Division of Infectious Diseases and International Health, Duke University, Durham, NC, USA; Kilimanjaro Christian Medical Centre, Moshi, Tanzania.
Division of Infectious Diseases and International Health, Duke University, Durham, NC, USA; Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Duke Global Health Institute, Duke University, Durham, NC, USA; Centre for International Health, University of Otago, Dunedin, New Zealand.
Clin Microbiol Infect. 2022 Aug;28(8):1150.e1-1150.e6. doi: 10.1016/j.cmi.2022.03.027. Epub 2022 Mar 28.
Numerous tuberculosis (TB) deaths remain undetected in low-resource endemic settings. With autopsy-confirmed tuberculosis as our standard, we assessed the diagnostic performance of Xpert MTB/RIF Ultra (Ultra; Cepheid) on nasopharyngeal specimens collected postmortem.
From October 2016 through May 2019, we enrolled pediatric and adult medical deaths to a prospective autopsy study at two referral hospitals in northern Tanzania with next-of-kin authorization. We swabbed the posterior nasopharynx prior to autopsy and tested the samples later by Ultra. At autopsy we collected lung, liver, and, when possible, cerebrospinal fluid for mycobacterial culture and histopathology. Confirmed tuberculosis was defined as Mycobacterium tuberculosis complex recovery by culture with consistent tissue histopathology findings; decedents with only histopathology findings, including acid-fast staining or immunohistochemistry, were defined as probable tuberculosis.
Of 205 decedents, 78 (38.0%) were female and median (range) age was 45 (0,96) years. Twenty-seven (13.2%) were found to have tuberculosis at autopsy, 22 (81.5%) confirmed and 5 (18.5%) probable. Ultra detected M. tuberculosis complex from the nasopharynx in 21 (77.8%) of 27 TB cases (sensitivity 70.4% [95% confidence interval {CI} 49.8-86.2%], specificity 98.9% [95% CI 96.0-99.9%]). Among confirmed TB, the sensitivity increased to 81.8% (95% CI 59.7-94.8%). Tuberculosis was not included as a death certificate diagnosis in 14 (66.7%) of the 21 MTBc detections by Ultra.
Nasopharyngeal Ultra was highly specific for identifying in-hospital tuberculosis deaths, including unsuspected tuberculosis deaths. This approach may improve tuberculosis death enumeration in high-burden countries.
在资源匮乏的地方性流行地区，仍有大量结核病（TB）死亡未被发现。以尸检确诊的结核病为标准，我们评估了 Xpert MTB/RIF Ultra（Ultra；Cepheid）在死后采集的鼻咽标本中的诊断性能。
从 2016 年 10 月至 2019 年 5 月，我们在坦桑尼亚北部的两家转诊医院开展了一项前瞻性尸检研究，征得近亲属同意后，纳入了儿科和成人医疗死亡病例。我们在尸检前对后鼻咽进行拭子取样，然后用 Ultra 进行后续检测。在尸检时，我们收集了肺、肝，当可能时，还收集了脑脊液进行分枝杆菌培养和组织病理学检查。确诊结核病定义为通过培养与一致的组织病理学发现恢复结核分枝杆菌复合体；仅具有组织病理学发现，包括抗酸染色或免疫组织化学的死者被定义为可能的结核病。
在 205 名死者中，78 名（38.0%）为女性，中位（范围）年龄为 45（0，96）岁。27 例（13.2%）在尸检中发现结核病，22 例（81.5%）确诊，5 例（18.5%）可能。Ultra 从 27 例结核病病例中的 21 例（77.8%）的鼻咽中检测到结核分枝杆菌复合体（敏感性 70.4%[95%置信区间{CI} 49.8-86.2%]，特异性 98.9%[95% CI 96.0-99.9%]）。在确诊结核病中，敏感性增加至 81.8%（95% CI 59.7-94.8%）。在 21 例 Ultra 检测到的 MTBc 中，有 14 例（66.7%）未将结核病纳入死亡证明诊断。
鼻咽 Ultra 高度特异性地识别医院内结核病死亡，包括未被怀疑的结核病死亡。这种方法可能会提高高负担国家的结核病死亡计数。
