Forensic postmortem examination as sentinel evidence of rifampicin-resistant tuberculosis outside routine clinical reporting

Kayonde, Nathan M; Mulenga, Bwalya; Himwaze, Cordilia M; Mumba, Chibamba N; Dokowe, Vutisa; Chingoli, Chitala; Telendiy, Viktor; Mazyopa, Luce; Patlakwe, Thato M; Elton, Linzy; Tembo, John; McHugh, Timothy D.; Ntoumi, Francine; Mucheleng’anga, Luchenga A.

Forensic postmortem examination as sentinel evidence of rifampicin-resistant tuberculosis outside routine clinical reporting

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Kayonde, Nathan M, Mulenga, Bwalya, Himwaze, Cordilia M, Mumba, Chibamba N, Dokowe, Vutisa, Chingoli, Chitala, Telendiy, Viktor, Mazyopa, Luce, Patlakwe, Thato M, Elton, Linzy, Tembo, John, McHugh, Timothy D., Ntoumi, Francine and Mucheleng’anga, Luchenga A. (2026) Forensic postmortem examination as sentinel evidence of rifampicin-resistant tuberculosis outside routine clinical reporting. International Society for Infectious Diseases (ISID), 20.

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Official URL: https://www.sciencedirect.com/science/article/pii/...

Abstract

Objectives:
Drug-resistant tuberculosis (TB) is underascertained when deaths occur outside health facilities. We evaluated whether forensic postmortem molecular testing identifies rifampicin-resistant TB among community deaths not represented in routine clinical reporting.

Methods:
We conducted a prospective observational study of community deaths receiving medico-legal postmortem examination in Lusaka, Zambia (September 2022-April 2024). Cases with macroscopic features suggestive of TB underwent histologic evaluation, and histology-compatible cases were tested using GeneXpert MTB/RIF Ultra.

Results:
Among 2988 postmortem examinations, 73 decedents had histologic features consistent with TB. Mycobacterium tuberculosis deoxyribonucleic acid was detected in 56/73 cases, with rifampicin resistance identified in eight/56.

Conclusion:
Forensic postmortem molecular testing identified rifampicin-resistant TB among community deaths not represented in routine clinical drug-resistance reporting. Although not informative of prevalence, these findings indicate that postmortem examination can provide sentinel evidence of drug-resistant TB beyond conventional diagnostic pathways.

Item Type:	Article
Identifier:	10.1016/j.ijregi.2026.100924
Keywords:	Rifampicin-resistant tuberculosis; Postmortem examination; Community deaths; GeneXpert MTB/RIF Ultra; Sentinel surveillance
Subjects:	Medicine and health > Microbiology Medicine and health > Clinical medicine
Date Deposited:	28 Oct 2026
Dates:	Date Publication status 22 May 2026 Accepted 23 May 2026 Published Online 19 June 2026 Published
School, department or research centre:	CIGMis (The Centre for Innovation in Genomics and Microbiome Sciences) School of Medicine and Biosciences
Keywords:	Rifampicin-resistant tuberculosis; Postmortem examination; Community deaths; GeneXpert MTB/RIF Ultra; Sentinel surveillance
URI:	https://repository.uwl.ac.uk/id/eprint/15677