T Omar1, E Variava2, E Moroe3, A Billioux4, R E Chaisson4, L Lebina3, N Martinson5. 1. Department of Anatomical Pathology, National Health Laboratory Service and University of the Witwatersrand, Johannesburg, South Africa. 2. Department of Internal Medicine, Klerksdorp Tshepong Hospital Complex and University of the Witwatersrand, Johannesburg, South Africa. 3. Perinatal HIV Research Unit, and Medical Research Council Soweto Matlosana Centre for HIV/AIDS and TB Research, University of the Witwatersrand, Johannesburg, South Africa. 4. Johns Hopkins University Center for TB Research, Baltimore, Maryland, USA. 5. Perinatal HIV Research Unit, and Medical Research Council Soweto Matlosana Centre for HIV/AIDS and TB Research, University of the Witwatersrand, Johannesburg, South Africa; Johns Hopkins University Center for TB Research, Baltimore, Maryland, USA; Department of Science and Technology/National Research Foundation Centre of Excellence for Biomedical TB Research, University of the Witwatersrand, Johannesburg, South Africa.
Abstract
BACKGROUND: A high proportion of deaths in Africa occur at home, where cause of death (CoD) is often unknown. We ascertained undiagnosed pulmonary tuberculosis (TB) by performing limited autopsies in adults dying at home in whom there was no apparent CoD. METHODS: Mortuaries in Matlosana, South Africa, identified potentially eligible adults with no ante-mortem diagnosis and/or no recent hospital admission. A questionnaire was administered to family members. Bilateral lung core biopsies and modified bronchoalveolar lavage (BAL) were performed. The biopsies were examined histologically and submitted with BAL aspirates for mycobacterial culture (MGIT(TM)) and Xpert(®) MTB/RIF testing. Human immunodeficiency virus (HIV) testing was not performed. RESULTS: Of 162 families approached, 28 refused and 29 of the deceased were on or had recently stopped anti-tuberculosis treatment; 85 were included. All were Black and 53% were men. The median age was 57 years (interquartile range [IQR] 44-66) and median symptom duration (mainly cough) was 63 days (IQR 14-112). Laboratory evidence of TB was found in 27 (31.8%); 21 were Xpert-positive, 23 were MGIT-positive and 14 had histological evidence consistent with active TB. CONCLUSION: In this high HIV prevalence setting, a quarter of the home deaths had evidence of undiagnosed, likely infectious TB, suggesting that TB-related mortality is under-ascertained and under-reported, with serious implications for TB control in high TB burden settings.
BACKGROUND: A high proportion of deaths in Africa occur at home, where cause of death (CoD) is often unknown. We ascertained undiagnosed pulmonary tuberculosis (TB) by performing limited autopsies in adults dying at home in whom there was no apparent CoD. METHODS: Mortuaries in Matlosana, South Africa, identified potentially eligible adults with no ante-mortem diagnosis and/or no recent hospital admission. A questionnaire was administered to family members. Bilateral lung core biopsies and modified bronchoalveolar lavage (BAL) were performed. The biopsies were examined histologically and submitted with BAL aspirates for mycobacterial culture (MGIT(TM)) and Xpert(®) MTB/RIF testing. Human immunodeficiency virus (HIV) testing was not performed. RESULTS: Of 162 families approached, 28 refused and 29 of the deceased were on or had recently stopped anti-tuberculosis treatment; 85 were included. All were Black and 53% were men. The median age was 57 years (interquartile range [IQR] 44-66) and median symptom duration (mainly cough) was 63 days (IQR 14-112). Laboratory evidence of TB was found in 27 (31.8%); 21 were Xpert-positive, 23 were MGIT-positive and 14 had histological evidence consistent with active TB. CONCLUSION: In this high HIV prevalence setting, a quarter of the home deaths had evidence of undiagnosed, likely infectious TB, suggesting that TB-related mortality is under-ascertained and under-reported, with serious implications for TB control in high TB burden settings.
Authors: Rachel M Wake; Nelesh P Govender; Tanvier Omar; Carolina Nel; Ahmad Haeri Mazanderani; Aaron S Karat; Nazir A Ismail; Caroline T Tiemessen; Joseph N Jarvis; Thomas S Harrison Journal: Clin Infect Dis Date: 2020-04-10 Impact factor: 9.079
Authors: Lesley Scott; Pedro da Silva; Catharina C Boehme; Wendy Stevens; Christopher M Gilpin Journal: Curr Opin HIV AIDS Date: 2017-03 Impact factor: 4.283
Authors: Aaron S Karat; Tanvier Omar; Anne von Gottberg; Mpho Tlali; Violet N Chihota; Gavin J Churchyard; Katherine L Fielding; Suzanne Johnson; Neil A Martinson; Kerrigan McCarthy; Nicole Wolter; Emily B Wong; Salome Charalambous; Alison D Grant Journal: PLoS One Date: 2016-11-09 Impact factor: 3.240
Authors: Aaron S Karat; Mpho Tlali; Katherine L Fielding; Salome Charalambous; Violet N Chihota; Gavin J Churchyard; Yasmeen Hanifa; Suzanne Johnson; Kerrigan McCarthy; Neil A Martinson; Tanvier Omar; Kathleen Kahn; Daniel Chandramohan; Alison D Grant Journal: PLoS One Date: 2017-03-23 Impact factor: 3.240
Authors: Sibongile Walaza; Stefano Tempia; Andries Dreyer; Halima Dawood; Ebrahim Variava; Neil A Martinson; Jocelyn Moyes; Adam L Cohen; Nicole Wolter; Claire von Mollendorf; Anne von Gottberg; Sumayya Haffejee; Florette Treurnicht; Orienka Hellferscee; Nazir Ismail; Cheryl Cohen Journal: Open Forum Infect Dis Date: 2017-08-07 Impact factor: 3.835