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 note: This work is licensed under a Creative Commons Attribution 4.0 International License. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in the credit line; if the material is not included under the Creative Commons license, users will need to obtain permission from the license holder to reproduce the material. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/ 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