Effect of Concomitant Tuberculosis Infection on COVID-19 Disease in Children: A Matched, Retrospective Cohort Study

Abstract

Background Coronavirus disease 2019 (COVID-19) has had devastating effects on the health of millions globally. Patients with tuberculosis (TB) are a vulnerable population. There is paucity of data to assess association between the 2 diseases in Pediatric population. Objective To elucidate the effect of concomitant TB on clinical course of pediatric COVID-19 disease. Methods Retrospective matched cohort study was conducted at dedicated tertiary COVID-19 hospital in India. All consecutive patients aged <18 y admitted with COVID-19 were line listed. Patients with current or recently diagnosed TB were included. Consecutive age and sex matched COVID-19 patients with no history of TB were included as controls. Medical records were retrieved, clinical data entered in pre-determined proforma. Results During study period, 327 pediatric COVID-19 patients were admitted. Study group included 17 patients with TB. These patients, tended to be referred from other hospitals, be sicker, had lower SpO2 at arrival and higher severity of COVID-19 as compared to controls (All P < 0.05). They required more mechanical ventilation, had longer length of stay and worse outcome. Conclusion COVID-19 may secondarily affect and modify the course of TB in children. Given the high case fatality rate in this association and potentially treatable nature of TB, attention of the policy makers is drawn to this. Name of IEC committee Maulana Azad Medical College and Associated Hospital Institutional Ethics Committee. IEC no: F.1/IEC/MAMC/(80/8/2020/No274). Dated 9 November 2020. Trial registration CTRI/2021/02/031197 [Registered on: 10 February 2021].

Immunopathogenesis in SARS-CoV-2 and Mycobacterium tuberculosis: The danger of overlapping crises

“…Co-infection with SARS CoV-2 and MTB is of concern as the diagnosis of tuberculosis is more likely to be missed due to nonspecific presentation and a lack of typical radiological findings. Preexisting TB and underlying lung comorbidities aggravate the disease in COVID-19 (Tadolini et al, 2020) possibly through (Kumar et al, 2021), further a tertiary care hospital in India also showed association of TB (10%) in paediatric COVID-19 patients (Mathur et al, 2022).…”

Review of Pediatric Tuberculosis in the Aftermath of COVID-19

“…As more data are revealed, pediatric TB has emerged to be a hidden threat behind the effects of COVID-19 as recent data showed how exposed pediatric patients are more susceptible to the disease than we previously thought [ 57 ], with signs of increased household transmissions from stay-at-home measures due to various risk factors such as tobacco smoking [ 6 ], as well as worse prognoses from co-infection [ 73 ], despite TB being a preventable and treatable disease. Ryckman et al in their review article on “Ending tuberculosis in a post-COVID-19 world” suggested that a person-centered, equity-oriented response focusing on targeting the widened health disparities as a result of the pandemic is key to our approach moving forward [ 128 ].…”

“…These patients had a more severe disease course with lower SpO 2 on arrival, higher mechanical ventilation rates, longer length of hospital stays, and worse outcomes. Considering that TB is preventable and treatable, the conclusion of their study pointed out once again to the importance of screening, diagnosing, and treating for pediatric tuberculosis, especially during the pandemic to prevent worse outcomes with co-infection [ 73 ].…”

Radiological features of aspergillomas and surrounding areas after pulmonary tuberculosis

“…In addition, in HIV-positive patients, who are several times more likely to develop pulmonary TB than those without HIV, physicians must exercise caution, because the use of highly active antiretroviral therapy in patients who are already infected with TB may result in paradoxical worsening of pulmonary disease [9]. During the multiple waves of the coronavirus disease 2019 (COVID-19) pandemic, numerous studies in adults revealed that patients with COVID-19 and TB have a two times greater risk of death than those without TB and are less likely to recover than patients with COVID-19 without TB [35]. Comorbidity with TB is strongly associated with moderate-severe COVID-19 illness in children at admission [35].…”

“…During the multiple waves of the coronavirus disease 2019 (COVID-19) pandemic, numerous studies in adults revealed that patients with COVID-19 and TB have a two times greater risk of death than those without TB and are less likely to recover than patients with COVID-19 without TB [35]. Comorbidity with TB is strongly associated with moderate-severe COVID-19 illness in children at admission [35]. Concomitant mucormycosis and TB infection is uncommon [36,37], and the outcomes of the ten cases documented in the literature have been poor [37].…”