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Clinical and Developmental Immunology
Volume 2012, Article ID 937013, 5 pages
Clinical Study

Inaccuracy of Death Certificate Diagnosis of Tuberculosis and Potential Underdiagnosis of TB in a Region of High HIV Prevalence

1Division of Infectious Diseases, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada K1H 8L6
2Department of Medicine, Edendale and Grey’s Hospitals, Pietermaritzburg, KwaZulu-Natal 3200, South Africa
3Division of Respirology, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada K1H 8L6

Received 11 July 2011; Accepted 11 January 2012

Academic Editor: Stephan Schwander

Copyright © 2012 Theresa T. Liu et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Despite the South African antiretroviral therapy rollout, which should reduce the incidence of HIV-associated tuberculosis (TB), the number of TB-attributable deaths in KwaZuluNatal (KZN) remains high. TB is often diagnosed clinically, without microbiologic confirmation, leading to inaccurate estimates of TB-attributed deaths. This may contribute to avoidable deaths, and impact population-based TB mortality estimates. Objectives. (1) To measure the number of cases with microbiologically confirmed TB in a retrospective cohort of deceased inpatients with TB-attributed hospital deaths. (2) To estimate the rates of multi-drug resistant (MDR) and extensively drug resistant (XDR) TB in this cohort. Results. Of 2752 deaths at EDH between September 2006 and March 2007, 403 (15%) were attributed to TB on the death certificate. 176 of the TB-attributed deaths (44%) had a specimen sent for smear or culture; only 64 (36%) had a TB diagnosis confirmed by either test. Of the 39 culture-confirmed cases, 27/39 (69%) had fully susceptible TB and 27/39 (69%) had smear-negative culture-positive TB (SNTB). Two patients had drug monoresistance, three patients had MDR-TB, and one had XDR-TB. Conclusions. Most TB-attributed deaths in this cohort were not microbiologically confirmed. Of confirmed cases, most were smear-negative, culture positive and were susceptible to all first line drugs.