Osman, Muhammad ORCID: 0000-0003-3818-9729, Verster, Janette, Dempers, Johan J, Du Preez, Karen, von Delft, Arne, Dunbar, Rory, Welte, Alex, Naidoo, Pren and Hesseling, Anneke C (2021) Tuberculosis in persons with sudden unexpected death, in Cape Town, South Africa. International Journal of Infectious Diseases, 105. pp. 75-82. ISSN 1201-9712 (doi:https://doi.org/10.1016/j.ijid.2021.02.036)

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Abstract

Background
Globally, tuberculosis (TB) remains one of the leading causes of death from a single infectious agent, but there has been little work to estimate mortality before the diagnosis of TB. We investigated the burden of diagnosed and undiagnosed TB in adult and child sudden unexpected deaths (SUDs) evaluated at Tygerberg Forensic Pathology Services, South Africa.
Methods
In a retrospective descriptive study spanning 2016, we identified all SUDs where active TB was detected at post-mortem and matched with routine health service data to differentiate decedents who were diagnosed or undiagnosed with TB before death. A patient pathway analysis of the health service activities preceding SUD in adults with active TB was conducted.
Results
Active TB was identified at post-mortem in 6.2% (48/770) of SUDs and was undiagnosed before death in 91.7% (44/48). The prevalence of active TB was 8.1% in adult SUDs (90.1% undiagnosed before SUD) and 1.8% in children (none diagnosed before SUD). Patient pathway analysis was possible for 15 adult SUDs, and this documented primary health care clinic attendances and hospital admissions in the six months preceding death and missed opportunities for TB investigations.
Conclusion
The prevalence of TB among SUDs in the Eastern Metro of Cape Town is high. Most active TB at post-mortem was undiagnosed before death, and multiple missed opportunities for TB investigation and diagnosis were noted. The systematic evaluation of all SUDs for TB could improve the reporting of undiagnosed TB and support risk mitigation for healthcare workers involved with the post-mortem process.

Item Type:	Article
Uncontrolled Keywords:	tuberculosis mortality
Subjects:	Q Science > QR Microbiology > QR355 Virology R Medicine > RB Pathology
Faculty / School / Research Centre / Research Group:	Faculty of Education, Health & Human Sciences Faculty of Education, Health & Human Sciences > School of Human Sciences (HUM)
Last Modified:	23 May 2022 11:13
URI:	http://gala.gre.ac.uk/id/eprint/35559

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