Tuberculosis at autopsy in inpatients at a tertiary referral centre in India: a prospective study

Background: India has the highest burden of TB in the world, an estimated 2 million cases annually, and accounting for approximately one fifth of the global incidence. It is also estimated by the World Health Organization (WHO) that 300,000 people die from TB each year in India. The diagnosis of tuberculosis may not be established during the inpatient stay due to many reasons (e.g. extra pulmonary TB, TB in immunocompromised host etc). We did an autopsy study to find out the prevalence of tuberculosis at post mortem in medical inpatients at a tertiary care hospital in Mumbai, India. Methods: This is a prospective study and analysis of 112 consecutive medical autopsies of patients over a period of 12 months carried out at Grant Medical College and Sir JJ group of Hospitals, Mumbai, India. During this period, there were a total of 1558 deaths. A total of 112 medical autopsies were performed and included in this study .We did gross pathological and histopathological analysis. The primary outcome measure was specific disease or diseases. Secondary outcomes were missed tuberculosis, and co morbidities with tuberculosis. Results: The median age of the 112 included patients was 32 years, 70 (63%) were men and 42 (37%) were females. 24 (21%) patients had tuberculosis, of whom 15 (62%) were infected with HIV. 13 (55%) of these 24 patients had disseminated tuberculosis. The risk of disseminated tuberculosis was higher among HIV infected patients than among uninfected patients with 11 of the 13 cases of disseminated tuberculosis diagnosed in HIV infected patients (p<0.009). 6 (33%) of 24 patients with tuberculosis were not diagnosed during their life. Conclusion: Tuberculosis remains a major cause of death in India .Tuberculosis often remains undiagnosed and hence there is a need to increase awareness and actively screen for tuberculosis especially in HIV positive patients.