RT Journal Article SR Electronic T1 Unmasking the hidden tuberculosis mortality burden in a large post mortem study in Maputo Central Hospital, Mozambique JF European Respiratory Journal JO Eur Respir J FD European Respiratory Society SP 1900312 DO 10.1183/13993003.00312-2019 VO 54 IS 3 A1 Alberto L. Garcia-Basteiro A1 Juan Carlos Hurtado A1 Paola Castillo A1 Fabiola Fernandes A1 Mireia Navarro A1 Lucilia Lovane A1 Isaac Casas A1 Llorenç Quintó A1 Dercio Jordao A1 Mamudo R. Ismail A1 Cesaltina Lorenzoni A1 Carla Carrilho A1 Ariadna Sanz A1 Natalia Rakislova A1 Aurea Mira A1 Miriam J. Alvarez-Martínez A1 Anélsio Cossa A1 Frank Cobelens A1 Inácio Mandomando A1 Jordi Vila A1 Quique Bassat A1 Clara Menendez A1 Jaume Ordi A1 Miguel J. Martínez YR 2019 UL http://erj.ersjournals.com/content/54/3/1900312.abstract 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: three out of 54 (6%) children, five out of 57 (9%)maternal deaths and 23 out of 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, Mycobacterium tuberculosis DNA was identified by TB-PCR and Xpert Ultra in the absence of histological TB lesions. Overall, 62 (27.8%) cases 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.This study shows the usefulness of molecular assays in ascertaining TB diagnosis at death. It questions the information of clinical diagnoses obtained from hospital registries as a reliable tool for TB mortality estimation. http://bit.ly/2KrzTBJ