Impact of COVID-19 Coinfection on Management of Tuberculosis Patients Registered at DOTS Center in a Tertiary Care Hospital
Ruchi Arora Sachdeva, Litika Verma, Lokesh Parashar, Manas Kamal Sen, Kamran Chaudhary, Harshita, Avinash Kumar, Amrita Swati
Antituberculosis treatment, Coronavirus disease 2019, Directly observed therapy, National tuberculosis elimination program
Citation Information :
Sachdeva RA, Verma L, Parashar L, Sen MK, Chaudhary K, Harshita, Kumar A, Swati A. Impact of COVID-19 Coinfection on Management of Tuberculosis Patients Registered at DOTS Center in a Tertiary Care Hospital. Indian J Respir Care 2023; 12 (1):17-22.
Introduction: This study was conducted to determine the impact of coronavirus disease 2019 (COVID-19) and the ensuing lockdown on tuberculosis (TB) management undergoing treatment under the National Tuberculosis Elimination Program (NTEP) and vice-versa. Aims: To study (1) the occurrence of COVID-19 and its severity among patients suffering from TB and (2) the impact of a pandemic on TB management under NTEP. Materials and methods: A retrospective observational study was conducted in patients registered at Directly observed therapy short-course (DOTS) center from 1st April 2020 to 31st July 2021 at ESIC Medical College and Hospital, Faridabad, Haryana, India, using a semi-structured predesigned questionnaire administered telephonically. Results: Out of 387 TB patients registered at the DOTS center, 191 participated in the study. The occurrence of COVID-19 in patients with TB was 10 (5.2%), of which five (50%) were symptomatic; four (40%) had pulmonary TB, and six (60%) had extrapulmonary TB. Nine (90%) patients had mild and one (10%) moderately severe disease requiring hospitalization. Amongst 191 patients, 29 (15.2%) missed anti-TB treatment (ATT); 15 (51.7%) could not access the DOTS center due to restrictions, and seven (24.1%) due to personal reasons, eight (27.5%) forgot to take medication, and one (0.34%) migrated elsewhere. Conclusions: The occurrence of COVID-19 in patients with TB was found to be 5.2% in this study. The severity of COVID-19 was mostly mild and the mortality rate in patients with a coinfection of TB and COVID-19 was 10%. The COVID-19 pandemic had a negative impact on TB management under NTEP due to the imposed lockdown. The limitation of this study was the small sample size.
World Health Organisation. WHO Listings of WHO's response to COVID-19 dated 29 June 2020. Available from: https://www.who.int/news/item/29-06-2020-covidtimeline
World Health Organisation. WHO Director-General's opening remarks at the media briefing on COVID-19 - 11 March 2020 Last accessed on 21 June 2021. Available from: https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020
Andrews MA, Areekal B, Rajesh KR, et al. First confirmed case of COVID-19 infection in India: a case report. Indian J Med Res 2020;151(5):490–492. DOI: 10.4103/ijmr.IJMR_2131_20
Government of India. COVID-19 Live Dashboard. Last accessed on 1st August 2021. Available from: https://www.mygov.in/covid-19
Government of India and National Disaster Management Authority Policy and plan division, New Delhi. Order no 1-29/2020-PP(pt II). Dated 24th March 2020. Available from: https://www.mha.gov.in/sites/default/files/ndma%20order%20copy.pdf
Central TB division. Annual reports. India TB report 2021. March 2021. Last accessed on 22 June 2021. Available from: https://tbcindia. gov.in/index1.php?lang=1&level=1&sublinkid=4160&lid=2807
MoHFW. Guidance note on Bi-directional TB-COVID screening and screening of TB among ILI/SARI cases Dated 26.08.2020. Last accessed on 23 July 2021. Available from: https://www.mohfw.gov.in/pdf/1TBCOVIDscreeningguidancenote.pdf
Stop TB Partnership, Imperial College, Avenir Health, Johns Hopkins University, and USAID. The potential impact of the COVID-19 response on Tuberculosis in high-burden countries: a modelling analysis. 2020. Last accessed on 11 July 2021. Available from: http://www.stoptb.org/assets/documents/news/Modeling%20Report_1%20May%202020_FINAL.pdf?utm_source=The+Stop+TB+Partnership+News&utm_campaign=4bee55b759-partner+survey+2019_COPY_01&utm_medium=email&utm_term=0_75a3f23f9f-4bee55b759-190003997
Iyengar KP, Jain VK. Tuberculosis and COVID-19 in India- double trouble! Indian J Tuberc 2020;67(4S):S175–S176. DOI: 10.1016/j.ijtb.2020.07.014
Tale S, Meitei Soibam P. Care of Tuberculosis patients in the times of COVID-19. Indian J Tuberc 2021;68(2):285–286. DOI: 10.1016/j.ijtb.2020.09.004
Gupta N, Ish P, Gupta A, et al. A profile of a retrospective cohort of 22 patients with COVID-19 and active/treated tuberculosis. Eur Respir J 2020;56(5):2003408. DOI: 10.1183/13993003.03408-2020
Patel AV, Rathod KK, Patel NR, et al. A retrospective study of Covid-19 disease in confirmed tuberculosis patients from a tertiary care centre in ahmedabad. Natl J Community Med 2020;11(11):409–412. DOI: 10.5455/njcm.20201006052006
Tadolini M, Codecasa LR, García-García JM, et al. Active tuberculosis, sequelae and COVID-19 coinfection: first cohort of 49 cases. Eur Respir J 2020;56(5):2001398. DOI: 10.1183/13993003.01398-2020
Motta I, Centis R, D'Ambrosio L, et al. Tuberculosis, COVID-19 and migrants: preliminary analysis of deaths occurring in 69 patients from two cohorts. Pulmonology 2020;26(4):233–240. DOI: 10.1016/j.pulmoe.2020.05.002
Stochino C, Villa S, Zucchi P, et al. Clinical characteristics of COVID-19 and active tuberculosis coinfection in an Italian reference hospital. Eur Respir J 2020;56(1):2001708. DOI: 10.1183/13993003.01708-2020
Yu Chen, Yaguo Wang, Fleming J, et al. Active or latent tuberculosis increases susceptibility to COVID-19 and disease severity. MedRxiv 2020;03(10):20033795. DOI: 10.1101/2020.03.10.20033795
He G, Wu J, Shi J, et al. COVID-19 in tuberculosis patients: a report of three cases. J Med Virol 2020;92(10):1802–1806. DOI: 10.1002/jmv.25943
Sy KTL, Haw NJL, Uy J. Previous and active tuberculosis increases risk of death and prolongs recovery in patients with COVID-19. Infect Dis (Lond) 2020;52(12):902–907. DOI: 10.1080/23744235.2020.1806353
Western Cape: COVID-19 and HIV/Tuberculosis 2020 dated 9 June 2020. Last accessed on 11 July 2021. Available from: https://storage.googleapis.com/stateless-bhekisisa-website/wordpress-uploads/2020/06/94d3ea42-covid_update_bhekisisa_wc_3.pdf
AIIMS/ICMR -COVID 19 national task force/joint monitoring group/MoHFw, GOI dated May 18, 2021. Clinical guidance for management of adult covid-19 patients May 18, 2021. Last accessed on 23 June 2021. Available from: https://covid.aiims.edu/clinical-guidance-for-management-of-adult-covid-19-patients/
Saleem SM, Jan SS. Modified Kuppuswamy socioeconomic scale updated for the year 2021. Indian J Forensic Community Med 2021;8(1):1–3. DOI: 10.18231/j.ijfcm.2021.001
Udwadia ZF, Vora A, Tripathi AR, et al. COVID-19 -tuberculosis interactions: when dark forces collide. Indian J Tuberc 2020;67(4S):S155–S162. DOI: 10.1016/j.ijtb.2020.07.003
Biswas M, Rahaman S, Biswas T, et al. Association of sex, age, and comorbidities with mortality in COVID-19 patients: a systematic review and meta-analysis. Intervirology 2021;64(1):36–47. DOI: 10.1159/000512592
Bhattacharya A, Ranjan P, Ghosh T, et al. Evaluation of the dose-effect association between the number of doses and duration since the last dose of COVID-19 vaccine, and its efficacy in preventing the disease and reducing disease severity: a single centre, cross-sectional analytical study from India. Diabetes Metab Syndr 2021;15(5):102238. DOI: 10.1016/j.dsx.2021.102238
Our world in data. Share of people vaccinated against COVID-19, Dec 25, 2021. Last accessed on 26th December 2021. Available from: https://ourworldindata.org/covid-vaccinations?country=OWID_WRL
Global tuberculosis report 2020. Geneva, World Health Organization; 2020 (https://www.who.int/publications/i/item/9789240013131).
“Basic TB Facts”. Centers for Disease Control and Prevention (CDC). 13 March 2012. Archived from the original on 6 February 2016. Retrieved 11 February 2016.
Li Q, Guan X, Wu P, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med 2020;382:1199–1207. DOI: 10.1056/NEJMoa2001316
Guan WJ, Ni ZY, Hu Y, et al. Clinical characteristics of 2019 novel coronavirus infection in China. medRxiv 2020;02(6):20020974. DOI: 10.1101/2020.02.06.20020974
Aveyard P, Gao M, Lindson N. Association between pre-existing respiratory disease and its treatment, and severe COVID-19: a population cohort study. Lancet Respir Med 2021;9(8):909–923. DOI: 10.1016/S2213-2600(21)00095-3
World Health Organization. Global Tuberculosis Reports. (2020). Available online at: https://www.who.int/teams/global-tuberculosis-programme/tb-reports (accessed December 19, 2020).
Callender L, Curran M, Bates S, et al. The impact of pre-existing comorbidities and therapeutic interventions on COVID-19. Front Immunol 2020;11:1991. DOI: 10.3389/fimmu.2020.01991