RT Journal Article SR Electronic T1 Unmasking the hidden tuberculosis mortality burden in a largepost mortem莫桑比克马普托留学中心医院,摩根富林明欧盟ropean Respiratory Journal JO Eur Respir J FD European Respiratory Society SP 1900312 DO 10.1183/13993003.00312-2019 VO 54 IS 3 A1 Garcia-Basteiro, Alberto L. A1 Hurtado, Juan Carlos A1 Castillo, Paola A1 Fernandes, Fabiola A1 Navarro, Mireia A1 Lovane, Lucilia A1 Casas, Isaac A1 Quintó, Llorenç A1 Jordao, Dercio A1 Ismail, Mamudo R. A1 Lorenzoni, Cesaltina A1 Carrilho, Carla A1 Sanz, Ariadna A1 Rakislova, Natalia A1 Mira, Aurea A1 Alvarez-Martínez, Miriam J. A1 Cossa, Anélsio A1 Cobelens, Frank A1 Mandomando, Inácio A1 Vila, Jordi A1 Bassat, Quique A1 Menendez, Clara A1 Ordi, Jaume A1 Martínez, Miguel J. YR 2019 UL //www.qdcxjkg.com/content/54/3/1900312.abstract AB Sensitive tools are needed to accurately establish the diagnosis of tuberculosis (TB) at death, especially in low-income countries. The objective of this study was to evaluate the burden of TB in a series of patients who died in a tertiary referral hospital in sub-Saharan Africa using an in-house real time PCR (TB-PCR) and the Xpert MTB/RIF Ultra (Xpert Ultra) assay.Complete diagnostic autopsies were performed in a series of 223 deaths (56.5% being HIV-positive), including 54 children, 57 maternal deaths and 112 other adults occurring at the Maputo Central Hospital, Mozambique. TB-PCR was performed in all lung, cerebrospinal fluid and central nervous system samples in HIV-positive patients. All samples positive for TB-PCR or showing histological findings suggestive of TB were analysed with the Xpert Ultra assay.TB was identified as the cause of death in 31 patients: three out of 54 (6%) children, five out of 57 (9%)maternal deaths and 23 out of 112 (21%) other adults. The sensitivity of the main clinical diagnosis to detect TB as the cause of death was 19.4% (95% CI 7.5–37.5) and the specificity was 97.4% (94.0–99.1) compared to autopsy findings. Concomitant TB (TB disease in a patient dying of other causes) was found in 31 additional cases. Xpert Ultra helped to identify 15 cases of concomitant TB. In 18 patients, Mycobacterium tuberculosis DNA was identified by TB-PCR and Xpert Ultra in the absence of histological TB lesions. Overall, 62 (27.8%) cases had TB disease at death and 80 (35.9%) had TB findings.The use of highly sensitive, easy to perform molecular tests in complete diagnostic autopsies may contribute to identifying TB cases at death that would have otherwise been missed. Routine use of these tools in certain diagnostic algorithms for hospitalised patients needs to be considered. Clinical diagnosis showed poor sensitivity for the diagnosis of TB at death.This study shows the usefulness of molecular assays in ascertaining TB diagnosis at death. It questions the information of clinical diagnoses obtained from hospital registries as a reliable tool for TB mortality estimation. http://bit.ly/2KrzTBJ