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 (>1.5 cm) 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.
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/mm3. 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.
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.