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

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 tuberculosis. 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 ¼ 0.75,05% CI 0.63-0.91). Similarly, time-to-death was significantly shorter (p ¼ .0031) and time-to-recovery significantly longer in patients with tuberculosis (p ¼ .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.

Human immunodeficiency virus and mortality from coronavirus disease 2019: A systematic review and meta-analysis

“…49,50 Previously published studies regarding COVID-19 have revealed that the presence of tuberculosis was associated with higher severity and mortality from COVID-19. 51,52 Secondly, some proportions of PLWH may have incomplete immune reconstitution and evidence of persistent immune activation. 53 They may show an abnormal innate and adaptive immune response, characterised by the elevation of macrophages, cytokines [tumour necrosis factor alpha, interleukin (IL)-1, IL-6, IL-8 and IL-10], acute phase proteins [serum amyloid A, C-reactive protein (CRP)], elements of the coagulation cascade (D-dimer and tissue factor), increased turnover and exhaustion of T cells, increased turnover of B cells and hyperimmunoglobulinaemia.…”

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 coinfection 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].…”

Nowcasting and forecasting provincial-level SARS-CoV-2 case positivity using google search data in South Africa

“…4,5 Moreover, as of October 2020, cases have been steadily increasing in South Africa. 6,7 A number of factors facilitate increased COVID-19 transmission in Africa, including weak health care systems, 8 high prevalence of other diseases such as HIV and TB, [9][10][11][12] and the inability to adhere to physical distancing and other intervention strategies. 13 Although the current reported mortality burden is lower than had been projected by public health experts, the pandemic has highlighted gaps in surveillance systems.…”

“…4,5 Moreover, as of October 2020, cases have been steadily increasing in South Africa. 6,7 A number of factors facilitate increased COVID-19 transmission in Africa, including weak health care systems, 8 high prevalence of other diseases such as HIV and TB, 9-12 and the inability to adhere to physical distancing and other intervention strategies. 13…”