Autopsies and better data on causes of death in Africa

Active tuberculosis, particularly when extrapulmonary or disseminated, can be extremely difficult to diagnose before death and is often missed, including as a cause of death. Therefore, autopsy studies can be especially informative. In their classic 1960 study, Petersdorf and Beeson¹ identified tuberculosis as the most common cause of fever of unknown origin; most cases were extrapulmonary, and although most were diagnosed both before and after death, one case was only identified after death. In the same decade, autopsy played a crucial part in defining cryptic disseminated tuberculosis as a variant of reactivated tuberculosis that occurred particularly in elderly Scottish women and that was difficult to diagnose.² More recently, autopsy studies have helped delineate the spectrum of HIV-associated disease in Africa and have shown that active tuberculosis in all its forms is a common cause of adult death.^{3, 4}