# name
Unmasking the hidden tuberculosis mortality burden in a large postmortem study in Maputo Central Hospital, Mozambique

# metadata.dc.description.abstract[].value
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.

# metadata.dc.source[].value
Articles publicats en revistes (ISGlobal)

# metadata.dc.title[].value
Unmasking the hidden tuberculosis mortality burden in a large postmortem study in Maputo Central Hospital, Mozambique