Active tuberculosis, sequelae and COVID-19 co-infection first cohort of 49 cases

Active tuberculosis, sequelae and COVID-19 co-infection first cohort of 49 cases

Active tuberculosis, sequelae and COVID-19 co-infection first cohort of 49 casesActive tuberculosis, sequelae and COVID-19 co-infection first cohort of 49 cases

Marina Tadolini, Luigi Ruffo Codecasa, José-María García-García, François-Xavier Blanc, Sergey Borisov, Jan-Willem Alffenaar, Claire Andréjak, Pierre Bachez, Pierre-Alexandre Bart, Evgeny Belilovski, José Cardoso-Landivar>,Rosella Centis,Lia D’Ambrosio, María- Luiza De Souza-Galvão, Angel Dominguez-Castellano, Samir Dourmane, Mathilde Fréchet Jachym, Antoine Froissart, Vania Giacomet, Delia Goletti, Soazic Grard, Gina Gualano, Armine Izadifar, Damien Le Du,Margarita Marín Royo, Jesica Mazza-Stalder, Ilaria Motta, Catherine Wei Min Ong, Fabrizio Palmieri, Frédéric Rivière, Teresa Rodrigo, Denise Rossato Silva, Adrián Sánchez-Montalvá, Matteo Saporiti, Paolo Scarpellini, Frédéric Schlemmer, Antonio Spanevello, Elena Sumarokova, Eva Tabernero, Paul Anantharajah Tambyah, Simon Tiberi, Alessandro Torre, Dina Visca,Miguel Zabaleta Murguiondo, Giovanni Sotgiu, Giovanni Battista Migliori

European Respiratory Journal 2020 56: 2001398; DOI: 10.1183/13993003.01398-2020

Diagnostic, treatment and outcome details of 49 COVID-19 patients with concurrent or previous tuberculosis from 8 countries show varied clinical profiles

To the Editor:

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (COVID-19) pandemic has attracted interest because of its global rapid spread, clinical severity, high mortality rate and capacity to overwhelm healthcare systems. SARS-CoV-2 transmission occurs mainly through droplets, although surface contamination contributes and debate continues on aerosol transmission.

The disease is usually characterised by initial signs and symptoms similar to those of related viral infections (e.g. influenza, SARS, Middle East respiratory syndrome) and tuberculosis (TB), although prognosis and complications sometimes differ. Experience with concomitant TB and COVID-19 is extremely limited.

One case–control study of COVID-19 patients with interferon-γ release assay-confirmed TB infection and a single case of TB with COVID-19 have been submitted to, but not yet published in, peer-reviewed journals. In a recent analysis of 1217 consecutive respiratory specimens collected from COVID-19 patients (Mycobacterium tuberculosis was not tested), the authors concluded that higher rates of co-infection between SARS-CoV-2 and other respiratory pathogens can be expected.

The present study describes the first-ever global cohort of current or former TB patients (post-TB treatment sequelae) with COVID-19, recruited by the Global Tuberculosis Network (GTN) in eight countries and three continents. No analysis for determinants of outcome was attempted.

The study is nested within the GTN project monitoring adverse drug reactions for which the coordinating centre has an ethics committee approval, alongside ethics clearance from participating centres according to respective national regulation. A specific nested database was created in collaboration with the eight countries reporting patients with TB and COVID-19; the remaining countries had not yet observed COVID-19 in their patients at the time this manuscript was written.

Continuous variables, if not otherwise specified, are presented as medians with interquartile ranges.

Overall, 49 consecutive patients with current or former TB and COVID-19 from 26 centres in Belgium (n=1), Brazil (Porto Alegre, Rio Grande do Sul State; n=1), France (n=12), Italy (n=17), Russia (Moscow Region; n=6), Singapore (n=1), Spain (n=10) and Switzerland (Vaud Canton; n=1) were recruited (dataset updated as of 25 April, 2020) (table 1).


Demographic, epidemiological and clinical characteristics of a cohort of 49 tuberculosis (TB) patients with coronavirus disease 2019 (COVID-19)

The first onset of COVID-19 in the cohort was observed in an Italian patient with TB sequelae on 12 March, 2020 (symptoms from 6 March).

Of 49 patients, 26 (53.0%) had TB before COVID-19, 14 (28.5%) had COVID-19 first and nine (18.3%) had both diseases diagnosed within the same week (four on the same day).

42 (85.7%) patients had active TB (median age 45.5 (28.0–63.0) years) and seven (14.3%) had post-TB treatment sequelae (median age 69.0 (66.0–70.0) years; p=0.01); the patients with TB sequelae (from five centres in Italy, Singapore, Spain and Switzerland) were cured 8.2 (2.7–44.3) years earlier.

Overall, 26/49 (53.1%) patients were migrants, 15/48 (31.3%) unemployed, and 2/48 (4.1%) healthcare workers (medical doctor and radiology technician).

46 (93.9%) patients had confirmed SARS-CoV-2 infection and three other patients (6.1%) had chest high-resolution computed tomography (HRCT) highly suggestive of COVID-19 related pneumonia (bilateral ground glass opacities) .

48 patients had pulmonary TB (one caused by Mycobacterium bovis).

37 patients had drug-susceptible (or were treated with the standard first-line regimen for new cases) and eight had drug-resistant TB (and were treated with second-line drugs).

Of the 14 non-clustered patients with COVID-19 diagnosis preceding TB, a child of Gambian origin (3 months old) had SARS-CoV-2 identified 3 days before TB diagnosis although TB was probably pre-existing (pulmonary and extra-pulmonary TB, meningitis). The child is continuing anti-TB treatment and has now recovered from COVID-19. Altogether the diagnosis of COVID-19 preceded that of TB by a median (range) time of 4 (2–10) days.

Those 14 patients, managed in nine centres (in France, Italy, Russia, Spain) were young (median age 33 (26.0–46.0) years); 11/14 (78.5%) were migrants.