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Free Content Pathology and causes of death in a group of 128 predominantly HIV-positive patients in Botswana, 1997–1998

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Abstract:

BACKGROUND: Little is known about causes of death in countries of southern Africa seriously affected by the HIV/AIDS epidemic.

METHODS: After obtaining informed consent, autopsies were performed on 128 mainly hospitalised adults in Francistown, Botswana, between July 1997 and June 1998. Criteria for case selection included those who died before a diagnosis could be established, those whose condition deteriorated unexpectedly during hospitalization, and those who had respiratory disease. This represented 14% of adult medical patients who died in hospital during the study period.

RESULTS: Of the 128 patients, 104 (81%) were HIV-positive. Among HIV-positive patients, the most common pathologic findings were tuberculosis (TB) (40%), bacterial pneumonia (23%), Pneumocystis carinii pneumonia (11%), and KaposiÕs sarcoma (11%); these conditions were the cause of death in 38%, 14%, 11%, and 6%, respectively. Of the 40 pulmonary TB cases, 90% also had disseminated extra-pulmonary TB. Chest radiology could not reliably distinguish the pathologies pre-mortem.

CONCLUSIONS: TB was the leading cause of death in our series of HIV-positive adults in Botswana, selected towards those with chest disease; in most, it was widely disseminated. Bacterial pneumonia also played an important role in mortality. Pneumocystis carinii pneumonia was present, but relatively uncommon.

Keywords: Africa; Botswana; HIV/AIDS; Pneumocystis carinii; mortality; pathology; tuberculosis

Document Type: Regular Paper

Affiliations: 1: The BOTUSA Project, Gaborone, Botswana and Department of Histopathology, Guy's, King's, & St. Thomas' School of Medicine, London, UK 2: Department of Pathology, Nyangabgwe Hospital, Francistown, Botswana 3: Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, USA 4: Department of Medicine, Nyangabgwe Hospital, Francistown, Botswana 5: The BOTUSA Project, Gaborone, Botswana and Department of Pathology, Nyangabgwe Hospital, Francistown, Botswana 6: Department of Histopathology, Guy's, King's, & St. Thomas' School of Medicine, London, UK

Publication date: January 1, 2002

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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