A Descriptive Study on the Clinical Profile and Outcomes of Patients with COVID-19 and Tuberculosis Co-infection.

Abstract

Tuberculosis (TB) control has been a challenge in the country and its overall health impact remains significant. COVID-19 has caused significant morbidity and mortality especially among hospitalized patients. TB and COVID-19 co-infection (COVID-TB) may cause more catastrophic consequences and outcomes among afflicted individuals and management may be daunting. There is limited local data on COVID-TB. The clinical profile of COVID-TB patients who were admitted were described. Comparison of the clinical outcomes was also done versus the general admitted COVID-19 patients without concomitant TB in the same institution. Relevant patient outcomes were reported which included admission to an intensive care unit (ICU), length of hospital stay, and mortality rate. This is a descriptive study on the demographics and clinical outcomes of patients admitted in the Philippine General Hospital (PGH) for COVID-19 with TB co-infection from March 2020 to September 2020. We aimed to characterize patients with COVID-TB and analyzed their outcomes. There was a total of 79 patients who were admitted for COVID-19 (confirmed with RT-PCR) with TB co-infection during the study period. Majority of them were males (70.9%) with a median age of 54 (IQR 42 to 64) years. In terms of TB affliction, 75 (94.9%) patients were identified to have pulmonary tuberculosis. Majority of patients had at least one co-morbid illness with hypertension (16.5%), diabetes mellitus (13.9%), and heart failure (11.4%) as the most common. Respiratory symptoms (dyspnea and cough) were the predominant presenting complaint during hospital admission. Majority of the patients were classified as severe (8 or 10.1%) and critical (36 or 45.57%) COVID-19 disease. Fifty-six (70.9%) were bacteriologically confirmed tuberculosis. Radiologic imaging studies revealed findings consistent with pulmonary tuberculosis in 70 (88.61%) through plain radiograph. Forty-seven underwent HRCT and 46 of these (97.8%) had findings suggestive of PTB. Overall, 61 patients (77%) subsequently required oxygen supplementation. The in-hospital mortality within the study population was 36.7% (29/79) in contrast to the general COVID patients admitted in the same period which revealed significantly less fatality at 17.5% (35/200). The length of hospital stay was found to be 21.1 days ± 14.75 days across all study patients, and with median of 20 days for surviving patients. TB treatment outcomes were tracked in the 50 surviving COVID-19 patients where cure was declared in 8/50 (16%) while 22/50 (44%) successfully completed their six-month treatment regimen. This study of COVID-TB provides an initial evaluation of the potential association between active TB infection and COVID-19 severity and mortality. The data generated from this study may be a starting point to assess the interaction of these two diseases. Furthermore, bidirectional screening may be recommended even at hospitals' triage areas since both diseases may have similar presentations.