SARS‐CoV‐2 coinfection in children with severe airway obstruction due to pulmonary tuberculosis

Abstract

IntroductionThe severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) pandemic had a significant impact on tuberculosis (TB) control globally, with the number of new TB diagnoses decreasing. Coinfection with some viruses, especially measles, could aggravate TB in children. This is presumably a result of depressed cellular immunity. Reports on children with TB and SARS‐CoV‐2 coinfection are limited.MethodsA retrospective analysis of children up to 13 years old admitted to Tygerberg Hospital, Cape Town, South Africa, from March 2020 to December 2022 with suspected TB‐induced airway compression requiring bronchoscopy. Children were included if they presented with severe intrathoracic airway obstruction and/or radiographic evidence of complicated TB. The patients were divided into two groups based on SARS‐CoV‐2 respiratory polymerase chain reaction results. Demographics, TB exposure, microbiology, SARS‐CoV‐2 laboratory data, imaging, inflammatory cytokine levels, and bronchoscopy data were collected. Statistical analyses compared SARS‐CoV‐2 positive and negative groups.ResultsOf the 50 children undergoing bronchoscopy for TB airway obstruction, 7 (14%) were SARS‐CoV‐2 positive. Cough was more prevalent in the SARS‐CoV‐2 positive group (p = 0.04). There was no difference in TB culture yield between groups. However, SARS‐CoV‐2 positive children showed slower radiological improvement at 1 month (p = 0.01), pleural effusions (p < 0.001), and a higher need for endoscopic enucleation (p < 0.001). FDG PET/CT scans indicated an ongoing inflammation in the SARS‐CoV‐2 positive group.ConclusionsCoinfection with SARS‐CoV‐2 in children with TB airway obstruction appears to complicate the disease course, necessitating more medical interventions and demonstrating a longer duration of the TB inflammatory process. Further research is needed to understand the impact of viral infections on TB progression and outcomes in pediatric patients.