{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T17:53:35Z","timestamp":1785779615955,"version":"3.56.0"},"reference-count":24,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T00:00:00Z","timestamp":1778112000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T00:00:00Z","timestamp":1778112000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Tropical Med Int Health"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Tuberculous pleural effusion (TPE), the second most common form of extra\u2010pulmonary tuberculosis (TB), remains difficult to diagnose due to low\u2010yield, invasive and often unavailable diagnostics in resource\u2010limited settings. This study aimed to evaluate the diagnostic accuracy of sonographic characteristics alone to predict TB aetiology of pleural effusions using point\u2010of\u2010care ultrasound (POCUS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This cross\u2010sectional study included 45 participants in Zambia who underwent ultrasound scanning and diagnostic thoracentesis. Key sonographic characteristics of pleural effusions\u2014presence of septations, presence of plankton sign and unilateral location\u2014were evaluated for their association with TB, using pleural fluid adenosine deaminase (ADA) \u2265\u200940\u2009IU\/L, combined with Xpert MTB\/RIF and lipoarabinomannan, as the gold standard. Sensitivity, specificity, positive predictive values and negative predictive values were calculated for each characteristic alone and in combination and multivariate logistic regression was used to determine statistical significance. Interrater reliability between clinician and expert image interpretation was calculated using a kappa statistic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Significant associations were found between TB positivity and unilateral location (either side) (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.037), right\u2010sided location (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.043) and any two POCUS signs (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.044). Diagnostic performance varied across the three POCUS signs, with the presence of any two POCUS signs demonstrating the highest sensitivity (90.9%) but moderate specificity (41.7%) and the presence of all 3 POCUS signs showing strong specificity (83.3%) but poor sensitivity (45.5%). Agreement also varied, with the lowest kappa score observed for the plankton sign and the highest for unilateral location.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Multiple sonographic characteristics, including unilateral location (either side), unilateral right\u2010sided location and any two positive signs were significantly associated with TB aetiology. Limitations included small sample size, potential selection bias, imperfect gold standard options, and inability to fully assess potential confounders. With additional study, these findings may be used to inform development of a non\u2010invasive tool to predict TB aetiology of pleural effusions\u2014and expedite initiation of anti\u2010TB therapy\u2014in high TB settings globally.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/tmi.70143","type":"journal-article","created":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T14:39:57Z","timestamp":1778164797000},"page":"1128-1134","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Predictive Ability of Sonographic Characteristics Alone to Diagnose Tuberculous Pleural Effusions in a Resource\u2010Limited Setting: A Cross\u2010Sectional Pilot Study in Zambia"],"prefix":"10.1111","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-2695-2833","authenticated-orcid":false,"given":"Lukonde","family":"Zimba","sequence":"first","affiliation":[{"name":"Department of Community and Family Medicine, School of Public Health University of Zambia  Lusaka Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salom\u00e9\u2010Jo\u00eblle","family":"Gass","sequence":"additional","affiliation":[{"name":"Department of Health Services, Policy, and Management, Arnold School of Public Health University of South Carolina  Columbia South Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mpundu C.","family":"Makasa","sequence":"additional","affiliation":[{"name":"Department of Community and Family Medicine, School of Public Health University of Zambia  Lusaka Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4656-6547","authenticated-orcid":false,"given":"Matthew S.","family":"Haldeman","sequence":"additional","affiliation":[{"name":"Department of Family and Preventive Medicine University of South Carolina School of Medicine  Columbia South Carolina USA"},{"name":"Seed Global Health  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,7]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1183\/20734735.0166\u20102022"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jctube.2025.100510"},{"key":"e_1_2_11_4_1","volume-title":"Tuberculosis profile: Zambia","author":"WHO"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0146392"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0191608"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.03205\u201015"},{"issue":"1","key":"e_1_2_11_8_1","first-page":"18","article-title":"Diagnostic Accuracy of Combined Sonographic Findings and Pleural Fluid Adenosine Deaminase Levels for Tuberculous Pleural Effusions in Endemic Areas \u2010A Study of 415 Patients","volume":"13","author":"Qureshi A. 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