Tuberculosis in persons with sudden unexpected death, in Cape Town, South Africa.
Sudden unexpected death
Tuberculosis mortality
Undiagnosed TB
Journal
International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases
ISSN: 1878-3511
Titre abrégé: Int J Infect Dis
Pays: Canada
ID NLM: 9610933
Informations de publication
Date de publication:
Apr 2021
Apr 2021
Historique:
received:
14
12
2020
revised:
27
01
2021
accepted:
07
02
2021
pubmed:
15
2
2021
medline:
3
6
2021
entrez:
14
2
2021
Statut:
ppublish
Résumé
Globally, tuberculosis (TB) remains one of the leading causes of death from a single infectious agent, but there has been little work to estimate mortality before the diagnosis of TB. We investigated the burden of diagnosed and undiagnosed TB in adult and child sudden unexpected deaths (SUDs) evaluated at Tygerberg Forensic Pathology Services, South Africa. In a retrospective descriptive study spanning 2016, we identified all SUDs where active TB was detected at post-mortem and matched with routine health service data to differentiate decedents who were diagnosed or undiagnosed with TB before death. A patient pathway analysis of the health service activities preceding SUD in adults with active TB was conducted. Active TB was identified at post-mortem in 6.2% (48/770) of SUDs and was undiagnosed before death in 91.7% (44/48). The prevalence of active TB was 8.1% in adult SUDs (90.1% undiagnosed before SUD) and 1.8% in children (none diagnosed before SUD). Patient pathway analysis was possible for 15 adult SUDs, and this documented primary health care clinic attendances and hospital admissions in the six months preceding death and missed opportunities for TB investigations. The prevalence of TB among SUDs in the Eastern Metro of Cape Town is high. Most active TB at post-mortem was undiagnosed before death, and multiple missed opportunities for TB investigation and diagnosis were noted. The systematic evaluation of all SUDs for TB could improve the reporting of undiagnosed TB and support risk mitigation for healthcare workers involved with the post-mortem process.
Sections du résumé
BACKGROUND
BACKGROUND
Globally, tuberculosis (TB) remains one of the leading causes of death from a single infectious agent, but there has been little work to estimate mortality before the diagnosis of TB. We investigated the burden of diagnosed and undiagnosed TB in adult and child sudden unexpected deaths (SUDs) evaluated at Tygerberg Forensic Pathology Services, South Africa.
METHODS
METHODS
In a retrospective descriptive study spanning 2016, we identified all SUDs where active TB was detected at post-mortem and matched with routine health service data to differentiate decedents who were diagnosed or undiagnosed with TB before death. A patient pathway analysis of the health service activities preceding SUD in adults with active TB was conducted.
RESULTS
RESULTS
Active TB was identified at post-mortem in 6.2% (48/770) of SUDs and was undiagnosed before death in 91.7% (44/48). The prevalence of active TB was 8.1% in adult SUDs (90.1% undiagnosed before SUD) and 1.8% in children (none diagnosed before SUD). Patient pathway analysis was possible for 15 adult SUDs, and this documented primary health care clinic attendances and hospital admissions in the six months preceding death and missed opportunities for TB investigations.
CONCLUSION
CONCLUSIONS
The prevalence of TB among SUDs in the Eastern Metro of Cape Town is high. Most active TB at post-mortem was undiagnosed before death, and multiple missed opportunities for TB investigation and diagnosis were noted. The systematic evaluation of all SUDs for TB could improve the reporting of undiagnosed TB and support risk mitigation for healthcare workers involved with the post-mortem process.
Identifiants
pubmed: 33582368
pii: S1201-9712(21)00122-3
doi: 10.1016/j.ijid.2021.02.036
pmc: PMC8358423
mid: NIHMS1730717
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
75-82Subventions
Organisme : FIC NIH HHS
ID : K43 TW011006
Pays : United States
Informations de copyright
Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.
Références
Emerg Infect Dis. 2011 Mar;17(3):488-94
pubmed: 21392441
Glob Health Action. 2017;10(1):1340396
pubmed: 28715934
Int J Popul Data Sci. 2019 Nov 20;4(2):1143
pubmed: 32935043
J Int AIDS Soc. 2016 Jan 12;19(1):20714
pubmed: 26765347
S Afr Med J. 2016 Jun 17;106(7):675-7
pubmed: 27384357
Int J Tuberc Lung Dis. 2015 Nov;19(11):1320-5
pubmed: 26467584
Public Health Action. 2017 Dec 21;7(4):258-267
pubmed: 29584794
BMC Health Serv Res. 2016 Aug 20;16(1):416
pubmed: 27544429
Int J Environ Res Public Health. 2018 Apr 12;15(4):
pubmed: 29649095
AIDS. 2015 Sep 24;29(15):1987-2002
pubmed: 26266773
J Clin Pathol. 2007 May;60(5):487-91
pubmed: 16731598
S Afr Med J. 2012 Jan 27;102(2):90-4
pubmed: 22310440
Int J Tuberc Lung Dis. 2020 Aug 1;24(8):857-859
pubmed: 32912394
Lancet. 2002 Sep 28;360(9338):985-90
pubmed: 12383668