The Prevalence and Drug Sensitivity of Tuberculosis among Patients Dying in Hospital in KwaZulu-Natal, South Africa: A Postmortem Study
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
Vyšlo v časopise:
The Prevalence and Drug Sensitivity of Tuberculosis among Patients Dying in Hospital in KwaZulu-Natal, South Africa: A Postmortem Study. PLoS Med 7(6): e32767. doi:10.1371/journal.pmed.1000296
Kategorie:
Research Article
prolekare.web.journal.doi_sk:
https://doi.org/10.1371/journal.pmed.1000296
Souhrn
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
Zdroje
1. UNAIDS/WHO Epidemiological Fact Sheet on HIV and AIDS, 2008 Update.
Available: http://apps.who.int/globalatlas/predefinedReports/EFS2008/full/EFS2008_ZA.pdf
2. World Health Organization
2009
Global tuberculosis control – epidemiology, strategy, financing
Geneva
World Health Organization (WHO/HTM/TB/2009.411)
3. ColebundersR
BastianI
2000
A review of the diagnosis and treatment of smear-negative pulmonary tuberculosis.
Int J Tuberc Lung Dis
4
97
107
4. HarriesAD
MaherD
NunnP
1998
An approach to the problems of diagnosing and treating adult smear-negative pulmonary tuberculosis in high-HIV-prevalence settings in sub-Saharan Africa.
Bull World Health Organ
76
651
662
5. Abdool KarimSS
ChurchyardGJ
Abdool KarimQ
LawnSL
2009
HIV infection and tuberculosis in South Africa: an urgent need to escalate the public health response.
Lancet
374
921
933
6. GandhiNR
MollA
SturmAW
PawinskiR
GovenderT
2006
Extensively drug-resistant tuberculosis as a cause of death in patients co-infected with tuberculosis and HIV in a rural area of South Africa.
Lancet
368
1575
1580
7. Statistics South Africa
2009
Mortality and causes of death in South Africa 2007: finding from death notification.
Available: http://www.statssa.gov.za/publications/statsdownload.asp?PPN=P0309.3&SCH=4507
8. South African Institute of Race Relations
South Africa Survey 2008/2009.
Press Report available online http://www.sairr.org.za/press-office/press-releases/027-2009-survey-12-press-release-12-11-2009.pdf; accessed Dec 12, 2009
9. AlvarezGG
ThembelaBL
MullerFJ
ClinchJ
SinghalN
CameronDW
2004
Tuberculosis at Edendale Hospital in Pietermaritzburg, Kwazulu Natal, South Africa.
Int J Tuberc Lung Dis
8
1472
1478
10. The Italian Cooperation in South Africa, Demographic and Health Indicators KwaZulu-Natal.
Public document available online http://italcoop.co.za/PublicDocuments/Demographic_Health_Statisticaldata_KW_EC_SA%20_EN.pdf (Accessed 01 March 2010)
11. National Department of Health, South Africa
2007
The national HIV and syphilis survey, South Africa.
http://www.doh.gov.za/docs/reports/2007/hiv/part1.pdf (Accessed 01 March 2010)
12. Le CouerS
HalembokakaG
KhlatM
BrouardN
PurhuenceF
2005
Impact of AIDS on adult mortality: a morgue-based study in Pointe-Noire, Republic of Congo.
AIDS
19
1683
1687
13. WebberLM
SwanevelderC
GrabowWO
FourieP
2000
Evaluation of a rapid test for HIV antibodies in saliva and blood.
SA Med
90
1004
1007
14. ZehnerR
BratzkeH
MebsD
1995
Evaluation of a rapid assay system, HIV 1/HIV 2 Testpack, Abbott, to detect human immunodeficiency virus antibodies in postmortem blood.
J Forensic Sci
40
113
115
15. WilliamsPL
WarwickR
DysonM
BannisterL
1989
Gray's Anatomy, thirty seventh edition
Edinburgh
Churchill Livingstone
16. GuerraI
OrtizE
PortuJ
AtaresB
Aldamiz-EtxebarriaM
2001
Value of limited necropsy in HIV-positive patients.
Pathol Res Pract
197
165
168
17. SatyanarayanaS
KalghatgiAT
MalaviyaAK
BhardwajJR
MuralidharA
2003
Needle necropsy in AIDS.
Indian J Pathol Microbiol
46
416
419
18. GutierrezEB
ZanettaDM
SaldivaPH
CapelozziVL
2002
Autopsy-proven determinants of death in HIV-infected patients treated for pulmonary tuberculosis in Sao Paulo, Brazil.
Pathol Res Pract
198
339
346
19. HannaBA
2004
Laboratory diagnosis.
RomWN
GaraySM
Tuberculosis (2nd Edition)
Philadelphia
Lippincott Williams and Wilkins
20. KentPT
KubicaGP
1985
Public Health Mycobacteriology.
A Guide For the Level III Laboratory. Atlanta, U.S department of Health and Human Services, Public Health Service, CDC
21. IsenbergHD
2004
Clinical Microbiology Procedures Handbook, vol(1) Chapter 5.13.1
Washington DC
ASM Press
22. RanaFS
HawkenMP
MwachariC
BhattSM
AbdullahF
2000
Autopsy study of HIV-1-positive and HIV-1-negative adult medical patients in Nairobi, Kenya.
J Acquir Immune Defic Syndr
24
23
29
23. EchejohGO
MandongBM
TankoMN
ManassehAN
OkekeEN
2006
Hepatic histopathological findings in HIV patients at postmortem in Jos university teaching hospital, Nigeria.
Tropical doctor
36
228
231
24. AnsariNA
KombeAH
KenyonTA
HoneNM
TapperoJW
2002
Pathology and causes of death in a group of 128 predominantly HIV-positive patients in Botswana, 1997–1998.
Int J Tuberc Lung Dis
6
55
63
25. MartinsonNA
KarstaedtA
VenterF
OmarT
KingP
2007
Causes of death in hospitalized adults with a premortem diagnosis of tuberculosis: an autopsy study.
AIDS
21
2043
2050
26. ChideyaS
WinstonCA
PeloquinCA
BradfordWZ
HopewellPC
2009
Isoniazid, rifampin, ethambutol, and pyrazinamide pharmacokinetics and treatment outcomes among a predominantly HIV-infected cohort of adults with tuberculosis from Botswana.
Clin Infect Dis
48
1685
1694
27. BwireR
BorgdorffMW
Sticht-GrohV
RiederHL
KawumaHJ
1999
Tuberculosis chemotherapy and sputum conversion among HIV-seropositive and HIV-seronegative patients in south-eastern Uganda.
East Afr Med J
76
307
313
28. MeintjesG
SchoemanH
MorroniC
WilsonD
MaartensG
2008
Patient and provider delay in tuberculosis suspects from communities with a high HIV prevalence in South Africa: a cross-sectional study.
BMC Infect Dis
25
8
72
29. MillenSJ
UysPW
HargroveJ
van HeerdenPD
WilliamsBJ
2008
The effect of diagnostic delays on the drop-out rate and the total delay to diagnosis of tuberculosis.
PLoS ONE
3
e1933
30. CainKP
McCarthyKD
HeiligCM
MonkongdeeP
2010
An algorithm for tuberculosis screening and diagnosis in people with HIV.
N Eng J Med
362
707
16
31. HiraoS
YassinMA
KhamofuHG
LawsonL
CambanisA
2007
Same-day smears in the diagnosis of tuberculosis.
Trop Med Int Health
12
1459
1463
32. SteingartKR
NgV
HenryM
HopewellPC
RamsayA
2006
Sputum processing methods to improve the sensitivity of smear microscopy for tuberculosis: a systematic review.
Lancet Infectious Diseases
6
664
674
33. MaraisBJ
BrittleW
PainczykK
HesselingAC
BeyersN
2008
Use of light-emitting diode fluorescence microscopy to detect acid-fast bacilli in sputum.
Clin Infect Dis
47
203
207
34. LawnSD
KranzerK
WoodR
2009
Antiretroviral therapy for control of the HIV-associated tuberculosis epidemic in resource-limited settings.
Clin Chest Med
30
685
99
35. PaiM
KalantriS
DhedaK
2006
New tools and emerging technologies for the diagnosis of tuberculosis: part II. Active tuberculosis and drug resistance.
Expert Rev Mol Diagn
6
423
432
36. Mäkinenj
MarttilaHJ
MarjamäkiM
ViljanenMK
SoiniH
2006
Comparison of two commercially available DNA line probe assays for detection of multidrug-resistant Mycobacterium tuberculosis.
J Clin Microbiol
44
350
352
37. BarnardM
AlbertH
CoetzeeG
O'BrienR
BosmanME
2008
Rapid molecular screening for multidrug-resistant tuberculosis in a high-volume public health laboratory in South Africa.
Am J Respir Crit Care Med
177
787
792
Štítky
Interné lekárstvoČlánok vyšiel v časopise
PLOS Medicine
2010 Číslo 6
- Parazitičtí červi v terapii Crohnovy choroby a dalších zánětlivých autoimunitních onemocnění
- Pleiotropní účinky statinů na kardiovaskulární systém
- Statiny indukovaná myopatie: Jak na diferenciální diagnostiku?
- Zástava srdce u pacienta se střelnými ranami – kazuistika
- Statinová intolerance
Najčítanejšie v tomto čísle
- Gestational Age at Delivery and Special Educational Need: Retrospective Cohort Study of 407,503 Schoolchildren
- Evaluating the Quality of Research into a Single Prognostic Biomarker: A Systematic Review and Meta-analysis of 83 Studies of C-Reactive Protein in Stable Coronary Artery Disease
- Closing the Gaps: From Science to Action in Maternal, Newborn, and Child Health in Africa
- Maternal Health: Time to Deliver