| Summary: | A research report submitted to the Faculty of Health Sciences,
University of the Witwatersrand, in partial fulfillment of the
requirement for the degree of Master of Medicine in the branch
Anatomical Pathology
Johannesburg, 2016 === Background: A high proportion of deaths in Africa occur at home where cause of
death (CoD) is often unknown. We ascertained undiagnosed pulmonary TB in
adults dying at home in whom there was no apparent CoD by doing limited
autopsies.
Methods: Mortuaries in Matlosana, South Africa identified eligible adults without
an ante-mortem diagnosis and/or no recent hospital admission. A questionnaire
was administered to next-of-kin. Bilateral lung core biopsies, and modified
broncho-alveolar lavages (BAL) were performed. Biopsies were examined
histologically and submitted with BAL aspirates for mycobacterial culture and
Xpert® MTB/RIF. HIV testing was not performed.
Results: 162 families were approached to participate. 28 Refused; 49 were not
eligible for the study and included 29 deceased who were on, or had recently
stopped TB treatment; 85 were included. All were Black and 53% were men. The
median age was 57 years (IQR: 44-66), and median symptom duration 63 days
(IQR: 14-112). Laboratory evidence of TB was found in 27(31.8%); 21 were Xpert
positive, 23 were MGIT positive, and 14 had histological evidence consistent with
TB.
Conclusion: In this high HIV prevalence setting, almost one third of home deaths
had evidence of undiagnosed TB, suggesting TB-related mortality is underascertained
and under-reported, with grave implications for TB control in high TB
burden settings. === MT2016
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