Active or latent tuberculosis increases susceptibility to COVID-19 and disease severity

Abstract

medRxiv preprint SARS-CoV-2 infection. Patients with active or latent TB were more susceptible to SARS-CoV-2, and COVID-19 symptom development and progression were more rapid and severe.Meaning: Tuberculosis status should be assessed carefully at patient admission and management and therapeutic strategies adjusted accordingly to prevent rapid development of severe COVID-19 complications. AbstractImportance: Risk factors associated with COVID-19, the viral pneumonia originating in Wuhan, China, in Dec 2019, require clarification so that medical resources can be prioritized for those at highest risk of severe COVID-19 complications. Infection with M. tuberculosis (MTB), the pathogen that causes TB and latently infects ~25% of the global population, may be a risk factor for SARS-CoV-2 infection and severe COVID-19 pneumonia.Objective: To determine if latent or active TB increase susceptibility to SARS-COV-19 infection and disease severity, and lead to more rapid development of COVID-19 pneumonia. Design: An observational case-control study of 36 confirmed COVID-19 cases from Shenyang, China, conducted in Feb 2020. Final date of follow-up: Feb 29, 2020. Cases were grouped according to COVID-19 pneumonia severity (mild/moderate, severe/critical), and MTB infection status compared. Comparisons were made with MTB infection data from another case-control study on bacterial/viral pneumonia at Shenyang Chest Hospital. Setting: Multi-center study involving three primary care hospitals in Shenyang, China. Participants: 86 suspected COVID-19 cases from participating primary-care hospitals in Shenyang. All 36 SARS-CoV-2 +ve cases (based on RT-PCR assay) were included. Disease severity was assessed using the Diagnostic and Treatment Guidelines of the National Health Commission of China (v6). Mean age, 47 years (range: 25-79), gender ratio, 1:1.Exposures: Confirmed COVID-19 pneumonia. Interferon-gamma Release Assays (IGRA) were performed using peripheral blood to determine MTB infection. Main Outcome and Measures: Epidemiological, demographic, clinical, radiological, and laboratory data were collected. Comparison of MTB infection status between patients with mild/moderate and severe/critical COVID-19 pneumonia. Results: Mean age of 36 COVID-19 patients: 47 (range: 25-79); M/F: 18/18; Wuhan/Hubei connection: 42%. Mild/moderate cases: 27 (75%); severe/critical: 9 (25%). MTB infection (IGRA+ve): 13 cases (36.11%), including 7 of 9 severe/critical cases. MTB infection rate: higher in COVID-19 (36.11%) than bacterial pneumonia (20%; p=0.0047) and viral pneumonia patients (16.13%; p=0.024). MTB infection more common than other co-morbidities (36.11% vs diabetes:25%; hypertension: 22.2%; coronary heart disease: 8.33%; COPD: 5.56%). MTB co-infection linked with disease severity (severe/critical 78% vs mild/moderate cases 22%; p=0.0049), and rate of disease progression: infection to development of symptoms (MTB+SARS-CoV-2: 6.5±4.2 days vs SARS-COV-2: 8.9±5.2 days; p=0.073); from symptom development to diagnosed as severe (MTB+SARS-CoV-2:...

Implications of COVID-19 in high burden countries for HIV/TB: A systematic review of evidence

“…Each article that met selection criteria was fundamentally assessed for Author/Country, Population/Study design, Exposures, Comparators, Treatments, TB occurrence and SARS/MERS/COVID-19 severity, recovery and mortality rate. [28][29][30][31], one case control study [32] and four case series [33][34][35][36] were conducted in China, two case series [37][38] were done in Singapore, one case series [39] and one case control study [40] were undertaken in Saudi Arabia, a case series [41] was conducted in Italy, one cohort study was done in South Africa [42] and another in the Philippines [43], one case study was conducted in the United State of America [44], other three case studies were found in Turkey [45], Hong Kong [46] and India [47] respectively.…”

“…However, the mortality rates for COVID-19/TB or COVID/HIV/TB coinfection seem to be higher than the mortality rate of 3.81% for COVID-19 worldwide [7]. Three studies [32,[40][41] reported COVID-19 recovery time from 9 to 54 days. This is important to highlight that qualitative analysis included three cases related to SARS-CoV/HIV/TB co-infection (one case) [46] and COVID-19/HIV/TB co-infection (two cases) [27][28][29][30][31][32][33][34][35][36][37][38][39][40][41].…”

“…We included seven observational studies (six cohort studies and one case control study) in the meta-analysis ( Figure 2). A case control and four cohort studies were conducted in China [28][29][30][31][32] and two other cohort studies were undertaken in South Africa [42] and the Philippines [43] (see Table 2). One cohort included COVID-19/HIV/TB and COVID-19/TB co-infected groups were included in the TB occurrence outcome, with a total sample of 2,015 participants.…”

“…The results of the meta-analysis based on seven observational studies including HIV/TB or TB as exposures that may impact on COVID-19 outcomes were described as follows: Figure 3). COVID-19 severity: Three cohort studies [29][30][31] and one case control studies [32] were included to compare mild/moderate versus severe/critical COVID-19 stages in COVID-19/TB co-infected patients. The pooled result revealed that the COVID-19/TB group was at high risk of developing severe/critical COVID-19 compared to the COVID-19 group OR 4.50 (95%CI 1.12-18.10, P=0.03).…”

Does Endometriosis Increase Susceptibility to COVID–19 Infections? A case-control study in Women of Reproductive Age

“…The recent COVID-19 pandemic has forced researchers to focus on the different aspects of this disease, and studying factors that can predispose the individual to disease (20). Studies have investigated the effect of nutrition (21), serum parameters, such as blood group (22) and elevated plasmin(ogen) (23), as well as underlying autoimmune diseases, such as tuberculosis (24) and lupus erythematosus (25), on COVID-19 susceptibility. However, as far as the authors are concerned, the risk of COVID-19 infection in women with endometriosis has not been clinically evaluated, to date.…”