Figures & Tables
Figures
Images of Findings From Focused Assessment With Sonography of HIV-Associated Tuberculosis Protocol in Participants With Signs and Symptoms of Tuberculosis (a) Anechoic fluid surrounding the heart consistent with a moderate pericardial effusion. (b) Anechoic area superior (left) to the diaphragm and liver consistent with a large right pleural effusion. (c) Isoechoic nodules consistent with peri-portal and para-aortic lymphadenopathy. (d) Color Doppler further differentiates vasculature from lymph nodes.© 2016 Daniel Kahn/UCLA
- FIGURE 1
Participant Enrollment in a Prospective Cohort Study Assessing Diagnostic Utility of FASH at an Urban Medical Center, Lilongwe, Malawi, and Clinicians' Stepwise Diagnostic Evaluation and Decision Making
Abbreviations: FASH, focused assessment with sonography for HIV-associated tuberculosis; LAM, lipoarabinomannan; MTB, Mycobacterium tuberculosis; RIF, rifampicin; TB, tuberculosis.
aFinal categorization made by study investigators based on 6-month data and definitions above.
bIncludes 2 deaths.
cIncludes 12 deaths: 7 in Subgroup 2 and 5 in Subgroup 3.
- FIGURE 2
Comparison of Clinicians' Decision to Empirically Treat TB in Participants at 2 Time Points at an Urban Medical Center, Lilongwe, Malawi, by TB Categorya
Abbreviations: FASH, focused assessment with sonography for HIV-associated tuberculosis; H, history; P, physical exam; TB, tuberculosis.
aTB categories determined by study authors after 6-month follow-up.
Tables
- TABLE 1.
Baseline Demographic and Clinical Characteristics of Participants at an Urban Medical Center, Lilongwe, Malawi, Stratified by TB Category (N=181)
Unlikely TB (n=125) Probable/Confirmed TB (n=56) P Value Age, years, median (IQR)a 40.0 (34.0–45.0) 39.0 (33.0–43.0) .51 Gender .42 Male, No. (%) 56.0 (44.8) 29.0 (51.7) Female, No. (%) 69.0 (55.2) 27.0 (48.2) Baseline CD4 Count (cells/mm3), median (IQR)b 256.0 (80.0–484.0) 117.0 (29.0–176.0) <.001 Viral Load (copies/ml)c .21 <1,000, No. (%) 80.0 (64.0) 28.0 (50.0) 1,000–50,000, No. (%) 14.0 (11.2) 11.0 (19.6) >50,000, No. (%) 22.0 (17.6) 9.0 (16.0) Baseline ART Regimend .001 TDF/3TC/EFV, No. (%) 70.0 (56.0) 20.0 (35.7) Other NNRTI-based regimen, No. (%) 17.0 (13.6) 2.0 (3.6) Protease inhibitor-based regimen, No. (%) 12.0 (9.6) 3.0 (5.4) No ART, No. (%) 25.0 (20.0) 26.0 (46.4) Previous TB,e No. (%) 32.0 (25.6) 12.0 (21.4) .58 TB Sign/Symptomf Fever, No. (%) 83.0 (66.4) 42.0 (75.0) .30 Cough, No. (%) 108.0 (86.4) 51.0 (91.1) .47 Night sweats, No. (%) 77.0 (61.6) 37.0 (66.1) .62 Weight loss, No. (%) 98.0 (78.4) 50.0 (89.3) .10 BMI, median (IQR) 19.2 (17.5–22.9) 18.6 (16.7–19.8) .01 Abbreviations: ART, antiretroviral therapy; BMI, body mass index; IQR, interquartile range; NNRTI, non-nucleoside reverse transcriptase inhibitor; TB, tuberculosis; TDF/3TC/EFZ, tenofovir disoproxil fumarate/lamivudine/efavirenz.
↵a Missing in 5 individuals.
↵b Missing in 4 individuals.
↵c Missing in 17 individuals.
↵d Missing in 6 individuals.
↵e Based on participant self report.
↵f Participants could have 2 or more signs/symptoms based on screening questions at study entry.
- TABLE 2.
Baseline FASH Findings in Participants at an Urban Medical Center, Lilongwe, Malawi, Stratified by TB Category (N=181)
Overall, No. (%) (N=181) Unlikely TB, No. (%) n=125 Probable/Confirmed TB, No. (%) n=56 P Value Pericardial effusiona 36 (19.9) 12 (9.6) 24 (42.9) <.001 Pleural effusion 9 (5.0) 1 (0.8) 8 (14.3) <.001 Ascites 14 (7.7) 5 (4.0) 9 (16.1) .01 Abdominal lymphadenopathy 15 (8.3) 2 (1.6) 13 (23.2) <.001 Liver lesions 4 (2.2) 3 (2.4) 1 (1.8) >.99 Splenic lesions 5 (2.8) 2 (1.6) 3 (5.4) .17 FASH positiveb 70 (38.7) 30 (24.0)c 40 (71.4) <.001 FASH negative 111 (61.3) 95 (76.0) 16 (28.6) <.001 Abbreviations: FASH, focused assessment with sonography for HIV-associated tuberculosis; TB, tuberculosis.
↵a Trace pericardial effusions were excluded from the analysis due to unclear clinical significance.
↵b Any single finding of the protocol is positive.
↵c Positive FASH for unlikely TB subgroups: (1) low clinical suspicion with improvement=19/111; (2) low clinical suspicion without improvement= 5/8; (3) High clinical suspicion, treated, without improvement=6/6.
- TABLE 3.
Associations of FASH Findings With Probable/Confirmed TB in Participants at an Urban Medical Center, Lilongwe, Malawi (N=56)
Variable OR (95% CI) Sensitivity (95% CI) Specificity (95% CI) PPV (95% CI) NPV (95% CI) PLR (95% CI) NLR (95% CI) Pericardial effusiona 7.06 (3.18, 15.66) 0.43 (0.30, 0.57) 0.90 (0.84, 0.95) 0.67 (0.49, 0.81) 0.78 (0.70, 0.84) 4.30 (2.32, 7.97) 0.63 (0.50, 0.80) Pleural effusion 8.91 (2.35, 33.82) 0.18 (0.09, 0.30) 0.98 (0.93, 1.00) 0.77 (0.46, 0.95) 0.73 (0.65, 0.79) 9.00 (2.58, 31.45) 0.84 (0.74, 0.95) Ascites 4.60 (1.47, 14.44) 0.16 (0.08, 0.28) 0.96 (0.91, 0.99) 0.64 (0.35, 0.87) 0.72 (0.64, 0.79) 4.00 (1.40, 11.39) 0.88 (0.78, 0.99) Abdominal lymphadenopathy 13.35 (3.66, 48.71) 0.25 (0.14, 0.38) 0.98 (0.93, 1.00) 0.82 (0.57, 0.96) 0.74 (0.67, 0.81) 12.50 (3.74, 41.80) 0.77 (0.66, 0.90) Hepatic lesions 0.74 (0.08, 7.27) 0.02 (0.00, 0.10) 0.98 (0.93, 1.00) 0.25 (0.01, 0.81) 0.69 (0.62, 0.76) 1.00 (0.11,9.40) 1.00 (0.96, 1.05) Splenic lesions 3.48 (0.57, 21.43) 0.05 (0.01, 0.15) 0.98 (0.94, 1.00) 0.60 (0.15, 0.95) 0.70 (0.63, 0.77) 2.50 (0.43, 14.55) 0.97 (0.91, 1.04) FASH positive 7.92 (3.89, 16.12) 0.71 (0.58, 0.83) 0.76 (0.68, 0.83) 0.57 (0.45, 0.69) 0.86 (0.78, 0.92) 2.96 (2.08, 4.21) 0.38 (0.25, 0.58) Abbreviations: CI, confidence interval; FASH, focused assessment with sonography for HIV-associated tuberculosis; NLR, negative likelihood ratio; NPV, negative predictive value; OR, odds ratio; PLR, positive likelihood ratio; PPV, positive predictive value; TB, tuberculosis.
↵a Trace pericardial effusions were excluded from the analysis due to unclear clinical significance.
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