Clinical Features and Treatment Outcome of Coronavirus and Tuberculosis Co-Infected Patients: A Systematic Review of Case Reports

Abstract

Background

Coronavirus disease 19 (COVID-19) and Mycobacterium tuberculosis (MTB) are among the top ongoing health crises globally. Both cause respiratory diseases, and the clinical presentations are similar. There is no summarized information about cases of COVID-19 patients with concomitant TB infection from different settings. Therefore this review aimed to summerize the clinical features and treatment outcomes of coronavirus and tuberculosis co-infected patients.

Methods

An electronic search of case reports published between 2020 and 2021 was conducted using Google Scholar, PubMed, Scopus, and ScienceDirect. From eligible reports, data were collected for the selected variables. We analyzed the collected information using SPSS version 27 software. Descriptive statistics were computed for the selected variables.

Results

A total of 83 patient histories were collected from 47 case reports. The majority (80%) of the cases were reported for male patients. The mean age was 42.6 years (3 months to 84 years, SD=17.3). Fever was reported in 80% of cases, followed by cough (73.3%) and hypotension (37.1%). Blood cell parameters revealed lymphopenia (52%), lower hemoglobin (30%), elevated CRP (70%), elevated ferritin (28%), and increased D-dimer (23.4%). Treatment outcome is significantly associated with blood cell count results (p-0.044) and a rise in blood inflammatory cytokines(p-0.041). The mean days for viral clearance or negative PCR was 23 days (Range 5–82 days) and the overall mean duration of hospitalization was 27 days. The total death rate was 22.4%. Recovery was reported for 76.6% of cases. Survival status (p-0.613) and disease severity (p-0.68) are not significantly associated with the gender of the participants.

Conclusion

An alteration in blood cell parameters is associated with an unfavorable treatment outcome. There is a higher death rate in COVID-19/TB co-infection. The death is associated with older age, smoking or smoking history, drug abuse, and co-morbidity of non-communicable diseases. Conversely, there is a lower death rate in HIV patients.

Keywords:

• coronavirus
• SARSCOV-2
• COVID-19
• Mycobacterium tuberculosis
• tuberculosis
• TB
• co-infection

Abbreviations

ADA, Adenosine Di Aminase; AOR, Adjusted Odds Ratio; BCG, Bacillus Calmette Guerin Vaccine; COVID 19, Corona Virus Disease −2019; CRP, Inflammatory Reactive C- Protein; DOT, Directly Observed Therapy; HIV, Human Immuno-Deficiency Virus; LDH, Lactate De Hydrogenase; MTB, Mycobacterium Tuberculosis; OR, Odds Ratio; PCR, Polymerase Chain Reaction; PLWH, Peoples Living with Human Immuno-Deficiency Virus; RHZE, Rifampicin, Isoniazid, Pyrazinamide, Ethambutol; SARS COV 2, Severe Acute Respiratory Syndrome Corona Virus; TB, Tuberculosis; WHO, World Health Organization.

Data Sharing Statement

The data related to this document can be obtained by contacting the principal investigator.

Acknowledgment

We acknowledge clinicians for reporting and publishing the cases used for reviewing this article.

Author Information

Hilina Mollalign is an associate researcher at the National Tuberculosis Reference Laboratory, Ethiopian Public Health Institute.

Dawit Chala is the technical manager and COVID-19 testing coordinator at the National Immunohematology Reference Laboratory, Ethiopian Public Health Institute.

Dereje Beyene is an assistant professor in molecular genetics and functional genomics at Addis Ababa University College of Natural and Computational Science, Department of Microbial, Cellular, and Molecular Biology.

Author Contributions

All authors have made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising, or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted, and agree to be accountable for all aspects of the work.

Disclosure

The authors declare that they have no conflicts of interest in relation to this work.

Additional information

Funding

There is no funding to report.