title: The role of Xpert MTB/RIF in diagnosing pulmonary tuberculosis in post-mortem tissues.
abstract: The extent to which the Xpert MTB/RIF (Gene Xpert) contributes to tuberculosis (TB) diagnosis in samples other than sputum and cerebrospinal fluid remains uncertain. We aimed to assess the role of Xpert MTB/RIF for detecting M. tuberculosis in post-mortem tissues. We conducted a study among 30 complete diagnostic autopsies (CDA) performed at the Maputo Central Hospital (Mozambique). Lung tissues were screened for TB in all cases. In addition other tissues were tested when compatible lesions were identified in the histological exam. We used in-house real time PCR and LAMP assays to confirm the presence of M. tuberculosis DNA. The diagnosis of tuberculosis at death was established based on microbiological and histopathological results. Eight out of 30 cases (26.7%) were diagnosed of tuberculosis. Xpert had a sensitivity to detect TB in lung tissue of 87.5% (95% CI 47.3-99.7) and a specificity of 95.7% (95% CI: 78.1-99.9). In-house DNA amplification methods and Xpert showed 93.6% concordance for lung tissue and 100% concordance for brain and liver tissues. The final cause of death was attributable to tuberculosis in four cases. Xpert MTB/RIF may represent a valuable, easy-to perform technique for post-mortem TB diagnosis.
authors: Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.|ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.|Amsterdam Institute for Global Health and Development (AIGHD), Amsterdam, The Netherlands.
authors: Alberto L
authors: AL
authors: García-Basteiro
authors: Department of Pathology, Faculty of Medicine/Eduardo Mondlane University and Maputo Central Hospital, Maputo, Mozambique.
authors: Mamudo R
authors: MR
authors: Ismail
authors: Department of Pathology, Faculty of Medicine/Eduardo Mondlane University and Maputo Central Hospital, Maputo, Mozambique.
authors: Carla
authors: C
authors: Carrilho
authors: Department of Pathology, Faculty of Medicine/Eduardo Mondlane University and Maputo Central Hospital, Maputo, Mozambique.
authors: Esperança
authors: E
authors: Ussene
authors: ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.|Department of Pathology, Hospital Clinic, Universitat de Barcelona, Spain.
authors: Paola
authors: P
authors: Castillo
authors: Department of Pathology, Faculty of Medicine/Eduardo Mondlane University and Maputo Central Hospital, Maputo, Mozambique.
authors: Dércio
authors: D
authors: Chitsungo
authors: ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.|Department of Clinical Microbiology, Hospital Clinic, Universitat de Barcelona, Spain.
authors: Cristina
authors: C
authors: Rodríguez
authors: Department of Pathology, Faculty of Medicine/Eduardo Mondlane University and Maputo Central Hospital, Maputo, Mozambique.
authors: Lucília
authors: L
authors: Lovane
authors: Department of Clinical Microbiology, Hospital Clinic, Universitat de Barcelona, Spain.
authors: Andrea
authors: A
authors: Vergara
authors: Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.|ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.
authors: Elisa
authors: E
authors: López-Varela
authors: Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.|Instituto Nacional de Saúde (INS), Ministério da Saúde, Maputo, Moçambique.
authors: Inacio
authors: I
authors: Mandomando
authors: Department of Pathology, Faculty of Medicine/Eduardo Mondlane University and Maputo Central Hospital, Maputo, Mozambique.
authors: Cesaltina
authors: C
authors: Lorenzoni
authors: ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.|Department of Pathology, Hospital Clinic, Universitat de Barcelona, Spain.
authors: Jaume
authors: J
authors: Ordi
authors: Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.|ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.
authors: Clara
authors: C
authors: Menéndez
authors: Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.|ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.
authors: Quique
authors: Q
authors: Bassat
authors: ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.|Department of Clinical Microbiology, Hospital Clinic, Universitat de Barcelona, Spain.
authors: Miguel J
authors: MJ
authors: Martínez
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001921:Brain / Q000382:microbiology / Q000473:pathology; D002423:Cause of Death; D004269:DNA, Bacterial / Q000235:genetics / Q000378:metabolism*; D024901:Drug Resistance, Multiple, Bacterial / Q000187:drug effects / Q000235:genetics; D005260:Female; D006801:Humans; D008099:Liver / Q000382:microbiology / Q000473:pathology; D008168:Lung / Q000382:microbiology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000235:genetics* / Q000302:isolation & purification; D021141:Nucleic Acid Amplification Techniques; D011933:Reagent Kits, Diagnostic; D012293:Rifampin / Q000494:pharmacology; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis / Q000401:mortality; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000401:mortality; D055815:Young Adult
chemical_list: D004269:DNA, Bacterial; D011933:Reagent Kits, Diagnostic; D012293:Rifampin