Utility of chest imaging in the diagnosis and management of patients with visceral leishmaniasis: A systematic review

Abstract

Objectives: Visceral leishmaniasis remains a deadly parasitic disease with diagnostic complexities. Currently, point-of-care chest imaging is gaining momentum in the diagnosis of infectious diseases. Respiratory symptoms are common in visceral leishmaniasis. Here we aimed to systematically synthesize the evidence on the utility of chest imaging on the diagnosis and management of patients with visceral leishmaniasis. Methods: We searched PubMed, Scopus, Web of Science, ScienceDirect, and Google Scholar databases for studies reporting chest imaging findings in patients with visceral leishmaniasis, published in English from database inception to November 2022. We used the Joanna Briggs Institute checklists to evaluate the risk of bias. The protocol of this systematic review was registered with the Open Science Framework: https://doi.org/10.17605/OSF.IO/XP24W . Results: Of 1792 studies initially retrieved, 17 studies with 59 participants were included. Of the 59 patients, 51% (30) had respiratory symptoms and 20% (12) were human immunodeficiency virus co-infected. Chest X-ray, high-resolution computed tomography, and chest ultrasound findings were available for 95% (56), 93% (55), and 2% (1) of the patients, respectively. The most common findings were pleural effusion (20%; 12), reticular opacities (14%; 8), ground-glass opacities (12%; 7), and mediastinal lymphadenopathies (10%; 6). High-resolution computed tomography was more sensitive than chest X-ray and detected lesions that were lost on chest X-ray, 62% (37) versus 29% (17). In almost all cases, regression of the lesions was observed with treatment. Microscopy of pleural or lung biopsy detected amastigotes. Polymerase chain reaction yield was better in pleural and bronchoalveolar lavage fluids. A parasitological diagnosis from pleural and pericardial fluid was possible in AIDS patients. Overall, the risk of bias was low. Conclusions: Visceral leishmaniasis patients frequently had abnormal findings on high-resolution computed tomography. Chest ultrasound is a useful alternative in resource-limited settings to aid in diagnosis and subsequent treatment follow-up, especially when routine tests yield negative results despite clinical suspicion.

Diagnostic accuracy of barium enema versus full‐thickness rectal biopsy in children with clinically suspected Hirschsprung's disease: A comparative cross‐sectional study

“…5 As part of the developing world, Ethiopia is not exempt from this reality, despite recent expansions in pediatric health services. 11,12 BE can play an important role in resource-constrained settings given the need for locally available diagnostic modalities close to the patient's place of residence to expedite diagnosis and initiation of treatment. 4,5,9 However, the lack of pediatric surgeons and pediatric anesthesia, which is limited to tertiary teaching hospitals, and the backlog of patients on the waiting list for a definitive surgical diagnosis or management represent major obstacles.…”

“…Consequently, late presentations with advanced and complicated cases are common 5 . As part of the developing world, Ethiopia is not exempt from this reality, despite recent expansions in pediatric health services 11,12 …”

“… 5 As part of the developing world, Ethiopia is not exempt from this reality, despite recent expansions in pediatric health services. 11 , 12 …”