Unmasking the hidden tuberculosis mortality burden in a large

Adolescent Adult Autopsy Cause of Death Child Child, Preschool Female HIV Infections / complications Humans Infant Infant, Newborn Male Maternal Mortality Meningitis / mortality Mozambique / epidemiology Mycobacterium tuberculosis Prospective Studies Real-Time Polymerase Chain Reaction Tertiary Care Centers Tuberculosis, Miliary / mortality Tuberculosis, Multidrug-Resistant / mortality Tuberculosis, Pulmonary / mortality

Journal

The European respiratory journal

ISSN: 1399-3003

Titre abrégé: Eur Respir J

Pays: England

ID NLM: 8803460

Informations de publication

Date de publication:
09 2019

Historique:

received: 13 02 2019

accepted: 17 06 2019

pubmed: 28 7 2019

medline: 21 10 2020

entrez: 27 7 2019

Statut: epublish

Résumé

Sensitive tools are needed to accurately establish the diagnosis of tuberculosis (TB) at death, especially in low-income countries. The objective of this study was to evaluate the burden of TB in a series of patients who died in a tertiary referral hospital in sub-Saharan Africa using an in-house real time PCR (TB-PCR) and the Xpert MTB/RIF Ultra (Xpert Ultra) assay.Complete diagnostic autopsies were performed in a series of 223 deaths (56.5% being HIV-positive), including 54 children, 57 maternal deaths and 112 other adults occurring at the Maputo Central Hospital, Mozambique. TB-PCR was performed in all lung, cerebrospinal fluid and central nervous system samples in HIV-positive patients. All samples positive for TB-PCR or showing histological findings suggestive of TB were analysed with the Xpert Ultra assay.TB was identified as the cause of death in 31 patients: three out of 54 (6%) children, five out of 57 (9%)maternal deaths and 23 out of 112 (21%) other adults. The sensitivity of the main clinical diagnosis to detect TB as the cause of death was 19.4% (95% CI 7.5-37.5) and the specificity was 97.4% (94.0-99.1) compared to autopsy findings. Concomitant TB (TB disease in a patient dying of other causes) was found in 31 additional cases. Xpert Ultra helped to identify 15 cases of concomitant TB. In 18 patients,

Identifiants

DOI: 10.1183/13993003.00312-2019 PMID: 31346005 PMC: PMC6769353

pubmed: 31346005

pii: 13993003.00312-2019

doi: 10.1183/13993003.00312-2019

pmc: PMC6769353

pii:

doi:

Types de publication

Journal Article Observational Study Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

Commentaires et corrections

Type : CommentIn

Informations de copyright

Déclaration de conflit d'intérêts

Conflict of interest: A.L. Garcia-Basteiro has nothing to disclose. Conflict of interest: J.C. Hurtado has nothing to disclose. Conflict of interest: P. Castillo has nothing to disclose. Conflict of interest: F. Fernandes has nothing to disclose. Conflict of interest: M. Navarro has nothing to disclose. Conflict of interest: L. Lovane has nothing to disclose. Conflict of interest: I. Casas has nothing to disclose. Conflict of interest: L. Quinto has nothing to disclose. Conflict of interest: D. Jordao has nothing to disclose. Conflict of interest: M.R. Ismail has nothing to disclose. Conflict of interest: C. Lorenzoni has nothing to disclose. Conflict of interest: C. Carrilho has nothing to disclose. Conflict of interest: A. Sanz has nothing to disclose. Conflict of interest: N. Rakislova has nothing to disclose. Conflict of interest: A. Mira has nothing to disclose. Conflict of interest: M.J. Alvarez-Martinez has nothing to disclose. Conflict of interest: A. Cossa has nothing to disclose. Conflict of interest: F. Cobelens has nothing to disclose. Conflict of interest: I. Mandomando has nothing to disclose. Conflict of interest: J. Vila has nothing to disclose. Conflict of interest: Q. Bassat has nothing to disclose. Conflict of interest: C. Menendez has nothing to disclose. Conflict of interest: J. Ordi has nothing to disclose. Conflict of interest: M.J. Martinez has nothing to disclose.

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