Point-of-care ultrasound for tuberculosis diagnosis in children: a Médecins Sans Frontières cross-sectional study in Guinea-Bissau

Objective Description of tuberculosis (TB)-focused point-of-care ultrasound (POCUS) findings for children with presumptive TB. Design Cross-sectional study (July 2019 to April 2020). Setting Simão Mendes hospital in Bissau, a setting with high TB, HIV, and malnutrition burdens. Participants Patients aged between 6 months and 15 years with presumptive TB. Interventions Participants underwent clinical, laboratory and unblinded clinician-performed POCUS assessments, to assess subpleural nodules (SUNs), lung consolidation, pleural and pericardial effusion, abdominal lymphadenopathy, focal splenic and hepatic lesions and ascites. Presence of any sign prompted a POCUS positive result. Ultrasound images and clips were evaluated by expert reviewers and, in case of discordance, by a second reviewer. Children were categorised as confirmed TB (microbiological diagnosis), unconfirmed TB (clinical diagnosis) or unlikely TB. Ultrasound findings were analysed per TB category and risk factor: HIV co-infection, malnutrition and age. Results A total of 139 children were enrolled, with 62 (45%) women and 55 (40%) aged Conclusions We found a high prevalence of POCUS signs in children with TB compared with children with unlikely TB. POCUS-positivity was dependent on nutritional status but not on HIV status or age. TB-focused POCUS could potentially play a supportive role in the diagnosis of TB in children. Trial registration number NCT05364593.