#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

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 lekárstvo

Článok vyšiel v časopise

PLOS Medicine


2010 Číslo 6
Najčítanejšie tento týždeň
Najčítanejšie v tomto čísle
Kurzy

Zvýšte si kvalifikáciu online z pohodlia domova

Aktuální možnosti diagnostiky a léčby litiáz
nový kurz
Autori: MUDr. Tomáš Ürge, PhD.

Všetky kurzy
Prihlásenie
Zabudnuté heslo

Zadajte e-mailovú adresu, s ktorou ste vytvárali účet. Budú Vám na ňu zasielané informácie k nastaveniu nového hesla.

Prihlásenie

Nemáte účet?  Registrujte sa

#ADS_BOTTOM_SCRIPTS#