 37.8% (95% CI, 31.1- 44.9) for definite EPTB. At 2 months, favorable outcomes were similar between participants with full and partial resolution of eFASH signs (83% versus 81%). In contrast, a higher proportion of favorable outcomes was seen in participants with full resolution of clinical signs and symptoms (90% versus 60%).

Conclusion

eFASH shows high sensitivity but low specificity for definite EPTB. Ultrasound can be used alongside clinical signs and symptoms to monitor treatment response in patients with EPTB.

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