Active tuberculosis, sequelae and COVID-19 co-infection: first cohort of 49 cases

Abstract

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (COVID-19) pandemic has attracted interest because of its global rapid spread, clinical severity, high mortality rate and capacity to overwhelm healthcare systems [1, 2]. SARS-CoV-2 transmission occurs mainly through droplets, although surface contamination contributes and debate continues on aerosol transmission [3-5]. The disease is usually characterised by initial signs and symptoms [4-9] similar to those of related viral infections (e.g. influenza, SARS, Middle East respiratory syndrome) and tuberculosis (TB), although prognosis and complications sometimes differ. Experience with concomitant TB and COVID-19 is extremely limited. One case-control study of COVID-19 patients with interferon-γ release assay-confirmed TB infection [10] and a single case of TB with COVID-19 have been submitted to, but not yet published in, peer-reviewed journals [11]. In a recent analysis of 1217 consecutive respiratory specimens collected from COVID-19 patients (Mycobacterium tuberculosis was not tested), the authors concluded that higher rates of co-infection between SARS-CoV-2 and other respiratory pathogens can be expected [12]. The present study describes the first-ever global cohort of current or former TB patients (post-TB treatment sequelae) with COVID-19, recruited by the Global Tuberculosis Network (GTN) in eight countries and three continents. No analysis for determinants of outcome was attempted. The study is nested within the GTN project monitoring adverse drug reactions [13, 14] for which the coordinating centre has an ethics committee approval, alongside ethics clearance from participating centres according to respective national regulation [13, 14]. A specific nested database was created in collaboration with the eight countries reporting patients with TB and COVID-19; the remaining countries had not yet observed COVID-19 in their patients at the time this manuscript was written. Continuous variables, if not otherwise specified, are presented as medians with interquartile ranges. Overall, 49 consecutive patients with current or former TB and COVID-19 from 26 centres in Belgium (n=1), Brazil (Porto Alegre, Rio Grande do Sul State; n=1), France (n=12), Italy (n=17), Russia (Moscow Region; n=6), Singapore (n=1), Spain (n=10) and Switzerland (Vaud Canton; n=1) were recruited (dataset updated as of

Fatal central nervous system co-infection with SARS-CoV-2 and tuberculosis in a healthy child

“…One had worsening chest radiographs and the other had improved imaging findings when compared to their last pre-COVID-19 studies; both survived [14]. A three-month-old Gambian child with COVID-19 was diagnosed with pulmonary and extrapulmonary tuberculosis (including meningitis) 3 days later and was placed on anti-tuberculous medications, but no details of how the diagnosis was reached were provided [16]. Further investigation into the role of co-infection by Mycobacterium tuberculosis and SARS-CoV-2 on severity and mortality is needed for both adults and children.…”

“…Demonstration of SARS-CoV-2 RNA in the central nervous system (CNS) has only been documented in three adults, one with a positive CSF RNA result, one using genome sequencing in CSF, and another utilizing transmission electron microscopy on brain tissue obtained post-mortem [5,8,9]. Pulmonary co-infections with common viral, bacterial, and fungal pathogens have been described in COVID-19 patients, but there is a paucity of literature on mycobacteria, including members of the Mycobacterium tuberculosis complex with which a third of the world population is infected [10][11][12][13][14][15][16][17]. We describe the unique case of a previously healthy child with acute SARS-CoV-2 infection, fever, and headache, with laboratory and imaging evidence of meningoencephalitis who rapidly deteriorated 2 weeks into her illness and was found to have both SARS-CoV-2 RNA and Mycobacterium tuberculosis complex DNA on a cerebellar biopsy with histopathology consistent with tuberculous meningitis, with the recovery of Mycobacterium tuberculosis from two tracheal aspirates several weeks after she died.…”

Severe Acute Respiratory Syndrome Coronavirus-2 and Pulmonary Tuberculosis Coinfection: Double Trouble

“…This relationship could not be underestimated as few studies have recently reported coinfection of SARS-CoV-2 with TB as summarized in Table 1. [12][13][14][15][16][17][18][19] An observational study recently reported that persons with latent TB have increased susceptibility for SARS-CoV-2 infection associated with rapid progression and severe involvement. [16] TB infection was more common among patients with SARS-CoV-2 infection than in those with bacterial or other viral infections.…”

DZK-Stellungnahme zu Tuberkulose, BCG und COVID-19*

“…Vermutlich ist nach einer erfolgreich behandelten TB ohne resultierende Folgeschäden weder die Wahrscheinlichkeit erhöht, eine SARS-CoV-2-Infektion zu bekommen, noch einen schweren Verlauf zu entwickeln. Komorbiditäten und Alter sind allerdings auch in diesem Zusammenhang entscheidende Einflussfaktoren [8].…”

“…Für eine heterogene internationale Kohorte (SARS-CoV-2 + Tuberkuloseerkrankung n = 42; SARS-CoV-2 + Folgeschäden nach überstandener Tuberkulose n = 7) wurde eine Case Fatality Rate von 12,3 % beschrieben, wobei 5 der 6 Verstorbenen älter als 60 Jahre waren und an mindestens einer Begleiterkrankung litten. Die Autoren können aus den bislang vorliegenden Daten keinen kausalen Zusammenhang zwischen Tuberkuloseerkrankung und Mortalität ableiten [8]. Eine Kann ich mich mithilfe einer Tuberkulose-Impfung (Bacille Calmette-Guérin; BCG) vor einer Infektion mit SARS-CoV-2 schützen?…”