Impact of Latent Tuberculosis on Severity and Outcomes in Admitted COVID-19 Patients.

Manu Madan,Pawan Tiwari,Saurabh Mittal,Bhvya Baldwa,Karan Madan,Arun Raja,Vijay Hadda,Tanima Dwivedi,Anant Mohan,Rahul Tyagi,Randeep Guleria

doi:10.7759/cureus.19882

Abstract

BackgroundThere is limited data on coronavirus disease 2019 (COVID-19) and latent tuberculosis infection (LTBI).MethodologyWe analyzed data of admitted COVID-19 patients evaluated for LTBI to examine the impact of LTBI on severity, laboratory parameters, and COVID-19 outcome. Prospectively collected data were analyzed for 60 patients who were administered the Mantoux tuberculosis skin test (TST) using five tuberculin units of purified protein derivative. All patients were administered TST irrespective of Bacille Calmette-Guérin (BCG) vaccination status. Comorbidities, clinical features, radiologic involvement, laboratory parameters, and clinical course were analyzed concerning LTBI.ResultsThe mean age was 45.9 (±15.2) years, and 35 (58.3%) patients had non-severe disease. The vast majority (n = 56/60; 93.3%) had been vaccinated with single-dose BCG in infancy or early childhood, as per national immunization guidelines. LTBI was diagnosed in 15 (25%) patients. LTBI prevalence was lower in severe (n = 1/25; 4%) than non-severe (n = 14/35; 40%) COVID-19 (p = 0.01) patients. LTBI patients had lower percentage neutrophil count, higher lymphocyte percentage, higher monocyte count, lower neutrophil-lymphocyte (NL) ratio, lower alanine aminotransferase, lower C-reactive protein, and lesser radiologic involvement compared to those without LTBI (p < 0.05). Similarly, among the mild COVID-19 subgroup, those with LTBI had higher lymphocyte and monocyte counts and lesser radiologic involvement than those without LTBI (p < 0.05).ConclusionsLTBI patients appear to have milder disease, higher lymphocyte and monocyte count, higher NL ratio, and lesser radiographic involvement. This observation needs to be studied in larger studies using interferon release assays.

Highlights

Coronavirus disease 2019 (COVID-19) is an infection caused by a novel coronavirus, termed severe acute respiratory syndrome coronavirus 2 [1]
latent tuberculosis infection (LTBI) prevalence was lower in severe (n = 1/25; 4%) than non-severe (n = 14/35; 40%) COVID-19 (p = 0.01) patients
The results indicate a potential association between LTBI and milder disease at presentation, higher lymphocyte counts, lower inflammatory markers, and lesser lung involvement, that is, lower chest X-ray scores

Summary

Introduction

Coronavirus disease 2019 (COVID-19) is an infection caused by a novel coronavirus, termed severe acute respiratory syndrome coronavirus 2 [1]. It has been hypothesized that BCG vaccination may augment cellular immune response and lead to faster virologic clearance and less severe infection. There was no significant difference in COVID-19 incidence or outcomes in a large population-based study, which compared adults born before or after the cessation of the universal BCG vaccination program [7,8]. Epidemiologic studies have shown significantly lower COVID-19 incidence and somewhat lower case-fatality rates in high tuberculosis (TB) burden countries compared to those with low TB burden [9]. TB was associated with severe disease and higher mortality in a recent case series from China [10]. Another conundrum is the impact of latent TB on COVID-19. There is limited data on coronavirus disease 2019 (COVID-19) and latent tuberculosis infection (LTBI)

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