Global prevalence, treatment and outcome of tuberculosis and COVID-19 coinfection: a systematic review and meta-analysis (from November 2019 to March 2021)

Abstract

IntroductionThe COVID-19 outbreak poses a significant threat to the patients with tuberculosis (TB). TB and COVID-19 (TB–COVID) coinfection means the disease caused by both Mycobacterium tuberculosis and SARS-CoV-2 infection. Currently, the prevalence status, treatment and outcomes of the coinfection are poorly characterised. We aimed to systematically review the evidence on this topic and provide comprehensive information to guide the control and treatment of TB–COVID coinfection.MethodsAn extensive screening was conducted using six electronic databases to search eligible studies from 1 November 2019 to 19 March 2021. Prevalence rate, treatment and outcomes of TB–COVID coinfection were extracted. Random-effects models were used to calculate mean fatality rates of coinfection with 95% CIs. The risks of bias were assessed with the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Study Reporting Prevalence Data and JBI Critical Appraisal Checklist for Case Report. A meta-analysis was conducted for subgroups on in-hospital fatality rate.ResultsForty-two studies were included into the analysis (35 case reports and 7 retrospective cohort studies). Nineteen countries reported coinfected patients, including high and low TB prevalence countries. The only study revealing prevalence rate came from West Cape Province, South Africa (people aged above 20 years, 0.04% until 1 June 2020 and 0.06% until 9 June 2020). The treatment regimens for coinfected patients were highly heterogeneous. The mean overall and in-hospital fatality rates of coinfection were 13.9% (95% CI: 1.6% to 26.2%) and 17.5% (95% CI: 8.9% to 26.0%). The mean in-hospital fatality rates for high-income countries (Italy and Argentina) and low/middle-income countries (LMICs) (India, Philippines, South Africa) were 6.5% (95% CI: −0.8% to ~13.9%) and 22.5% (95% CI: 19.0% to ~26.0%).ConclusionTB–COVID coinfection is common globally, and the coinfected patients suffer from higher fatality risk than patients with normal COVID-19. Outcomes shared significant differences between high-income countries and LMICs.PROSPERO registration numberCRD42021253660.

Primary Isoniazid Mono-Resistant Pulmonary Tuberculosis in a COVID-19-Positive Male: World's First Case of Its Kind in the Present Pandemic

“…In high TB burden countries, the pandemic has already overwhelmed healthcare systems and thus timely diagnosis backed with prompt treatment of both these infections is very important [ 6 ]. In a recent meta-analysis, the mean in-hospital fatality rates of cases with concomitant TB and COVID-19 were reported as 22.5% (95% CI: 19.0% to ~26.0%) in low/middle-income countries (India, Philippines, South Africa) [ 11 ]. This showed that there is a high fatality risk in the cases with both these infections [ 11 ].…”

“…In a recent meta-analysis, the mean in-hospital fatality rates of cases with concomitant TB and COVID-19 were reported as 22.5% (95% CI: 19.0% to ~26.0%) in low/middle-income countries (India, Philippines, South Africa) [ 11 ]. This showed that there is a high fatality risk in the cases with both these infections [ 11 ]. However, there is a paucity of literature about prevalence, treatment, and long-term outcomes in these countries in COVID-19 with DR-TB cases.…”

A Scoping Review of Three Dimensions for Long-Term COVID-19 Vaccination Models: Hybrid Immunity, Individual Drivers of Vaccinal Choice, and Human Errors

“…For instance, facemasks and social distancing can reduce other airborne diseases, while the prioritization of hospital resources for COVID-19 impacts other operations [ 118 ]. In addition, there is a growing interest in coinfection , particularly for coinfections of COVID-19 and bacteria [ 119 ], such as tuberculosis [ 120 ]. Consequently, COVID-19 cannot always be designed or expected to be utilized in isolation.…”

The Problem of Comorbid Socially Significant Infections Under The Conditions of The COVID-19 Pandemic

“…Кроме того, по сравнению с 2019 г., в 2020 г. в связи с карантинными мерами, отмечено снижение численности людей, прошедших диагностику, лечение или профилактическую терапию туберкулёза на фоне сокращения общих параметров финансирования основных видов противотуберкулёзной помощи в связи с их переориентацией на борьбу с COVID-19. Эксперты ВОЗ, проанализировав эпидемические показатели, отметили, что снижение количества заболевших туберкулёзом не является благоприятным показателем и может стать предпосылкой для повышения смертности на фоне позднего выявления инфекции и объективного снижения числа заболевших лиц [2][3][4].…”