COVID-19 and Tuberculosis Coinfection: An Overview of Case Reports/Case Series and Meta-Analysis

Abstract

Background: Coronavirus disease 2019 (COVID-19) and tuberculosis (TB) are two major infectious diseases posing significant public health threats, and their coinfection (aptly abbreviated COVID-TB) makes the situation worse. This study aimed to investigate the clinical features and prognosis of COVID-TB cases.Methods: The PubMed, Embase, Cochrane, CNKI, and Wanfang databases were searched for relevant studies published through December 18, 2020. An overview of COVID-TB case reports/case series was prepared that described their clinical characteristics and differences between survivors and deceased patients. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) for death or severe COVID-19 were calculated. The quality of outcomes was assessed using GRADEpro.Results: Thirty-six studies were included. Of 89 COVID-TB patients, 19 (23.46%) died, and 72 (80.90%) were male. The median age of non-survivors (53.95 ± 19.78 years) was greater than that of survivors (37.76 ± 15.54 years) (p < 0.001). Non-survivors were more likely to have hypertension (47.06 vs. 17.95%) or symptoms of dyspnea (72.73% vs. 30%) or bilateral lesions (73.68 vs. 47.14%), infiltrates (57.89 vs. 24.29%), tree in bud (10.53% vs. 0%), or a higher leucocyte count (12.9 [10.5–16.73] vs. 8.015 [4.8–8.97] × 109/L) than survivors (p < 0.05). In terms of treatment, 88.52% received anti-TB therapy, 50.82% received antibiotics, 22.95% received antiviral therapy, 26.23% received hydroxychloroquine, and 11.48% received corticosteroids. The pooled ORs of death or severe disease in the COVID-TB group and the non-TB group were 2.21 (95% CI: 1.80, 2.70) and 2.77 (95% CI: 1.33, 5.74) (P < 0.01), respectively.Conclusion: In summary, there appear to be some predictors of worse prognosis among COVID-TB cases. A moderate level of evidence suggests that COVID-TB patients are more likely to suffer severe disease or death than COVID-19 patients. Finally, routine screening for TB may be recommended among suspected or confirmed cases of COVID-19 in countries with high TB burden.

Real-Time Impact of COVID-19 on Clinical Care and Treatment of Patients with Tuberculosis: A Multicenter Cross-Sectional Study in Addis Ababa, Ethiopia

“…Studies conducted in different countries indicated a potential bidirectional link between TB and COVID-19. Patients with TB are more likely to experience poor outcomes from COVID-19 [25] and patients co-infected with COVID-19 and TB are more likely to suffer severe disease or death than patients with COVID-19 only [26]. The simultaneity of COVID-19 and pulmonary TB can issue a diagnostic dilemma [27] and new diagnostic challenges for clinicians [28].…”

Pathogenesis of SARS-CoV-2 and Mycobacterium tuberculosis Coinfection

“…COVID-19 and TB are the two leading causes of death among respiratory diseases ( 12 , 141 ). In a cohort of 49 COVID-19-TB cases from eight countries, i.e., Brazil, Singapore, Russia, Spain, Switzerland, Belgium, France, and Italy ( 15 ), 26 patients were detected as TB positive before COVID-19, and COVID-19 was diagnosed in 14 patients before TB treatment.…”

“…Studies have also elucidated the molecular interactions of the host with COVID-19-TB, and it was found that this viral-bacterial coinfection worsens respiratory disorders ( 12 , 141 ). Clinical manifestations such as hemoptysis, cough, weakness, and fever are common among people suffering from COVID-19-TB, making an accurate diagnosis difficult.…”

“…People affected by chronic respiratory, metabolic, or cardiovascular diseases carry a higher risk of severe COVID-19 infection ( 11 , 12 ). The COVID-19 signs and symptoms are almost identical to those of TB and other influenza infections.…”

Health-Related Quality of Life of Tuberculosis Patients During the COVID-19 Pandemic in Conakry, Guinea: A Mixed Methods Study

“…Since the beginning of the COVID-19 pandemic in Guinea in March 2020, several mitigation actions have been taken by the Guinean authorities to control the pandemic, but no specific actions have been taken which are focused on people at high risk such as TB patients, who are more likely to experience more severe negative outcomes from COVID-19 compared to non-TB patients [8]. COVID-19 and TB share similar symptoms and clinical presentation including cough and fever [9].…”