2026-04-17T20:29:32Zhttps://recercat.cat/oai/request

oai:recercat.cat:2445/1389902025-12-05T00:34:49Zcom_2072_1057col_2072_478917

urn:hdl:2445/138990 Unmasking the hidden tuberculosis mortality burden in a large postmortem study in Maputo Central Hospital, Mozambique García-Basteiro, Alberto L. Hurtado, Juan Carlos Castillo, Paola Fernandes, Fabiola Navarro, Mireia Lovane, Lucilia Casas, Isaac Quintó, Llorenç Jordao, Dercio Ismail, Mamudo Rafik Lorenzoni, Cesaltina Carrilho, Carla Sanz, Ariadna Rakislova, Natalia Mira, Aurea Álvarez Martínez, Míriam Cossa, Anelsio Cobelens, Frank Mandomando, Inácio Vila Estapé, Jordi Bassat Orellana, Quique Menéndez, Clara Ordi i Majà, Jaume Martínez Yoldi, Miguel Julián Tuberculosi Mortalitat Mozambic Tuberculosis Moratality Mozambique 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: 3/54 (6%) children, 5/57 (9%) maternal deaths and 23/112 (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, " - " DNA was identified by TB-PCR and Xpert Ultra in the absence of histological TB lesions. Overall, 62 cases (27.8%) had TB disease at death and 80 (35.9%) had TB findings.The use of highly sensitive, easy to perform molecular tests in complete diagnostic autopsies may contribute to identifying TB cases at death that would have otherwise been missed. Routine use of these tools in certain diagnostic algorithms for hospitalised patients needs to be considered. Clinical diagnosis showed poor sensitivity for the diagnosis of TB at death. 2019-09-02T11:01:20Z 2020-07-25T05:10:25Z 2019-07-25 2019-08-02T18:01:02Z info:eu-repo/semantics/article info:eu-repo/semantics/acceptedVersion Versió postprint del document publicat a: http://dx.doi.org/10.1183/13993003.00312-2019 European Respiratory Journal, 2019 http://dx.doi.org/10.1183/13993003.00312-2019 (c) European Respiratory Society, 2019 info:eu-repo/semantics/openAccess European Respiratory Society Articles publicats en revistes (ISGlobal)