Self-reported COVID-19 severity among persons with tuberculosis infection in western Kenya, 2021

Abstract

Whilst a quarter of the world's population is estimated to be infected with Mycobacterium tuberculosis, it is unknown whether TB infection (TBI) increases the risk of severe COVID-19, which is relevant in TB-endemic settings, especially where HIV co-infection is also common. A convenience cohort of symptomatic and asymptomatic COVID-19 patients aged 8-80 years in western Kenya was followed daily for 14 days to assess disease progression using the validated inFLUenza-Patient-Reported-Outcome Plus signs and symptom tool. Nasal swabbing for SARS-CoV-2 was conducted to confirm the virus using polymerase chain reaction. QuantiFERON-TB Gold Plus was used to diagnose TBI. HIV status was based on self-reports. Between January 3, 2021, and January 20, 2022, 373 out of 387 participants had conclusive QuantiFERON results. At baseline, 5.9% (22/373) had self-reported severe COVID-19, 33.2% (124/373) had TBI, and 11.1% (38/341) reported being HIV-infected. Median follow-up of the cohort was 105 days (range 0-368). Self-reported severe COVID-19 was experienced by 10 of 124 (8.1%) participants compared with 12 of 249 (4.8%) without TBI (odds ratio [OR] 1.73, 95% CI 0.73-4.12, p = 0.21). HIV was not associated with self-reported severe COVID-19 (OR 3.13, 0.96-8.77, p = 0.039, adjusted OR 2.77, 95%CI 0.84-7.93, p = 0.070), but age ≥ 50 years was associated with self-reported severe COVID-19 (OR 3.73, 1.47-9.07, p = 0.004, adjusted OR 2.91, 95%CI 1.02-7.69, p = 0.035). One participant died of COVID-19 three days after diagnosis, and another participant developed active TB 128 days after his COVID-19 diagnosis and was successfully treated. Both were QuantiFERON positive. Self-reported severe COVID-19 was associated with older age and not TBI. Our finding that increased age was associated with self-reported severe COVID-19 is consistent with findings in multiple settings around the world.

Fig 1. Flow diagram of the MALCOV-QFT cohort, western Kenya, January 2021-January 2022. Note. QFT, QuantiFERON-TB Gold Plus test.

Fig 2. Proportions of self-reported severe COVID-19, TB infection and HIV prevalences in SARS-CoV-2 infected persons by age group, western Kenya 2021-2022 (N = 373).

Note. (A) Severe COVID-19 during 14 days after diagnosis (n = 373); (B) TB infection (n = 373); (C) HIV infection (n = 341); age groups are in years and numbers are shown above the bars.

Fig 3. Self-reported COVID-19 illness by severity and TB infection (TBI) status over two weeks, western Kenya 2021-2022 (n = 373).

Note. (A) No symptoms; (B) Mild illness; (C) Moderate illness; (D) Severe illness. Open bars = QuantiFERON Gold Plus-negative, grey bars = QuantiFERON-TB Gold Plus-positive (i.e., with TBI).