Co-morbidities associated with tuberculosis in an autopsy case series

A retrospective review of cases of tuberculosis examined by our Autopsy Division was undertaken to determine the most common associated co-morbidities. Forty-six cases of tuberculosis were examined between 2000 and 2010. The subpopulation of decedents studied included a large number of incarcerated individuals and showed an age distribution from 30 to 78 years. Thirty-five of the cases reviewed showed one or more co-morbidities, primarily viral hepatitis C, cancer, human immunodeficiency virus (HIV), cardiovascular diseases, and chronic obstructive pulmonary diseases. Almost 30% of the cases showed evidence of extrapulmonary disease, including one case of tuberculous meningitis. In approximately 20% of the cases, rapid progressive or disseminated tuberculosis was identified as immediate cause of death. Tuberculosis was the immediate cause of death in 20% of the hepatitis C-infected group and in 14% of the decedents diagnosed with cancer, compared to over 45% of the HIV-infected decedents. This observation is consistent with previous studies reporting an enhanced mortality from tuberculosis in HIV-infected subjects. Interestingly, rapid progressive tuberculosis was identified as immediate cause of death in two cases with no associated co-morbidities; both decedents were young immunocompetent adults, suggesting an increasing susceptibility of this subpopulation to tuberculosis exposure and to severe disease.