{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T04:33:36Z","timestamp":1791952416265,"version":"4.3.4"},"reference-count":40,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2023,4,12]],"date-time":"2023-04-12T00:00:00Z","timestamp":1681257600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100009467","name":"University of the Witwatersrand, Johannesburg","doi-asserted-by":"publisher","award":["0012838438201512110500000000000000004550"],"award-info":[{"award-number":["0012838438201512110500000000000000004550"]}],"id":[{"id":"10.13039\/100009467","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,8,14]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Missing or undiagnosed patients with tuberculosis (TB) or coronavirus disease 2019 (COVID-19) are of concern. Identifying both infections in patients with no diagnosis prior to death contributes to understanding the burden of disease. To confirm reports of global reduction in TB incidence, a 2012 autopsy study of adults dying at home of natural causes in a high-TB-burden setting was repeated, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) assessments after the first COVID-19 surge in South Africa.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Adult decedents who died at home with insufficient information to determine cause of death, no recent hospitalization, and no current antemortem TB or COVID-19 diagnosis were identified between March 2019 and October 2020 with a 4-month halt during lockdown. A standardized verbal autopsy followed by minimally invasive needle autopsy (MIA) was performed. Biopsies were taken for histopathology from liver, bilateral brain and lung; bronchoalveolar lavage fluid was collected for Xpert (MTB\/RIF) and mycobacterial culture, and blood for human immunodeficiency virus (HIV) polymerase chain reaction (PCR) testing. After the start of the COVID-19 pandemic, a nasopharyngeal swab and lung tissue were subjected to SARS-CoV-2 PCR testing.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Sixty-six MIAs were completed in 25 men and 41 women (median age, 60 years); 68.2% had antemortem respiratory symptoms and 30.3% were people with HIV. Overall, TB was diagnosed in 11 of 66 (16.7%) decedents, and 14 of 41 (34.1%) in the COVID-19 pandemic were SARS-CoV-2 positive.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Undiagnosed TB in adults dying at home has decreased but remains unacceptably high. Forty percent of decedents had undiagnosed COVID-19, suggesting that estimates of excess deaths may underestimate the impact of SARS-CoV-2 on mortality.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciad212","type":"journal-article","created":{"date-parts":[[2023,4,12]],"date-time":"2023-04-12T04:29:10Z","timestamp":1681273750000},"page":"453-459","source":"Crossref","is-referenced-by-count":8,"title":["Undiagnosed Pulmonary Tuberculosis (TB) and Coronavirus Disease 2019 (COVID-19) in Adults Dying at Home in a High-TB-Burden Setting, Before and During Pandemic COVID-19: An Autopsy Study"],"prefix":"10.1093","volume":"77","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9402-0974","authenticated-orcid":false,"given":"Nadia","family":"Sabet","sequence":"first","affiliation":[{"name":"Perinatal HIV Research Unit, University of the Witwatersrand , Johannesburg , South Africa"},{"name":"Department of Internal Medicine, Klerksdorp-Tshepong Hospital Complex , Klerksdorp , South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanvier","family":"Omar","sequence":"additional","affiliation":[{"name":"Department of Anatomical Pathology, National Health Laboratory Service and University of the Witwatersrand , Johannesburg , South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minja","family":"Milovanovic","sequence":"additional","affiliation":[{"name":"Perinatal HIV Research Unit, University of the Witwatersrand , Johannesburg , South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tebogo","family":"Magajane","sequence":"additional","affiliation":[{"name":"Perinatal HIV Research Unit, University of the Witwatersrand , Johannesburg , South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Modiehi","family":"Mosala","sequence":"additional","affiliation":[{"name":"Perinatal HIV Research Unit, University of the Witwatersrand , Johannesburg , South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tumelo","family":"Moloantoa","sequence":"additional","affiliation":[{"name":"Perinatal HIV Research Unit, University of the Witwatersrand , Johannesburg , South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nalukenge","family":"Kato-Kalule","sequence":"additional","affiliation":[{"name":"Perinatal HIV Research Unit, University of the Witwatersrand , Johannesburg , South Africa"},{"name":"Imperial College Healthcare, National Health Service Trust , London , United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lenise Varela","family":"Semedo","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Klerksdorp-Tshepong Hospital Complex , Klerksdorp , South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Floris","family":"Swanepoel","sequence":"additional","affiliation":[{"name":"Perinatal HIV Research Unit, University of the Witwatersrand , Johannesburg , South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carole","family":"Wallis","sequence":"additional","affiliation":[{"name":"Bio Analytical Research Corporation , Johannesburg , South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pattamukkil","family":"Abraham","sequence":"additional","affiliation":[{"name":"Perinatal HIV Research Unit, University of the Witwatersrand , Johannesburg , South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Limakatso","family":"Lebina","sequence":"additional","affiliation":[{"name":"Perinatal HIV Research Unit, University of the Witwatersrand , Johannesburg , South Africa"},{"name":"Africa Health Research Institute , Durban , South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ebrahim","family":"Variava","sequence":"additional","affiliation":[{"name":"Perinatal HIV Research Unit, University of the Witwatersrand , Johannesburg , South Africa"},{"name":"Department of Internal Medicine, Klerksdorp-Tshepong Hospital Complex , Klerksdorp , South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neil","family":"Martinson","sequence":"additional","affiliation":[{"name":"Perinatal HIV Research Unit, University of the Witwatersrand , Johannesburg , South Africa"},{"name":"Center for Tuberculosis Research, Johns Hopkins University, Baltimore, Maryland , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,4,12]]},"reference":[{"key":"2023081421091025200_ciad212-B1","author":"Statistics South Africa","year":"2014"},{"key":"2023081421091025200_ciad212-B2","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2021-006766","article-title":"Who dies where? 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