COVID-19 in patients with tuberculosis: epidemiological and clinical features

Aim. To study the epidemiological and clinical features of COVID-19 among patients with tuberculosis.

Materials and Methods. We studied the incidence of COVID-19 in various population groups in Kemerovo Region in 2020 (from March, 13 to December, 31). The study cohort consisted of 3929 tuberculosis patients, including 113 with a verified COVID-19 diagnosis. The control cohort included tuberculosis-free subjects with COVID-19 (25,774 individuals). Out of these subjects, we enrolled 71 patients with tuberculosis and 71 age- and gender-matched controls. All patients underwent complete blood count, urinalysis, biochemical analysis, and coagulation testing.

Results. The incidence of COVID-19 in patients with tuberculosis was 2.96-fold higher than in the tuberculosis-free population (2876.05 and 971.17 per 100,000 population, respectively). In patients with tuberculosis, the highest incidence of COVID-19 was recorded in two age categories: from 18 to 29 years and ≥ 65 years of age. In tuberculosis patients, COVID-19 was mostly mild, was characterised by a 9.2-fold lower frequency of pneumonia, 11.8-fold less use of antibiotics, and oxygen therapy was required only in 1.41% of cases in comparison with 16.9% in the tuberculosis-free subjects. In addition, patients with tuberculosis less often suffered from hyperthermia, cough and weakness. Regarding the comorbid conditions, patients with tuberculosis showed lower prevalence of arterial hypertension, chronic heart failure, peripheral artery disease, and obesity. Further, patients with tuberculosis generally had higher glomerular filtration rate and rarely had neutrophilia or lymphopenia when compared with the control individuals with COVID-19, although having higher fibrinogen and aspartate aminotransferase serum levels.

Conclusion. Tuberculosis is a risk factor of COVID-19 but not a predictor of morbidity and mortality from this disease.

1. WHO. Global tuberculosis report 2020. Available at: https://www.who.int/publications/i/item/9789240013131 Accessed: 31 July, 2021.

2. Wu F, Zhao S, Yu B, Chen YM, Wang W, Song ZG, Hu Y, Tao ZW, Tian JH, Pei YY, Yuan ML, Zhang YL, Dai FH, Liu Y, Wang QM, Zheng JJ, Xu L, Holmes EC, Zhang YZ. A new coronavirus associated with human respiratory disease in China. Nature. 2020;579(7798):265- 269. https://doi.org/10.1038/s41586-020-2008-3

3. Adepoju P. Tuberculosis and HIV responses threatened by COVID-19. Lancet HIV. 2020;7(5):e319-e320. https://doi.org/10.1016/S2352-3018(20)30109-0

4. Amimo F, Lambert B, Magit A. What does the COVID-19 pandem-ic mean for HIV, tuberculosis, and malaria control? Trop Med Health. 2020;48:32. https://doi.org/10.1186/s41182-020-00219-6

5. Togun T, Kampmann B, Stoker NG, Lipman M. Anticipating the impact of the COVID-19 pandemic on TB patients and TB control programmes. Ann Clin Microbiol Antimicrob. 2020;19(1):21. https://doi.org/10.1186/s12941-020-00363-1

6. Dara M, Sotgiu G, Reichler MR, Chiang CY, Chee CBE, Migliori GB. New diseases and old threats: lessons from tuberculosis for the COVID-19 response. Int J Tuberc Lung Dis. 2020;24(5):544-545. https://doi.org/10.5588/ijtld.20.0151

7. Chen H, Zhang K. Insight into the impact of the COVID-19 epidem-ic on tuberculosis burden in China. Eur Respir J. 2020;56(3):2002710. https://doi.org/10.1183/13993003.02710-2020

8. Wenzhong liu, Hualan L. COVID-19:Attacks the 1-Beta Chain of Hemoglobin and Captures the Porphyrin to Inhibit Human Heme Metabolism. ChemRxiv. Cambridge: Cambridge Open Engage; 2020. Available at: https://chemrxiv.org/engage/chemrxiv/article-details/60c74fa50f50db305139743d. Accessed: 31 July, 2021.

9. Gao Y, Liu M, Chen Y, Shi S, Geng J, Tian J. Association between tuberculosis and COVID-19 severity and mortality: A rapid systematic review and meta-analysis. J Med Virol. 2021;93(1):194-196. https://doi.org/10.1002/jmv.26311

10. Tadolini M, Codecasa LR, García-García JM, Blanc FX, Borisov S, Alffenaar JW, Andréjak C, Bachez P, Bart PA, Belilovski E, Cardoso-Landivar J, Centis R, D'Ambrosio L, Luiza De Souza-Galvão M, Dominguez-Castellano A, Dourmane S, Fréchet Jachym M, Froissart A, Giacomet V, Goletti D, Grard S, Gualano G, Izadifar A, Le Du D, Marín Royo M, Mazza-Stalder J, Motta I, Ong CWM, Palmieri F, Rivière F, Rodrigo T, Silva DR, Sánchez-Montalvá A, Saporiti M, Scarpellini P, Schlemmer F, Spanevello A, Sumarokova E, Taber-nero E, Tambyah PA, Tiberi S, Torre A, Visca D, Zabaleta Murguiondo M, Sot-giu G, Migliori GB. Active tuberculosis, sequelae and COVID-19 co-infection: first cohort of 49 cases. Eur Respir J. 2020;56(1):2001398. https://doi.org/10.1183/13993003.01398-2020

11. Inoue K, Kashima S. Association of the past epidemic of Mycobac-terium tuberculosis with mortality and incidence of COVID-19. PLoS One. 2021;16(6):e0253169. https://doi.org/10.1371/journal.pone.0253169

12. Palaiodimos L, Kokkinidis DG, Li W, Karamanis D, Ognibene J, Arora S, Southern WN, Mantzoros CS. Severe obesity, increasing age and male sex are independently associated with worse in-hospital outcomes, and higher in-hospital mortality, in a cohort of patients with COVID-19 in the Bronx, New York. Metabolism. 2020;108:154262. https://doi.org/10.1016/j.metabol.2020.154262

13. Visca D, Ong CWM, Tiberi S, Centis R, D'Ambrosio L, Chen B, Mueller J, Mueller P, Duarte R, Dalcolmo M, Sotgiu G, Migliori GB, Goletti D. Tuberculosis and COVID-19 interaction: A review of biological, clinical and public health effects. Pulmonology. 2021;27(2):151-165. https://doi.org/10.1016/j.pulmoe.2020.12.012

14. Zuban ON, Reshetnikov MN, Ustinov AV. Covid-19 in tuberculosis patients: single сане center experience. Tuberkulez i sotsial'no-znachimye zabolevaniya. 2020;4:58-63.

15. Freites Nuñez DD, Leon L, Mucientes A, Rodriguez-Rodriguez L, Font Urgelles J, Madrid García A, Colomer JI, Jover JA, Fernandez-Gutierrez B, Abasolo L. Risk factors for hospital admissions related to COVID-19 in patients with autoimmune inflammatory rheumatic diseases. Ann Rheum Dis. 2020;79(11):1393-1399. https://doi.org/10.1136/annrheumdis-2020-217984

16. Molochkov AV, Karateev DE, Ogneva EYU, Zulkarnaev AB, Luchikhina EL, Makarova IV, Semenov DYU. Comorbidities and predicting the outcome of COVID-19: The treatment results of 13,585 patients hospitalized in the Moscow region. Almanac of clinical medicine. 2020;48(S1):1-10. https://doi.org/10.18786/2072-0505-2020-48-040

17. Ejaz H, Alsrhani A, Zafar A, Javed H, Junaid K, Abdalla AE, Ab-osalif KOA, Ahmed Z, Younas S. COVID-19 and comorbidities: Deleterious im-pact on infected patients. J Infect Public Health. 2020;13(12):1833- 1839. https://doi.org/10.1016/j.jiph.2020.07.014

18. Gao Y, Liu M, Chen Y, Shi S, Geng J, Tian J. Association between tuberculosis and COVID-19 severity and mortality: A rapid systematic review and meta-analysis. J Med Virol. 2021;93(1):194-196. https://doi.org/10.1002/jmv.26311