Tuberculosis (TB) is the leading infectious cause of death globally and the most frequent cause of death in HIV patients. However, estimating the real burden of the disease is elusive, since many of these deaths occur in settings where autopsies are not easy to perform. A team led by Miguel Martínez performed a detailed histopathological and microbiological analysis of over 200 autopsies on children, mothers and other adults to evaluate the real TB burden in Southern Mozambique, a region where the HIV and TB epidemics have had devastating consequences.

“This investigation is part of one of the largest autopsy studies conducted to date in sub-Saharan Africa,” says Alberto García-Basteiro, lead author of the study. The results revealed that the real burden of TB is probably higher than estimated. In fact, 28% of patients had tuberculosis at the time of death, and this percentage was even higher (51%) among HIV-positive adults. Many of these TB infections were missed by clinicians.

The study was performed within the framework of CaDMIA, a project that seeks to use minimally invasive autopsies as a tool to determine the causes of death in countries with limited resources and infrastructure. “Knowing with certitude what disease caused a patient’s death can help prevent new deaths,” says Jaume Ordi, who leads the project in collaboration with Clara Menéndez and Quique Bassat.