PT - JOURNAL ARTICLE AU - Alberto L. Garcia-Basteiro AU - Juan Carlos Hurtado AU - Paola Castillo AU - Fabiola Fernandes AU - Mireia Navarro AU - Lucilia Lovane AU - Isaac Casas AU - Llorenç Quintó AU - Dercio Jordao AU - Mamudo R. Ismail AU - Cesaltina Lorenzoni AU - Carla Carrilho AU - Ariadna Sanz AU - Natalia Rakislova AU - Aurea Mira AU - Miriam J. Alvarez-Martínez AU - Anelsio Cossa AU - Frank Cobelens AU - Inácio Mandomando AU - Jordi Vila AU - Quique Bassat AU - Clara Menendez AU - Jaume Ordi AU - Miguel J. Martínez TI - Unmasking the hidden tuberculosis mortality burden in a large postmortem study in Maputo Central Hospital, Mozambique AID - 10.1183/13993003.00312-2019 DP - 2019 Jan 01 TA - European Respiratory Journal PG - 1900312 4099 - http://erj.ersjournals.com/content/early/2019/06/19/13993003.00312-2019.short 4100 - http://erj.ersjournals.com/content/early/2019/06/19/13993003.00312-2019.full AB - 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, M. tuberculosis 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.FootnotesThis manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.Conflict of interest: Dr. Garcia-Basteiro has nothing to disclose.Conflict of interest: Dr. Hurtado has nothing to disclose.Conflict of interest: Dr. Castillo has nothing to disclose.Conflict of interest: Dr. Fernandes has nothing to disclose.Conflict of interest: Dr. Navarro has nothing to disclose.Conflict of interest: Dr. Lovane has nothing to disclose.Conflict of interest: Dr. Casas has nothing to disclose.Conflict of interest: Dr. Quinto has nothing to disclose.Conflict of interest: Dr. Jordao has nothing to disclose.Conflict of interest: Dr. Ismail has nothing to disclose.Conflict of interest: Dr. Lorenzoni has nothing to disclose.Conflict of interest: Dr. Carrilho has nothing to disclose.Conflict of interest: Dr. Sanz has nothing to disclose.Conflict of interest: Dr. Rakislova has nothing to disclose.Conflict of interest: Dr. Mira has nothing to disclose.Conflict of interest: Dr. Alvarez-Martinez has nothing to disclose.Conflict of interest: Dr. Cossa has nothing to disclose.Conflict of interest: Dr. Cobelens has nothing to disclose.Conflict of interest: Dr. Mandomando has nothing to disclose.Conflict of interest: Dr. Vila has nothing to disclose.Conflict of interest: Dr. Bassat has nothing to disclose.Conflict of interest: Dr. Menendez has nothing to disclose.Conflict of interest: Dr. Ordi has nothing to disclose.Conflict of interest: Dr. Martinez has nothing to disclose.