Inaccuracy of Death Certificate Diagnosis of Tuberculosis and Potential Underdiagnosis of TB in a Region of High HIV Prevalence
Despite the South African antiretroviral therapy rollout, which should reduce the incidence of HIV-associated tuberculosis (TB), the number of TB-attributable deaths in KwaZuluNatal (KZN) remains high. TB is often diagnosed clinically, without microbiologic confirmation, leading to inaccurate estima...
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| Format: | Article |
| Language: | English |
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Wiley
2012-01-01
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| Series: | Clinical and Developmental Immunology |
| Online Access: | http://dx.doi.org/10.1155/2012/937013 |
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| author | Theresa T. Liu Douglas Wilson Halima Dawood D. William Cameron Gonzalo G. Alvarez |
| author_facet | Theresa T. Liu Douglas Wilson Halima Dawood D. William Cameron Gonzalo G. Alvarez |
| author_sort | Theresa T. Liu |
| collection | DOAJ |
| description | Despite the South African antiretroviral therapy rollout, which should reduce the incidence of HIV-associated tuberculosis (TB), the number of TB-attributable deaths in KwaZuluNatal (KZN) remains high. TB is often diagnosed clinically, without microbiologic confirmation, leading to inaccurate estimates of TB-attributed deaths. This may contribute to avoidable deaths, and impact population-based TB mortality estimates.
Objectives. (1) To measure the number of cases with microbiologically confirmed TB in a retrospective cohort of deceased inpatients with TB-attributed hospital deaths. (2) To estimate the rates of multi-drug resistant (MDR) and extensively drug resistant (XDR) TB in this cohort. Results. Of 2752 deaths at EDH between September 2006 and March 2007, 403 (15%) were attributed to TB on the death certificate. 176 of the TB-attributed deaths (44%) had a specimen sent for smear or culture; only 64 (36%) had a TB diagnosis confirmed by either test. Of the 39 culture-confirmed cases, 27/39 (69%) had fully susceptible TB and 27/39 (69%) had smear-negative culture-positive TB (SNTB). Two patients had drug monoresistance, three patients had MDR-TB, and one had XDR-TB. Conclusions. Most TB-attributed deaths in this cohort were not microbiologically confirmed. Of confirmed cases, most were smear-negative, culture positive and were susceptible to all first line drugs. |
| format | Article |
| id | doaj-art-bb7823a85b044f4f8bf6a8d089dd49e4 |
| institution | OA Journals |
| issn | 1740-2522 1740-2530 |
| language | English |
| publishDate | 2012-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Clinical and Developmental Immunology |
| spelling | doaj-art-bb7823a85b044f4f8bf6a8d089dd49e42025-08-20T02:18:43ZengWileyClinical and Developmental Immunology1740-25221740-25302012-01-01201210.1155/2012/937013937013Inaccuracy of Death Certificate Diagnosis of Tuberculosis and Potential Underdiagnosis of TB in a Region of High HIV PrevalenceTheresa T. Liu0Douglas Wilson1Halima Dawood2D. William Cameron3Gonzalo G. Alvarez4Division of Infectious Diseases, The Ottawa Hospital, University of Ottawa, Ottawa, ON, K1H 8L6, CanadaDepartment of Medicine, Edendale and Grey’s Hospitals, Pietermaritzburg, KwaZulu-Natal 3200, South AfricaDepartment of Medicine, Edendale and Grey’s Hospitals, Pietermaritzburg, KwaZulu-Natal 3200, South AfricaDivision of Infectious Diseases, The Ottawa Hospital, University of Ottawa, Ottawa, ON, K1H 8L6, CanadaDivision of Infectious Diseases, The Ottawa Hospital, University of Ottawa, Ottawa, ON, K1H 8L6, CanadaDespite the South African antiretroviral therapy rollout, which should reduce the incidence of HIV-associated tuberculosis (TB), the number of TB-attributable deaths in KwaZuluNatal (KZN) remains high. TB is often diagnosed clinically, without microbiologic confirmation, leading to inaccurate estimates of TB-attributed deaths. This may contribute to avoidable deaths, and impact population-based TB mortality estimates. Objectives. (1) To measure the number of cases with microbiologically confirmed TB in a retrospective cohort of deceased inpatients with TB-attributed hospital deaths. (2) To estimate the rates of multi-drug resistant (MDR) and extensively drug resistant (XDR) TB in this cohort. Results. Of 2752 deaths at EDH between September 2006 and March 2007, 403 (15%) were attributed to TB on the death certificate. 176 of the TB-attributed deaths (44%) had a specimen sent for smear or culture; only 64 (36%) had a TB diagnosis confirmed by either test. Of the 39 culture-confirmed cases, 27/39 (69%) had fully susceptible TB and 27/39 (69%) had smear-negative culture-positive TB (SNTB). Two patients had drug monoresistance, three patients had MDR-TB, and one had XDR-TB. Conclusions. Most TB-attributed deaths in this cohort were not microbiologically confirmed. Of confirmed cases, most were smear-negative, culture positive and were susceptible to all first line drugs.http://dx.doi.org/10.1155/2012/937013 |
| spellingShingle | Theresa T. Liu Douglas Wilson Halima Dawood D. William Cameron Gonzalo G. Alvarez Inaccuracy of Death Certificate Diagnosis of Tuberculosis and Potential Underdiagnosis of TB in a Region of High HIV Prevalence Clinical and Developmental Immunology |
| title | Inaccuracy of Death Certificate Diagnosis of Tuberculosis and Potential Underdiagnosis of TB in a Region of High HIV Prevalence |
| title_full | Inaccuracy of Death Certificate Diagnosis of Tuberculosis and Potential Underdiagnosis of TB in a Region of High HIV Prevalence |
| title_fullStr | Inaccuracy of Death Certificate Diagnosis of Tuberculosis and Potential Underdiagnosis of TB in a Region of High HIV Prevalence |
| title_full_unstemmed | Inaccuracy of Death Certificate Diagnosis of Tuberculosis and Potential Underdiagnosis of TB in a Region of High HIV Prevalence |
| title_short | Inaccuracy of Death Certificate Diagnosis of Tuberculosis and Potential Underdiagnosis of TB in a Region of High HIV Prevalence |
| title_sort | inaccuracy of death certificate diagnosis of tuberculosis and potential underdiagnosis of tb in a region of high hiv prevalence |
| url | http://dx.doi.org/10.1155/2012/937013 |
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