Increase in Tuberculosis Diagnostic Delay during First Wave of the COVID-19 Pandemic: Data from an Italian Infectious Disease Referral Hospital

Abstract

Background: The WHO advised that the impact of COVID-19 pandemic on TB services was estimated to be dramatic due to the disruption of TB services. Methods: A retrospective data collection and evaluation was conducted to include all the patients hospitalized for TB at INMI from 9 March to 31 August 2020 (lockdown period and three months thereafter). For the purpose of the study, data from patients hospitalized in the same period of 2019 were also collected. Results: In the period of March–August 2019, 201 patients were hospitalized with a diagnosis of TB, while in the same period of 2020, only 115 patients, with a case reduction of 43%. Patients with weight loss, acute respiratory failure, concurrent extrapulmonary TB, and higher Timika radiographic scores were significantly more frequently hospitalized during 2020 vs. 2019. The median patient delay was 75 days (IQR: 40–100) in 2020 compared to 30 days (IQR: 10–60) in 2019 (p < 0.01). Diagnostic delays in 2020 remain significant in the multiple logistic model (AOR = 6.93, 95%CI: 3.9–12.3). Conclusions: Our experience suggests that COVID-19 pandemic had an impact on TB patient care in terms of higher diagnostic delay, reduction in hospitalization, and a greater severity of clinical presentations.

Pulmonary Tuberculosis in Older Adults: Increased Mortality Related to Tuberculosis Within Two Months of Treatment Initiation

“…Treatment of latent tuberculosis infection (LTBI) is not generally offered to older patients as the risk of LTBI treatment is perceived to outweigh its benefits. In addition, even though older TB patients rarely lead to clusters, TB transmission to younger persons has been observed in hospitals and nursing homes [ 19 ], and atypical presentations of TB among older patients may result in delayed TB diagnosis [ 3 ], especially given the current COVID-19 pandemic [ 20 , 21 ]. As our study highlights high mortality related to TB among older patients, the benefit of LTBI treatment in a selected older population can be revisited and the risk–benefit ratio among older LTBI patients should be re-evaluated with the use of safer, short-course rifamycin-based LTBI treatment regimens [ 22 – 24 ].…”

Public Awareness, Attitudes, and Adherence to COVID-19 Quarantine and Isolation in Saudi Arabia

“…It is imperative to promote and educate the masses regarding isolation and quarantine, as the burden of COVID-19 on hospitals and labs can lead to a diagnostic delay in other infectious diseases. 34 In Europe, there are five key factors that were found most relevant in making people adhered to self-isolation, such as sufficient financial support, provision of alternative accommodation temporarily if required, accessible and clear communication by the public health department, effective contact tracing, and monitored adherence to self-isolation. 32 Saudi Arabia can also strive for the provision of these factors that can help to minimize barriers related to self-isolation.…”

Dual Nature of Relationship between Mycobacteria and Cancer

“…The novel virulent coronavirus (CoV) named severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) causing the coronavirus disease 2019 (COVID-19) pandemic, which is now spreading around the world, may have an impact on the transmission and consequently on TB morbidity and mortality due to greater diagnostic delays, reduced hospitalization, and increased clinical severity. Although the effects of the COVID-19 pandemic are not yet apparent, rigorous monitoring across all national TB centers is needed to prevent the devastating consequences of the infection [ 3 ]…”