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Diagnosing Pulmonary Tuberculosis with the Xpert MTB/RIF Test
Published on: April 9, 2012
Forensic postmortem examination as sentinel evidence of rifampicin-resistant tuberculosis outside routine clinical
Nathan M Kayonde1, Bwalya Mulenga1, Cordilia M Himwaze1
1Office of the State Forensic Pathologist, Lusaka Provincial Forensic Pathology Unit, University Teaching Hospitals, Lusaka, Zambia.
Objectives:
Drug-resistant tuberculosis (TB) is underascertained when deaths occur outside health facilities. We evaluated whether forensic postmortem molecular testing identifies rifampicin-resistant TB among community deaths not represented in routine clinical reporting.
Methods:
We conducted a prospective observational study of community deaths receiving medico-legal postmortem examination in Lusaka, Zambia (September 2022-April 2024). Cases with macroscopic features suggestive of TB underwent histologic evaluation, and histology-compatible cases were tested using GeneXpert MTB/RIF Ultra.
Results:
Among 2988 postmortem examinations, 73 decedents had histologic features consistent with TB. Mycobacterium tuberculosis deoxyribonucleic acid was detected in 56/73 cases, with rifampicin resistance identified in eight/56.
Conclusion:
Forensic postmortem molecular testing identified rifampicin-resistant TB among community deaths not represented in routine clinical drug-resistance reporting. Although not informative of prevalence, these findings indicate that postmortem examination can provide sentinel evidence of drug-resistant TB beyond conventional diagnostic pathways.
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