Clinical outcomes of patients with coronavirus disease 2019 and active tuberculosis co-infection in Beijing China: A retrospective single-center descriptive study

Abstract

Background: Coronavirus disease 2019 (COVID-19) and tuberculosis (TB) co-infection (COVID-19-TB) has the potential to exacerbate lung damage; however, information about the clinical features of COVID-19-TB is limited. This study aims to clarify the clinical characteristics and outcomes of patients with COVID-19-TB.

Methods: In this single-center retrospective study, the clinical features and outcomes of patients with COVID-19 with active TB who were admitted to Beijing Chest Hospital, Beijing, China, from 1 December 2022 to 18 January 2023 were collected. The severity of COVID-19 and TB was graded according to guidelines from the World Health Organization. The relationships of demographic and clinical variables with intensive care unit (ICU) admission were evaluated using univariable and multivariable logistic regression models.

Results: Overall, 102 patients with COVID-19-TB were enrolled. The mean age was 54.5 years (range 36.5-70 years). The most common clinical manifestations were cough (68.63%), sputum production (53.92%), fever (51.96%), and ground-glass opacities (35.29%). Complications included acute respiratory distress syndrome (11.76%), sepsis (9.8%), and respiratory failure (7.84%). Patients with COVID-19-TB had high concentrations of various proinflammatory cytokines, including interferon-γ, interleukin-1β, interferon-γ-inducible protein 10 kD, and monocyte chemoattractant protein-1. Sixteen of the 102 patients with COVID-19-TB (15.69%) were admitted to the ICU, and 10 (9.80%) died during hospitalization. The significant risk factors for ICU admission were respiratory failure, pulmonary fungal infection, and ventilation and oxygen therapy.

Conclusions: The mortality rate of COVID-19-TB was 9.80%. Several demographic and clinical characteristics were associated with adverse outcomes, indicating the importance of early recognition and treatment.

Keywords: COVID-19; Co-infection; ICU; Mortality; Tuberculosis.

Fig. 1

Date of illness onset, and age and sex distribution, of patients with COVID-19-TB in Beijing, China, from 1 December 2022 to 18 January 2023. (A) Daily cases of COVID-19 and TB co-infection at Beijing Chest Hospital from 1 December 2022 to 18 January 2023. (B) Number of hospital admissions by age and sex group.

Fig. 2

Plasma concentrations of cytokines and chemokines among healthy controls, ICU patients, and non-ICU patients with COVID-19-TB in Beijing, China, from 1 December 2022 to 18 January 2023. Interleukin-6, interleukin-12p70, interleukin-2, IP-10, and MCP-1 are proinflammatory cytokines, while interleukin-10 is an anti-inflammatory cytokine. Abbreviation: IL, interleukin.

Fig. 3

(A) Chest CT images of two patients with COVID-19-TB in Beijing, China, from 1 December 2022 to 18 January 2023. Transverse chest CT images from a 68-year-old male with TB showing the tree-in-bud sign and small cavitations before COVID-19 infection. (B) On day 14 after COVID-19 infection, the CT images show bilateral multiple lobular and subsegmental areas of consolidation. (C) Transverse chest CT images from a 63-year-old female with TB showing extensive segmental consolidation and centrilobular nodules before COVID-19 infection. (D) On day 14 after COVID-19 infection, the CT images show bilateral multiple lobular and subsegmental areas of consolidation and pleural effusion.

Fig. 4

ICU admission, invasive mechanical ventilation, and death of hospitalized patients with COVID-19-TB in Beijing, China, from 1 December 2022 to 18 January 2023. (A) Number of patients according to age and presence of comorbidities. (B) Number of patients according to age and COVID-19 severity.