eprintid: 1463941
rev_number: 43
eprint_status: archive
userid: 608
dir: disk0/01/46/39/41
datestamp: 2015-03-19 19:48:53
lastmod: 2021-10-08 21:55:36
status_changed: 2018-03-15 15:11:46
type: article
metadata_visibility: show
item_issues_count: 0
creators_name: Bates, M
creators_name: Mudenda, V
creators_name: Shibemba, A
creators_name: Kaluwaji, J
creators_name: Tembo, J
creators_name: Kabwe, M
creators_name: Chimoga, C
creators_name: Chilukutu, L
creators_name: Chilufya, M
creators_name: Kapata, N
creators_name: Hoelscher, M
creators_name: Maeurer, M
creators_name: Mwaba, P
creators_name: Zumla, A
title: Tuberculosis at post-mortem in inpatient adults at a tertiary referral centre in sub-Saharan Africa - A prospective descriptive autopsy study
ispublished: pub
divisions: UCL
divisions: B02
divisions: C10
divisions: D15
keywords: Autopsy, Post-mortem, Adults, Tuberculosis, Inpatients, Respiratory tract infections, Sub-Saharan Africa, WHO
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abstract: Background: The World Health Organisation (WHO) estimates that 3 million cases of tuberculosis (TB) are missed every year. Identification and treatment of these are critical to achieving global TB control. Patients with sub-clinical TB, extra-pulmonary TB, and drug-resistant TB are difficult to diagnose and may be missed at all points of healthcare. An autopsy study was conducted to ascertain the burden of TB at post-mortem in adults who died in the inpatient general medical wards at a tertiary care referral center in Lusaka, Zambia. Methods: Complete whole body autopsies were performed on 125 adult inpatients. Pathological examination involved two stages: (1) Gross pathology was recorded, and samples were taken from all organs for histopathology and cryopreservation; and (2) Histopathological examination of tissue after appropriate staining. Specific pathology and diseases identified on examination were recorded. Lung tissues were processed using the GeneXpert MTB/RIF Assay. Primary outcome measures were specific diseases stratified by HIV status. Secondary outcomes were missed TB and drug-resistant TB cases. Findings: Of 125 adults, median age 35. years (IQR: 29-43), 80 (64%) were male and 101 (80.8%) were HIV-positive. Tuberculosis was the most common finding at autopsy with 78/125 cases (62.4%), of which 66/78 (84.6%) were HIV-infected. There were 35/78 cases (44.9%) with extra-pulmonary TB, the odds of which were higher among HIV-infected cases (aOR 5.14 (95% CI: 1.04-25.4), p=. 0.045); 25.6% (20/78) of the TB cases were not diagnosed ante-mortem; and 13/78 (16.7%) of the TB cases had undiagnosed MDR-TB. Other autopsy findings included: pyogenic pneumonia 36.8% (46/125); bacterial meningitis 7.2% (9/125); cardiac failure 7.2% (9/125); and malignancies 8.8% (11/125). Prevalence of HIV did not differ between TB and non-TB cases (84.6% vs. 74.5%: p=. 0.163). Interpretation: TB remains an important cause of death in adult inpatients. A substantial number of inpatients with TB and MDR-TB are not diagnosed by the current cascade of healthcare. Inpatient settings in high TB endemic countries should be included in WHO 'high risk' groups, and heightened clinical awareness and more proactive screening for TB and MDR-TB in all inpatients should be required.
date: 2015-01-01
date_type: published
official_url: https://doi.org/10.1016/j.ijmyco.2014.10.054
vfaculties: VGHCSCI
oa_status: green
full_text_type: pub
language: eng
primo: open
primo_central: open_green
article_type_text: Article
verified: verified_manual
elements_source: Scopus
elements_id: 1011430
doi: 10.1016/j.ijmyco.2014.10.054
lyricists_name: Bates, Matthew
lyricists_name: Zumla, Alimuddin
lyricists_id: MABAT85
lyricists_id: AZUML60
actors_name: Stacey, Thomas
actors_id: TSSTA20
actors_role: owner
full_text_status: public
publication: International Journal of Mycobacteriology
volume: 4
number: Supp 1
pagerange: 75-76
issn: 2212-554X
citation:        Bates, M;    Mudenda, V;    Shibemba, A;    Kaluwaji, J;    Tembo, J;    Kabwe, M;    Chimoga, C;                             ... Zumla, A; + view all <#>        Bates, M;  Mudenda, V;  Shibemba, A;  Kaluwaji, J;  Tembo, J;  Kabwe, M;  Chimoga, C;  Chilukutu, L;  Chilufya, M;  Kapata, N;  Hoelscher, M;  Maeurer, M;  Mwaba, P;  Zumla, A;   - view fewer <#>    (2015)    Tuberculosis at post-mortem in inpatient adults at a tertiary referral centre in sub-Saharan Africa - A prospective descriptive autopsy study.                   International Journal of Mycobacteriology , 4  (Supp 1)   pp. 75-76.    10.1016/j.ijmyco.2014.10.054 <https://doi.org/10.1016/j.ijmyco.2014.10.054>.       Green open access   
 
document_url: https://discovery.ucl.ac.uk/id/eprint/1463941/1/Bates%201-s2.0-S2212553114001769-main.pdf