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. 2016 Dec;6(4):198-201.
doi: 10.1016/j.afjem.2016.07.001. Epub 2016 Sep 6.

Focused assessment with sonography for HIV-associated tuberculosis (FASH) case series from a Rwandan district hospital

Gabin Mbanjumucyo  1 , Patricia C Henwood  2
Affiliations

Focused assessment with sonography for HIV-associated tuberculosis (FASH) case series from a Rwandan district hospital

Gabin Mbanjumucyo et al. Afr J Emerg Med. 2016 Dec.

Abstract
in English, Finnish

Introduction: The majority of HIV-TB co-infection worldwide is reported in Africa. The risk of developing extra-pulmonary tuberculosis (EPTB) increases as immune deficiency progresses but is difficult to diagnose. Point-of-care ultrasonography (POCUS) can be an effective adjunct to identify and treat EPTB-associated findings using the focused assessment with sonography for HIV-associated TB (FASH) protocol.

Case report: Three HIV-infected patients without known history of EPTB presented to a Rwandan district hospital with fever and unclear infection. Initial testing did not reveal a source. Each patient was then evaluated with the FASH protocol by a Rwandan emergency physician with POCUS training. All patients had findings suggestive of EPTB by ultrasound. Anti-TB treatment was initiated, and all subsequently demonstrated symptom improvement.

Discussion: This case series demonstrates the additional clinical information obtained. It describes how management was changed using POCUS and the FASH in a resource-limited setting in Rwanda and calls for further FASH protocol validation studies.

Introduction: La majorité des co-infections VIH-TB dans le monde sont signalées en Afrique. Le risque de développer une tuberculose extra-pulmonaire (EPTB) augmente à mesure qu’évolue le déficit immunitaire, mais elle est difficile à diagnostiquer. L’échographie là où les soins sont prodigués (POCUS) peut être un complément efficace pour identifier et traiter des résultats liés à l’EPTB à l’aide du protocole d’évaluation ciblée utilisant l’échographie de la tuberculose associée au VIH (FASH).

Rapport de cas: Trois patients infectés par le VIH sans antécédents connus d’EPTB se sont présentés à un hôpital de district rwandais avec de la fièvre et une infection indéterminée. Les tests initiaux n’ont pas révélé d’origine. Chaque patient a ensuite été évalué par le biais du protocole de FASH par un médecin d’urgence rwandais formé à la POCUS. Tous les patients présentaient des signes évocateurs de l’EPTB à l’échographie. Le traitement anti-TB a été initié, et tout a démontré par la suite une amélioration des symptômes.

Discussion: Cette série de cas confirme les informations cliniques supplémentaires obtenues. Elle décrit comment la prise en charge a été modifiée en utilisant la POCUS et la FASH dans un contexte de ressources limitées au Rwanda et appelle à d’autres études de validation du protocole de la FASH.

Keywords: Case report; Case series; Emergency ultrasound; Extra-pulmonary tuberculosis; HIV; Infectious disease; Point-of-care ultrasound; Tropical disease; Tuberculosis; Ultrasound.

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Figures

Figure 1
Figure 1
Pleural effusion and microabscesses in spleen, patient from Case 1.
Figure 2
Figure 2
Splenic microabscesses seen more easily with high frequency ultrasound transducer, patient from Case 2.
Figure 3
Figure 3
Enlarged para-aortic lymph nodes, patient from Case 2.
Figure 4
Figure 4
Circumferential pericardial effusion, patient from Case 3.
Figure 5
Figure 5
Pericardial effusion with right ventricular collapse, patient from Case 3.
See this image and copyright information in PMC

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