Causes of death in hospitalized adults with a premortem diagnosis of tuberculosis: an autopsy study.
OBJECTIVE
To ascertain the immediate and underlying causes of death in adults who died in hospital with a premortem diagnosis of tuberculosis.


METHODS
Causes of death were assessed independently by internists and pathologists in 50 adults admitted to two Soweto hospitals who died 24 h or more after admission. Detailed record reviews and complete autopsies, including HIV tests when not performed premortem, were performed. In addition, a variety of postmortem microbiological tests were performed.


RESULTS
Forty-seven patients had HIV infection; all were antiretroviral naive. Their median age was 34.5 years, median CD4 cell count was 48 cells/microl and median length of hospitalization before death was 6 days. Autopsy confirmed the premortem diagnosis of tuberculosis in 37 HIV-infected patients (79%), whereas 10 (21%) did not demonstrate tuberculosis. Bronchopneumonia and cytomegalovirus pneumonitis were the leading pathologies in these 10 patients. In 47 HIV-infected cadavers immediate or contributory causes of death were: extensive pulmonary tuberculosis, 32 (68%); disseminated tuberculosis, 28 (60%); bacterial pneumonia, 13 (26%); cytomegalovirus pneumonitis in seven (15%); cytomegalovirus DNA was found in 31 (66%) and Pneumocystis pneumonia was found in five cadavers (11%). The lung, followed by lymph nodes, liver and kidney, were the commonest sites of tuberculosis. Mycobacterium tuberculosis was cultured from 19 spleens, one of which was multidrug resistant, and Salmonella spp. was cultured from 11 splenic specimens.


CONCLUSIONS
We demonstrated disseminated, extensive tuberculosis associated with advanced HIV disease. Severe bacterial infections, including salmonellosis, were the leading co-morbidity, suggesting that hospitalized HIV-infected adults in whom tuberculosis is suspected may benefit from broad-spectrum antibiotic therapy.
Martinson
Neil A
NA
Johns Hopkins University Center for TB Research, Baltimore, Maryland, USA. neil1.martinson@gmail.com
Karstaedt
Alan
A
Venter
W D Francois
WD
Omar
Tanvier
T
King
Peter
P
Mbengo
Tumi
T
Marais
Else
E
McIntyre
James
J
Chaisson
Richard E
RE
Hale
Martin
M
D000328:Adult; D000368:Aged; D001344:Autopsy; D002423:Cause of Death; D003587:Cytomegalovirus / Q000302:isolation & purification; D003586:Cytomegalovirus Infections / Q000150:complications / Q000401:mortality; D005260:Female; D015658:HIV Infections / Q000150:complications; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D011014:Pneumonia / Q000150:complications / Q000401:mortality*; D011446:Prospective Studies; D013019:South Africa; D014376:Tuberculosis / Q000150:complications / Q000401:mortality*