The Prevalence and Drug Sensitivity of Tuberculosis among Patients Dying in Hospital in KwaZulu-Natal, South Africa: A Postmortem Study
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{"title"=>"The prevalence and drug sensitivity of tuberculosis among patients dying in hospital in kwazulu-natal, South Africa: A postmortem study", "type"=>"journal", "authors"=>[{"first_name"=>"Ted", "last_name"=>"Cohen", "scopus_author_id"=>"7202415780"}, {"first_name"=>"Megan", "last_name"=>"Murray", "scopus_author_id"=>"35479179200"}, {"first_name"=>"Kristina", "last_name"=>"Wallengren", "scopus_author_id"=>"6507315453"}, {"first_name"=>"Gonzalo G.", "last_name"=>"Alvarez", "scopus_author_id"=>"7102448881"}, {"first_name"=>"Elizabeth Y.", "last_name"=>"Samuel", "scopus_author_id"=>"36351121700"}, {"first_name"=>"Douglas", "last_name"=>"Wilson", "scopus_author_id"=>"22136817500"}], "year"=>2010, "source"=>"PLoS Medicine", "identifiers"=>{"issn"=>"15491277", "scopus"=>"2-s2.0-77955032894", "pui"=>"359258161", "doi"=>"10.1371/journal.pmed.1000296", "isbn"=>"1549-1676 (Electronic)\r1549-1277 (Linking)", "sgr"=>"77955032894", "pmid"=>"20582324"}, "id"=>"70adb044-d09f-3a6d-92bc-c5375b5fb378", "abstract"=>"BACKGROUND: Tuberculosis is the leading cause of death in South Africa by death notification, but accurate diagnosis of tuberculosis is challenging in this setting of high HIV prevalence. We conducted limited autopsies on young adults dying in a single public hospital in the province of KwaZulu-Natal between October 2008 and August 2009 in order to estimate the magnitude of deaths attributable to tuberculosis.\\n\\nMETHODS AND FINDINGS: We studied a representative sample of 240 adult inpatients (aged 20-45 years) dying after admission to Edendale Hospital. Limited autopsies included collection of respiratory tract secretions and tissue by needle core biopsies of lung, liver, and spleen. Specimens were examined by fluorescent microscopy for acid-fast bacilli and cultured in liquid media; cultures positive for M. tuberculosis were tested for drug susceptibility to first- and second-line antibiotics. Ninety-four percent of our study cohort was HIV seropositive and 50% of decedents had culture-positive tuberculosis at the time of death. Fifty percent of the participants were on treatment for tuberculosis at the time of death and 58% of these treated individuals remained culture positive at the time of death. Of the 50% not receiving tuberculosis treatment, 42% were culture positive. Seventeen percent of all positive cultures were resistant to both isoniazid and rifampin (i.e., multidrug resistant); 16% of patients dying during the initiation phase of their first ever course of tuberculosis treatment were infected with multidrug-resistant bacilli.\\n\\nCONCLUSIONS: Our findings reveal the immense toll of tuberculosis among HIV-positive individuals in KwaZulu-Natal. The majority of decedents who remained culture positive despite receiving tuberculosis treatment were infected with pan-susceptible M. tuberculosis, suggesting that the diagnosis of tuberculosis was made too late to alter the fatal course of the infection. There is also a significant burden of undetected multidrug-resistant tuberculosis among HIV-coinfected individuals dying in this setting. New public health approaches that improve early diagnosis of tuberculosis and accelerate the initiation of treatment are urgently needed in this setting. Please see later in the article for the Editors' Summary.", "link"=>"http://www.mendeley.com/research/prevalence-drug-sensitivity-tuberculosis-among-patients-dying-hospital-kwazulunatal-south-africa-pos-7", "reader_count"=>75, "reader_count_by_academic_status"=>{"Unspecified"=>6, "Professor > Associate Professor"=>3, "Librarian"=>1, "Researcher"=>20, "Student > Doctoral Student"=>2, "Student > Ph. D. Student"=>7, "Student > Postgraduate"=>5, "Student > Master"=>16, "Other"=>6, "Student > Bachelor"=>3, "Lecturer"=>1, "Lecturer > Senior Lecturer"=>2, "Professor"=>3}, "reader_count_by_user_role"=>{"Unspecified"=>6, "Professor > Associate Professor"=>3, "Librarian"=>1, "Researcher"=>20, "Student > Doctoral Student"=>2, "Student > Ph. D. Student"=>7, "Student > Postgraduate"=>5, "Student > Master"=>16, "Other"=>6, "Student > Bachelor"=>3, "Lecturer"=>1, "Lecturer > Senior Lecturer"=>2, "Professor"=>3}, "reader_count_by_subject_area"=>{"Unspecified"=>9, "Biochemistry, Genetics and Molecular Biology"=>2, "Nursing and Health Professions"=>2, "Mathematics"=>1, "Agricultural and Biological Sciences"=>7, "Medicine and Dentistry"=>41, "Social Sciences"=>8, "Computer Science"=>1, "Immunology and Microbiology"=>4}, "reader_count_by_subdiscipline"=>{"Medicine and Dentistry"=>{"Medicine and Dentistry"=>41}, "Social Sciences"=>{"Social Sciences"=>8}, "Immunology and Microbiology"=>{"Immunology and Microbiology"=>4}, "Agricultural and Biological Sciences"=>{"Agricultural and Biological Sciences"=>7}, "Computer Science"=>{"Computer Science"=>1}, "Nursing and Health Professions"=>{"Nursing and Health Professions"=>2}, "Biochemistry, Genetics and Molecular Biology"=>{"Biochemistry, Genetics and Molecular Biology"=>2}, "Mathematics"=>{"Mathematics"=>1}, "Unspecified"=>{"Unspecified"=>9}}, "reader_count_by_country"=>{"United States"=>3, "Japan"=>1, "Brazil"=>3, "South Africa"=>6, "Peru"=>1, "Switzerland"=>1}, "group_count"=>5}

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  • {"files"=>["https://ndownloader.figshare.com/files/843592"], "description"=>"<p>Study population characteristics.</p>", "links"=>[], "tags"=>["Infectious diseases", "infectious diseases/antimicrobials and drug resistance", "infectious diseases/bacterial infections", "infectious diseases/epidemiology and control of infectious diseases", "infectious diseases/hiv infection and aids", "public health and epidemiology/screening", "respiratory medicine/respiratory infections"], "article_id"=>514043, "categories"=>["Virology", "Infectious Diseases", "Medicine"], "users"=>["Ted Cohen", "Megan Murray", "Kristina Wallengren", "Gonzalo G. Alvarez", "Elizabeth Y. Samuel", "Douglas Wilson"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1000296.t001", "stats"=>{"downloads"=>1, "page_views"=>5, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Study_population_characteristics_/514043", "title"=>"Study population characteristics.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-02-21 00:51:44"}
  • {"files"=>["https://ndownloader.figshare.com/files/843528"], "description"=>"a<p>Alone or in combination with any other resistance.</p>b<p>Among those with sufficient DST results to classify MDR – does not include XDR.</p>", "links"=>[], "tags"=>["profiles", "categorized", "tb"], "article_id"=>513980, "categories"=>["Virology", "Infectious Diseases", "Medicine"], "users"=>["Ted Cohen", "Megan Murray", "Kristina Wallengren", "Gonzalo G. Alvarez", "Elizabeth Y. Samuel", "Douglas Wilson"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1000296.t004", "stats"=>{"downloads"=>1, "page_views"=>2, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Resistance_profiles_for_those_with_positive_cultures_categorized_by_TB_treatment_status_/513980", "title"=>"Resistance profiles for those with positive cultures, categorized by TB treatment status.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-02-21 00:51:18"}
  • {"files"=>["https://ndownloader.figshare.com/files/843557"], "description"=>"<p>Bivariate and multivariate associations with MDR (among those that were culture positive and with sufficient DST) at time of death.</p>", "links"=>[], "tags"=>["multivariate", "associations", "mdr"], "article_id"=>514018, "categories"=>["Virology", "Infectious Diseases", "Medicine"], "users"=>["Ted Cohen", "Megan Murray", "Kristina Wallengren", "Gonzalo G. Alvarez", "Elizabeth Y. Samuel", "Douglas Wilson"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1000296.t005", "stats"=>{"downloads"=>0, "page_views"=>6, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Bivariate_and_multivariate_associations_with_MDR_among_those_that_were_culture_positive_and_with_sufficient_DST_at_time_of_death_/514018", "title"=>"Bivariate and multivariate associations with MDR (among those that were culture positive and with sufficient DST) at time of death.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-02-21 00:51:32"}
  • {"files"=>["https://ndownloader.figshare.com/files/843664"], "description"=>"<p>Bivariate and multivariate association with culture positive TB at time of death.</p>", "links"=>[], "tags"=>["multivariate", "tb"], "article_id"=>514119, "categories"=>["Virology", "Infectious Diseases", "Medicine"], "users"=>["Ted Cohen", "Megan Murray", "Kristina Wallengren", "Gonzalo G. Alvarez", "Elizabeth Y. Samuel", "Douglas Wilson"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1000296.t003", "stats"=>{"downloads"=>0, "page_views"=>3, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Bivariate_and_multivariate_association_with_culture_positive_TB_at_time_of_death_/514119", "title"=>"Bivariate and multivariate association with culture positive TB at time of death.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-02-21 00:52:07"}

PMC Usage Stats | Further Information

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