Undiagnosed pulmonary tuberculosis (TB) and Coronavirus Disease 2019 (COVID-19) in adults dying at home in a high-TB-burden setting, before and during pandemic COVID-19: an autopsy study
Open accessAbstract
Background: Missing or undiagnosed patients with tuberculosis (TB) or coronavirus disease 2019 (COVID-19) are of concern. Identifying both infections in patients with no diagnosis prior to death contributes to understanding the burden of disease. To confirm reports of global reduction in TB incidence, a 2012 autopsy study of adults dying at home of natural causes in a high-TB-burden setting was repeated, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) assessments after the first COVID-19 surge in South Africa. Methods: Adult decedents who died at home with insufficient information to determine cause of death, no recent hospitalization, and no current antemortem TB or COVID-19 diagnosis were identified between March 2019 and October 2020 with a 4-month halt during lockdown. A standardized verbal autopsy followed by minimally invasive needle autopsy (MIA) was performed. Biopsies were taken for histopathology from liver, bilateral brain and lung; bronchoalveolar lavage fluid was collected for Xpert (MTB/RIF) and mycobacterial culture, and blood for human immunodeficiency virus (HIV) polymerase chain reaction (PCR) testing. After the start of the COVID-19 pandemic, a nasopharyngeal swab and lung tissue were subjected to SARS-CoV-2 PCR testing. Results: Sixty-six MIAs were completed in 25 men and 41 women (median age, 60 years); 68.2% had antemortem respiratory symptoms and 30.3% were people with HIV. Overall, TB was diagnosed in 11 of 66 (16.7%) decedents, and 14 of 41 (34.1%) in the COVID-19 pandemic were SARS-CoV-2 positive. Conclusions: Undiagnosed TB in adults dying at home has decreased but remains unacceptably high. Forty percent of decedents had undiagnosed COVID-19, suggesting that estimates of excess deaths may underestimate the impact of SARS-CoV-2 on mortality.
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- Authors
- Sabet, N., Omar, T., Milovanovic, M., Magajane, T., Mosala, M., Moloantoa, T., Kato-Kalule, N., Semedo, L. V., Swanepoel, F., Wallis, C., Abraham, P., Lebina, L., Variava, E., & Martinson, N.
- Affiliations
- University of the Witwatersrand (ZA)
- National Health Laboratory Service (ZA)
- National Health Service (GB)
- Department of Internal Medicine, Klerksdorp-Tshepong Hospital Complex , Klerksdorp , South Africa
- Bio Analytical Research Corporation , Johannesburg , South Africa
- Johns Hopkins University (US)
- Corresponding author
- Sabet, Nadia
- ORCID
- Venue
- Clinical Infectious Diseases
- Publisher
- Oxford University Press (OUP)
- Published
- 2023-04-12
- Volume
- 77
- Issue
- 3
- Pages
- 453-459
- ISSN
- 1058-4838 (ISSN-L)
- 1537-6591
- OpenAlex
- W4365136180
- Cited by
- 8
- References
- 25
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 4 · 2023: 1
- FWCI
- 1.66
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Clinical Infectious Diseases (publishedVersion)
- PubMed (publishedVersion)
- Funders
- University of the Witwatersrand, Johannesburg (0012838438201512110500000000000000004550)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Tuberculosis Research and Epidemiology
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Autopsy Techniques and Outcomes
- Health Sciences › Medicine › Surgery › Infectious Diseases and Tuberculosis
- Keywords
- undiagnosed tuberculosis, COVID-19 pandemic, SARS-CoV-2, autopsy, verbal autopsy, HIV, excess mortality, tuberculosis incidence, South Africa
- MeSH terms
- COVID-19, SARS-CoV-2, COVID-19 Testing, Adult, Autopsy, Communicable Disease Control, Female, Humans, Male, Middle Aged, Mycobacterium tuberculosis, Tuberculosis, Tuberculosis, Pulmonary, HIV Infections, Pandemics
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