Previous and active tuberculosis in COVID-19 patients increases risk of death and prolongs recovery

Abstract

Background: There is a growing literature on the association of SARS-CoV-2 and other chronic conditions, such as noncommunicable diseases. However, little is known about the impact of coinfection with tuberculosis. We aimed to compare the risk of death and recovery, as well as time-to-death and time-to-recovery, in COVID-19 patients with and without TB. Methods: We created a 4:1 propensity score matched sample of COVID-19 patients without and with tuberculosis, using COVID-19 surveillance data in the Philippines. We conducted a longitudinal cohort analysis of matched COVID-19 patients as of May 17, 2020, following them until June 15, 2020. The primary analysis estimated the risk ratios of death and recovery in patients with and without tuberculosis. Kaplan-Meier curves described time-to-death and time-to-recovery stratified by tuberculosis status, and differences in survival were assessed using the Wilcoxon test. Results: The risk of death in COVID-19 patients with tuberculosis was 2.17 times higher than in those without (95% CI: 1.40-3.37). The risk of recovery in COVID-19 patients with tuberculosis was 25% lower than in those without (RR=0.75, 95% CI 0.63-0.91). Similarly, time-to-death was significantly shorter (p=0.0031) and time-to-recovery significantly longer in patients with tuberculosis (p=0.0046). Conclusions: Our findings show that coinfection with tuberculosis increased morbidity and mortality in COVID-19 patients. Our findings highlight the need to prioritize routine and testing services for tuberculosis, although health systems are disrupted by the heavy burden of the SARS-CoV-2 pandemic.

Pathology of TB/COVID-19 Co-Infection: The phantom menace

“…In summary, most of the evaluated studies point to an association between TB and COVID-19. Both active TB and a previous history of TB seem to be related to an increased risk for the development of COVID-19, as well as worsening the infection prognosis [ [22] , [23] , [24] , [25] , [26] , [27] ].…”

“…Both studies also suggest that the co-infection is a clinically manageable condition, although that it can be potentiated due by elderly or in the presence of comorbidities [ 24 , 25 ]. Another study, conducted in the Philippines, reinforced the deleterious role of TB over COVID-19, associating the co-infection with a greater risk of morbidity and mortality [ 26 ]. However, the most significant evidence of the influence of TB on the prognosis of COVID-19 came from a South African cohort conducted by Davies et al Data of more than 3 million patients treated by the public health system, with or without COVID-19, were compared taking into account the presence of other comorbidities, including TB and HIV.…”

“…In general, the macrostructural changes resulting from TB compromise the functioning and defense of the lower respiratory tract, which could be a complication given the consequences of an exacerbated inflammatory response against SARS-CoV-2, such as a formation of an edema. Consequently, the lung becomes more susceptible to severe complications, such as pneumonia and respiratory failure; this is likely one of the reasons why individuals with previous history of TB, presenting pulmonary scars and fibrosis, seems to be more susceptible to SARS-CoV-2 and have a worse COVID-19 prognosis [ 22 , 26 , 27 ]. However, it should be noted that TB present a very heterogeneous spectrum of lesions, which vary according to the bacterial strain and the host's immune response [ 59 ].…”

COVID‐19 case fatality rate and tuberculosis in a metropolitan setting

“…1,2 COVID-19 may occur in patients with active tuberculosis or tuberculosis sequela. 3 There is growing evidence of the effect of tuberculosis on COVID-19 susceptibility and prognosis, 4,5 although a meta-analysis of Chinese studies did not show a significant association between tuberculosis and COVID-19 severity. 6 Clearly, it is urgent to improve our understanding of the intersection between COVID-19 and tuberculosis, especially in countries with a high burden of both diseases.…”

Bilateral Foot-Drop Secondary to Axonal Neuropathy in a Tuberculosis Patient With Co-Infection of COVID-19: A Case Report

“…In addition, with the recent pandemic of COVID-19, several studies have come forth regarding the co-infection of TB with COVID-19 with the first set of studies suggesting the synergistic potential of COVID-19 with TB worsening prognosis of TB patients [ 4 - 5 ].…”