COVID-19 in Socially Vulnerable Patients with Tuberculosis in Brazil

Abstract

INTRODUCTION: COVID-19 is a global public health problem. The first case reported in the socially vulnerable population in the territory of Mato Grosso do State/Brazil occurred in August 2020. However, information about the co-infection of Tuberculosis (TB) and COVID-19 is rarely described in the world literature. Objective: to describe for the first time a group of vulnerable patients who died or not due to Tuberculosis and COVID-19, using a Cohort study of a control group and a treatment group. 
 
 METHODS: Reporting 7 cases of TB associated with COVID-19 confirmed by respiratory RT-PCR, hospitalized in a hospital department of COVID-19 (CEAA: 42969320.0.0000.0021).
 
 RESULTS: The patients included in this case report were aged between 19 and 83 years, respectively, with a predominance of females, 4 patients were vaccinated with BCG. In addition, 3 patients died from COVID-19, and 2 patients were considered cured by COVID-19. The mean time to diagnosis between Tuberculosis and COVID-19 in the “control group” was 43 days and the mean time to diagnosis in the “treatment group” was 37 days. The average number of days of hospital stay in the “control group” was 50 days and in the “treatment group” it was 40 days. In the patients in the “control group”, 2 presented a unilateral pulmonary cavity lesion on the X-ray. In the “treatment group”, only 1 patient presented a unilateral pulmonary cavity lesion on the X-ray, and 2 presented a bilateral pulmonary cavity lesion, and only one developed bilateral non-cavitary lesion with infiltrates. Regarding drug resistance to the treatment of Tuberculosis, in the “treatment group” only 2 patients were sensitive and 3 were resistant. On the other hand, in the “control group”, 1 patient presented resistance and 1 sensitivity. It was found that 4 patients with drug resistance to Tuberculosis died (57%). Among the patients who died, it was observed that patients aged 83, 70 years and 66 years were not vaccinated with Bacillus Calmette-Guérin (BCG). It was found in this case report that patients with COVID-19 and Tuberculosis have 60% less chance of cure. Furthermore, patients cured with pulmonary sequelae of COVID-19 may be at greater risk of developing advances in the worsening of Tuberculosis in the future. However, according to the results found in this case report, in some socially vulnerable regions where the forms of advanced Tuberculosis occur there is the presence of drug-resistant Mycobacterium Tuberculosis strains. 
 
 CONCLUSION: Our study showed that Mycobactrium tuberculosis (MTB) infection in the socially vulnerable population increased the susceptibility to SARS-CoV-2 and the severity of COVID-19 or vice-versa. Based on this case report, it is recommended that, in the socially vulnerable population, the status of MTB infection be verified in patients with suspected COVID-19 at hospital admission.