Liu Theresa T, Wilson Douglas, Dawood Halima, Cameron D William, Alvarez Gonzalo G
Division of Infectious Diseases, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada K1H 8L6.
Clin Dev Immunol. 2012;2012:937013. doi: 10.1155/2012/937013. Epub 2012 Mar 19.
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.
(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.
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.
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.
尽管南非开展了抗逆转录病毒治疗，这本应降低与艾滋病毒相关的结核病（TB）发病率，但夸祖鲁-纳塔尔省（KZN）的结核病所致死亡人数仍然很高。结核病通常通过临床诊断，未经微生物学确认，导致对结核病所致死亡的估计不准确。这可能导致可避免的死亡，并影响基于人群的结核病死亡率估计。
（1）在一组因结核病归因于医院死亡的已故住院患者回顾性队列中，测量经微生物学确认的结核病病例数。（2）估计该队列中耐多药（MDR）和广泛耐药（XDR）结核病的发生率。
在2006年9月至2007年3月期间，爱德华王子港医院（EDH）有2752例死亡，死亡证明上有403例（15%）归因于结核病。176例结核病归因死亡（44%）有标本送检涂片或培养；只有64例（36%）通过任何一项检测确诊为结核病。在39例培养确诊病例中，27/39（69%）为完全敏感结核病，27/39（69%）为涂片阴性培养阳性结核病（SNTB）。2例患者有单一药物耐药，3例患者有耐多药结核病，1例患者有广泛耐药结核病。
该队列中大多数结核病归因死亡未经微生物学确认。在确诊病例中，大多数为涂片阴性、培养阳性且对所有一线药物敏感。
