The (in)significance of TB and COVID-19 co-infection

Khurana, Alkesh Kumar; Aggarwal, Deepak

doi:10.1183/13993003.02105-2020

Cited by 55 publications

(49 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The authors divided patients into cases with TB before COVID-19, those with COVID-19 followed by TB, and those in whom these two infections occurred in the same week. There was some discussion in the literature about the interpretation of the findings, particularly regarding the timing, with the suggestion that since TB has a chronic course, while COVID was an acute illness, this co-infection may be purely incidental; however, there was concern about the high mortality of that study of 12.3% in the cases with apparent co-infections, which is higher than that for COVID alone [ 74 , 75 ]. There was also a concern though, aside from these comments, that these co-infections, even if co-incidental, may nevertheless be an issue in countries with high TB (and post-TB sequelae) burdens and that both infections could have a significant, synergistic social and economic impact worldwide [ 74 ].…”

Section: Clinical Data On Co-infections With Covidmentioning

confidence: 99%

The role of co-infections and secondary infections in patients with COVID-19

2021

View full text Add to dashboard Cite

Background It has been recognised for a considerable time-period, that viral respiratory infections predispose patients to bacterial infections, and that these co-infections have a worse outcome than either infection on its own. However, it is still unclear what exact roles co-infections and/or superinfections play in patients with COVID-19 infection. Main body This was an extensive review of the current literature regarding co-infections and superinfections in patients with SARS-CoV-2 infection. The definitions used were those of the Centers for Disease Control and Prevention (US), which defines coinfection as one occurring concurrently with the initial infection, while superinfections are those infections that follow on a previous infection, especially when caused by microorganisms that are resistant, or have become resistant, to the antibiotics used earlier. Some researchers have envisioned three potential scenarios of bacterial/SARS-CoV-2 co-infection; namely, secondary SARS-CoV-2 infection following bacterial infection or colonisation, combined viral/bacterial pneumonia, or secondary bacterial superinfection following SARS-CoV-2. There are a myriad of published articles ranging from letters to the editor to systematic reviews and meta-analyses describing varying ranges of co-infection and/or superinfection in patients with COVID-19. The concomitant infections described included other respiratory viruses, bacteria, including mycobacteria, fungi, as well as other, more unusual, pathogens. However, as will be seen in this review, there is often not a clear distinction made in the literature as to what the authors are referring to, whether true concomitant/co-infections or superinfections. In addition, possible mechanisms of the interactions between viral infections, including SARS-CoV-2, and other infections, particularly bacterial infections are discussed further. Lastly, the impact of these co-infections and superinfections in the severity of COVID-19 infections and their outcome is also described. Conclusion The current review describes varying rates of co-infections and/or superinfections in patients with COVID-19 infections, although often a clear distinction between the two is not clear in the literature. When they occur, these infections appear to be associated with both severity of COVID-19 as well as poorer outcomes.

show abstract

Section: Clinical Data On Co-infections With Covidmentioning

confidence: 99%

The role of co-infections and secondary infections in patients with COVID-19

2021

View full text Add to dashboard Cite

show abstract

“…[29][30][31] One clinical study suggests that comorbidity with TB manifests atypical radiological features in individuals diagnosed with COVID-19. 32 Although a clear causal relationship between the two is debated, 33 the similarities in their initial physiological symptoms and shared risk factors (including poverty, overcrowding, and air pollution) mean that M. tuberculosis and SARS-CoV-2 are two intertwined infectious agents whose coinfection likely leads to worse prognosis than either one alone. [29][30][31]33 Indirectly, the ongoing pandemic redirects resources and attention away from TB, as well as from HIV and malaria.…”

Section: Resultsmentioning

confidence: 99%

“…32 Although a clear causal relationship between the two is debated, 33 the similarities in their initial physiological symptoms and shared risk factors (including poverty, overcrowding, and air pollution) mean that M. tuberculosis and SARS-CoV-2 are two intertwined infectious agents whose coinfection likely leads to worse prognosis than either one alone. [29][30][31]33 Indirectly, the ongoing pandemic redirects resources and attention away from TB, as well as from HIV and malaria. Restrictions in international commerce that limit access to necessary medications, shifts in manufacturing of TB diagnostic tests to COVID-19 tests, and reallocation of financial and human resources towards COVID-19 are only a few of many concerns for the future of TB control.…”

Section: Resultsmentioning

confidence: 99%

An Evaluation of Progress Towards the 2035 WHO End TB Targets in 40 High Burden Countries

Cha

Thwaites

Ashton

2020

Preprint

View full text Add to dashboard Cite

Tuberculosis (TB) is the leading global cause of death from a single infectious agent, with more than 10 million new cases annually. As a part of its efforts to control TB, the World Health Organisation (WHO) adopted the End TB Strategy in 2014 to reduce TB incidence by 90% between 2015 and 2035, with intermediate targets every five years. We examined TB incidence data from 2000 to 2018 for 40 high burden countries (HBCs) from the WHO published statistics, contextualized and assessed trends over time, and projected incidence to 2035 for each country. Two recurrent patterns accounted for 26 of the 40 HBCs: linear decrease (n = 14) or a peak in the 2000s followed by decline (n = 12). As uncontrolled HIV is the greatest risk factor for TB, we assessed trends in TB in HIV infected people and TB in HIV uninfected people separately in 15 Sub-Saharan African countries with high HIV prevalence. The projections of current trends were compared against the reductions required to meet the WHO End TB targets. Of the 25 countries without a high burden of TB, only 5 are on track to meet the End TB targets: Ethiopia, Laos, Myanmar, Russia, and South Korea. Of the 15 high HIV burden countries, 6 are on track to meet the End TB targets: Eswatini, Kenya, Lesotho, South Africa, Tanzania, and Zimbabwe. Overall, we predict 62 million excess cases of TB between 2020 and 2035 in the 29 HBCs projected to miss the WHO End TB targets. In high HIV burden countries, new programs aimed directly at TB will be required to maintain momentum. Moreover, our projections are based on data prior to the COVID-19 pandemic; the disruption of the pandemic is overwhelmingly likely to interrupt vital TB services and increase TB incidence. We anticipate that these findings will help orientate countries to their progress towards the End TB goals and inform the level of investment required to meet these important targets for a TB-free world.

show abstract

“…The average proportion of MDR-TB cases with XDR-TB was 6.2%. Poor regimen selection, inadequate drug supply and poor adherence of patients to the 6-months therapy may lead to development of drug-resistant Mtb strains, including multidrug-resistant (MDR-TB: resistant at least to INH and RIF) and extensively-drug-resistant (XDR-TB) strains [9].MDR-TB and XDR-TB still being a challenge for clinicians and staff operating in national TB programs [10]Considering the high worldwide prevalence of TB and current increasing burden of COVID-19, recent study showed a mortality much higher than isolated COVID-19 in the patients with dual infection [11,12] In the African Region, where the burden of HIV-associated TB is highest, 87% of TB patients had a documented HIV test result. A total of 477 461 TB cases among HIV-positive people were reported, of which 86% were on antiretroviral therapy [1].…”

Section: Introductionmentioning

confidence: 99%

Keys factors influencing multidrug-resistant tuberculosis: A Mixed Effects Modelling Study in Burundi

Iradukunda¹,

Ndayishimiye²,

Sinarinzi³

et al. 2020

Preprint

View full text Add to dashboard Cite

BackgroundTuberculosis is a serious global public health problem, and it is in the top 10 causes of mortality in low and middle income countries. MDR-TB and XDR-TB still being a challenge for clinicians and staff operating in national TB programs .Particularly in sub-Saharan African countries, it particularly coexists with high burden of other infectious and no communicable diseases, creating a complex public health situation which is difficult to address. Tackling this will require targeted public health intervention based on evidence well defines the at risk population. In this study, using data from two referral anti tuberculosis in Burundi, we model the determinants factors associated with MDR-TB in Burundi.MethodsProspective data of a sample of 180 tuberculosis randomly selected from a population of patients admitted in 2019 in two referral anti tuberculosis centres in Burundi: Kibumbu Sanatorium Centre and Bujumbura anti-tuberculosis Center. The associated factors were carried out by fixed and random effect logistic regression. Model performance was assessed by Area under Curve (AUC). Model was internally validated via bootstrapping with 1000 replications. All analysis were conducted in R 3.5.0.ResultsOver 180 participants of the study, 60 patients of them were MDR-TB and 120 were Drug Susceptible. High MDR-TB is observed in patients who lives in rural zone (51,3%),in collective residence (69,2%) ,in house with more than six people (59,5%), many people who live in the same room(70,0%) ,in patients with TB treatment history(86.4%) and in diabetics people(66.6%).HIV was 32.3% and 67.7% positive respectively in MDR-TB patients and Drug susceptible patients. More than half of cases (75%) and controls (73.3%) belonged to the age group of ≤ 45 years.The Pearson's Chi-squared test with Yates' continuity correction showed the house’s rooms (p = 0,010), People by house (p < 0,001), currently workers (p = 0,019), MDR-TB close contact (p < < 0.001), Collective residence (p = 0,004), Residence area (p = 0,007) and tobacco consumption (< 0.001) were not independent with MDR-TB.After modelling using fixed and random effects, Residence (AOR: 1.31, 95%CI: 1.12–1.80), People by house (AOR: 4.15, 95% CI: 3.06–5.39), MDR-TB close contact (AOR: 6.03, 95% CI: 4.01–8.12), History TB treatment (AOR: 2.16, 95% CI: 1.06–3.42), Tobacco consumption (AOR : 3.17 ,95% CI: 2.06–5.45) and Diabetes( AOR: 4.09,95% CI : 2.01–16.79) were statistically associated with MDR-TBs. With 2000 stratified bootstrap replicates, the model had an excellent predictive performance (AUC), accurately predicting 88.15%(95% CI: 82.06%-92.8%) of all observations. Drug susceptible patients with no close contact had the low probability around 10% to develop MDR-TB.ConclusionThe relatively high prevalence of tuberculosis and associated factors of MDR-TB in Burundi raises a call for concern especially in this context where there exist an equally high burden of chronic diseases, chronic malnutrition, HIV/SIDA and others infectious diseases. Targeting interventions based on these identified factors will allow judicious channel of resources and effective public health planning.

show abstract

The (in)significance of TB and COVID-19 co-infection

Cited by 55 publications

References 6 publications

The role of co-infections and secondary infections in patients with COVID-19

The role of co-infections and secondary infections in patients with COVID-19

An Evaluation of Progress Towards the 2035 WHO End TB Targets in 40 High Burden Countries

Keys factors influencing multidrug-resistant tuberculosis: A Mixed Effects Modelling Study in Burundi

Contact Info

Product

Resources

About