| The prevalence and drug sensitivity of tuberculosis among patients dying in hospital in KwaZulu-Natal, South Africa: a postmortem study. | |
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MedLine Citation:
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PMID: 20582324 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Tuberculosis is the leading cause of death in South Africa by death notification, but accurate diagnosis of tuberculosis is challenging in this setting of high HIV prevalence. We conducted limited autopsies on young adults dying in a single public hospital in the province of KwaZulu-Natal between October 2008 and August 2009 in order to estimate the magnitude of deaths attributable to tuberculosis. METHODS AND FINDINGS: We studied a representative sample of 240 adult inpatients (aged 20-45 years) dying after admission to Edendale Hospital. Limited autopsies included collection of respiratory tract secretions and tissue by needle core biopsies of lung, liver, and spleen. Specimens were examined by fluorescent microscopy for acid-fast bacilli and cultured in liquid media; cultures positive for M. tuberculosis were tested for drug susceptibility to first- and second-line antibiotics. Ninety-four percent of our study cohort was HIV seropositive and 50% of decedents had culture-positive tuberculosis at the time of death. Fifty percent of the participants were on treatment for tuberculosis at the time of death and 58% of these treated individuals remained culture positive at the time of death. Of the 50% not receiving tuberculosis treatment, 42% were culture positive. Seventeen percent of all positive cultures were resistant to both isoniazid and rifampin (i.e., multidrug resistant); 16% of patients dying during the initiation phase of their first ever course of tuberculosis treatment were infected with multidrug-resistant bacilli. CONCLUSIONS: Our findings reveal the immense toll of tuberculosis among HIV-positive individuals in KwaZulu-Natal. The majority of decedents who remained culture positive despite receiving tuberculosis treatment were infected with pan-susceptible M. tuberculosis, suggesting that the diagnosis of tuberculosis was made too late to alter the fatal course of the infection. There is also a significant burden of undetected multidrug-resistant tuberculosis among HIV-coinfected individuals dying in this setting. New public health approaches that improve early diagnosis of tuberculosis and accelerate the initiation of treatment are urgently needed in this setting. Please see later in the article for the Editors' Summary. |
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Authors:
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Ted Cohen; Megan Murray; Kristina Wallengren; Gonzalo G Alvarez; Elizabeth Y Samuel; Douglas Wilson |
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Publication Detail:
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Type: Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't Date: 2010-06-22 |
Journal Detail:
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Title: PLoS medicine Volume: 7 ISSN: 1549-1676 ISO Abbreviation: PLoS Med. Publication Date: 2010 Jun |
Date Detail:
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Created Date: 2010-06-28 Completed Date: 2010-12-03 Revised Date: 2011-08-23 |
Medline Journal Info:
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Nlm Unique ID: 101231360 Medline TA: PLoS Med Country: United States |
Other Details:
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Languages: eng Pagination: e1000296 Citation Subset: IM |
Affiliation:
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Division of Global Health Equity, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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AIDS-Related Opportunistic Infections
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drug therapy,
microbiology,
mortality* Adult Antitubercular Agents / therapeutic use* Autopsy Drug Resistance, Bacterial Female HIV* HIV Seropositivity / complications, mortality*, virology Hospitals Humans Isoniazid / therapeutic use Male Middle Aged Mycobacterium tuberculosis* Prevalence Rifampin / therapeutic use South Africa / epidemiology Tuberculosis, Multidrug-Resistant / drug therapy, microbiology, mortality* Young Adult |
| Grant Support | |
ID/Acronym/Agency:
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DP2 OD006663-01/OD/NIH HHS; DP2OD006663/OD/NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Antitubercular Agents; 13292-46-1/Rifampin; 54-85-3/Isoniazid |
| Comments/Corrections | |
Comment In:
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Future Microbiol. 2010 Nov;5(11):1641-3
[PMID:
21133686
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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