Causes of death in hospitalized adults with a premortem diagnosis of tuberculosis: an autopsy study
Causes of death in hospitalized adults with a premortem diagnosis of tuberculosis: an autopsy study
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DOI：
10.1097/qad.0b013e3282eea47f
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发表时间：
2007-10-01
期刊：
影响因子：
3.8
通讯作者：
Hale, Martin
中科院分区：
文献类型：
--
作者：
Martinson, Neil A.;Karstaedt, Alan;Hale, Martin
目的：探讨死于肺结核的成人的直接和潜在死亡原因。设计：由内科医生和病理学家对索韦托两家医院收治的入院后24小时或更长时间死亡的50名成年人的死亡原因进行独立评估。进行了详细的记录审查和完整的尸检，包括在未进行产前检查时进行艾滋病毒检测。此外，还进行了各种死后微生物学测试。结果：47例患者发生HIV感染；所有人都没有接受抗逆转录病毒治疗。他们的中位年龄为34.5岁，中位CD4细胞计数为48个/ μ l，中位死亡前住院时间为6天。尸检证实37例（79%）hiv感染患者死前诊断为结核病，而10例（21%）未表现出结核病。支气管肺炎和巨细胞病毒肺炎是这10例患者的主要病理。在47具感染艾滋病毒的尸体中，直接或部分死亡原因是：广泛性肺结核，32例（68%）；播散性肺结核28例(60%);细菌性肺炎13例（26%）；巨细胞病毒肺炎7例(15%);巨细胞病毒DNA 31例（66%），肺囊虫肺炎5例（11%）。肺，其次是淋巴结，肝脏和肾脏，是肺结核最常见的部位。19只脾标本（其中1只为多药耐药）培养结核分枝杆菌，11只脾标本培养沙门氏菌。结论:我们证实了与晚期HIV疾病相关的弥散性广泛结核病。包括沙门氏菌病在内的严重细菌感染是主要的合并症，这表明住院的怀疑患有结核病的艾滋病毒感染成人可能受益于广谱抗生素治疗。(C) 2007 Lippincott Williams & Wilkins。
Objective: To ascertain the immediate and underlying causes of death in adults who died in hospital with a premortem diagnosis of tuberculosis.Design: 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 premortern 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 countwas 48 cells/mu l and median length of hospitalization before death was 6 days. Autopsy confirmed the premortern 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. Mycobacteriurn tuberculosis was cultured from 19 spleens, one of which was multidrug resistant, and Salmonella spp. was cultured from 11 splenic specimens.Conclusion: 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. (C) 2007 Lippincott Williams & Wilkins.