key: cord-0941190-2f64dxbh
authors: Gupta, Nitesh; Ish, Pranav; Gupta, Amitesh; Malhotra, Nipun; Caminero, Jose Antonio; Singla, Rupak; Kumar, Rohit; Yadav, Siddharth Raj; Dev, Nishanth; Agrawal, Sumita; Kohli, Santvana; Sen, M.K.; Chakrabarti, Shibdas; Gupta, N.K.
title: A profile of a retrospective cohort of 22 patients with COVID-19 and active/treated tuberculosis
date: 2020-11-19
journal: Eur Respir J
DOI: 10.1183/13993003.03408-2020
sha: 0bc85e02aaef95c4a65f97b29b0e33d1c33b1bba
doc_id: 941190
cord_uid: 2f64dxbh

Both tuberculosis and COVID-19 being communicable and prevalent diseases in India, the co-existence can lead to worse outcomes, as seen in this study, where there was high mortality among active as well as treated TB patients with COVID-19 co-infection https://bit.ly/3jHcGbQ

All patients, except one, were symptomatic at the time of presentation. All 12 patients with active TB, who were already receiving ATT at the time of admission, had become almost asymptomatic for TB symptoms. Among them, signs and symptoms attributed to COVID-19 included fever (100%), dry cough (53.8%) and dyspnoea (30.8%) (median (range) duration 2 (2-30) days). Nine treated TB patients were also almost asymptomatic for TB prior to the development of current COVID-19 infection. Among them fever (88.9%), dry cough (44.4%) and dyspnoea (33.3%), respectively were present (median (range) duration of 5 (2-30) days), which could be attributed to COVID-19 disease. Radiological examination, conducted at admission, revealed pulmonary parenchymal fibrosis in all patients in the treated TB group with three (33.3%) patients having accompanying residual cavitation as well. Among the 13 active TB patients, nine (69.2%) had pulmonary TB and four (30.8%) had extra-pulmonary TB. Among the nine active pulmonary TB patients, cavitation was present in three (33.3%), and six (66.7%) had parenchymal infiltrates/ consolidation on chest radiography but no cavitation. Among four active extra-pulmonary TB patients, one had cerebral tuberculoma, two had pleural effusion, and one patient had only cervical lymphadenopathy. One active pulmonary TB patient had multidrug-resistant (MDR) TB (isoniazid and rifampicin resistant), receiving conventional MDR treatment regimen as per national guidelines. All treated TB cases had had pulmonary TB.

Lymphopenia was found in only one patient. In all, seven patients (31.8%) required critical care, 4/13 (30.7%) in the active TB group and 3/9 (33.3%) in the treated TB group. All but one patient who required @ERSpublications Both tuberculosis and COVID-19 being communicable and prevalent diseases in India, the co-existence can lead to worse outcomes, as seen in this study, where there was high mortality among active as well as treated TB patients with COVID-19 co-infection https://bit.ly/3jHcGbQ

Cite this article as: Gupta N, Ish P, Gupta critical care also required invasive mechanical ventilation. Among these, 3/13 (23.1%) patients were from the active TB group and 3/9 (33.3) patients were from the treated TB group. All these six patients died; this group also included one MDR-TB patient.

All six patients who died had hypoxaemia and a Glasgow Coma Scale (GCS) score of 3-4 on admission.

Quick sepsis-related organ failure scores were 3 in four patients, and 2 and 1 in one patient each. Death in all deceased patients was attributed to COVID-19 co-infection, as all were otherwise responding clinically and radiologically to ATT in the active TB group or were clinically stable in the treated TB group. In the initial cohort of 40 COVID-19 patients who had been admitted to the authors' centre up to 31 March 2020, no patient had active or previously treated TB; however, over the subsequent 6 weeks, the incidence of active and treated TB went up to 1.21 and 0.83 per 100 hospital admissions for COVID-19, respectively [9] .

The limitations of the study were that the role of pathological and biochemical factors, such as D-dimer, C reactive protein, IL-6 and ferritin, etc., and use of investigational drugs, such as tocilizumab, remdesivir, favipiravir and steroids, for patient management were not studied, as neither of these were a component of national treatment guidelines during the study period [6] . Also, because of the small sample size, analysis of various risk factors was not carried out.

In conclusion, patients with treated or active TB may be considered another vulnerable group for COVID-19 and may require special attention and appropriate preventive measures for development of COVID-19. Further, a high mortality, along with a greater need for critical care, was found in active as well as treated TB patients co-infected with COVID-19.

Dept of Tuberculosis and Respiratory Diseases, National Institute of Tuberculosis and Respiratory Diseases

Author contributions: All the 14 authors made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; or drafting the work or revising it critically for important intellectual content; and towards final approval of the version to be published

Declaration of patient consent: the authors certify that they have obtained written informed consent from the patients to publish their personal details and follow up. The patients understand that their name and initials will not be published but, anonymity cannot be guaranteed. Ethics committee approval was not required as it was a retrospective observational study

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