Tuberculosis and COVID-19 interaction: A review of biological, clinical and public health effects
D. Visca,
C.W.M. Ong,
S. Tiberi,
R. Centis,
L. D’Ambrosio,
B. Chen,
J. Mueller,
P. Mueller,
R. Duarte,
M. Dalcolmo,
G. Sotgiu,
G.B. Migliori,
D. Goletti
Affiliations
D. Visca
Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy; Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, Tradate, Varese-Como, Italy
C.W.M. Ong
Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Institute for Health Innovation & Technology (iHealthtech), National University of Singapore, Singapore
S. Tiberi
Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom; Division of Infection, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
R. Centis
Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy
L. D’Ambrosio
Public Health Consulting Group, Lugano, Switzerland
B. Chen
Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
J. Mueller
The Mueller Health Foundation, Boston, MA, USA
P. Mueller
The Mueller Health Foundation, Boston, MA, USA
R. Duarte
Pulmonology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal; Public Health Science and Medical Education Dept, Faculty of Medicine, University of Porto, Porto, Portugal
M. Dalcolmo
Centro de Referência Professor Hélio Fraga, Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
G. Sotgiu
Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
G.B. Migliori
Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy; Corresponding author at: Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri IRCCS, Via Roncaccio 16, Tradate, Varese, 21049, Italy.
D. Goletti
Translational Research Unit, Epidemiology and Preclinical Research Department, “L. Spallanzani” National Institute for Infectious Diseases (INMI), IRCCS, Rome, Italy
Evidence is accumulating on the interaction between tuberculosis (TB) and COVID-19.The aim of the present review is to report the available evidence on the interaction between these two infections. Differences and similarities of TB and COVID-19, their immunological features, diagnostics, epidemiological and clinical characteristics and public health implications are discussed. The key published documents and guidelines on the topic have been reviewed.Based on the immunological mechanism involved, a shared dysregulation of immune responses in COVID-19 and TB has been found, suggesting a dual risk posed by co-infection worsening COVID-19 severity and favouring TB disease progression.The available evidence on clinical aspects suggests that COVID-19 happens regardless of TB occurrence either before, during or after an active TB diagnosis. More evidence is required to determine if COVID-19 may reactivate or worsen active TB disease. The role of sequeale and the need for further rehabilitation must be further studiedSimilarly, the potential role of drugs prescribed during the initial phase to treat COVID-19 and their interaction with anti-TB drugs require caution. Regarding risk of morbidity and mortality, several risk scores for COVID-19 and independent risk factors for TB have been identified: including, among others, age, poverty, malnutrition and co-morbidities (HIV co-infection, diabetes, etc.). Additional evidence is expected to be provided by the ongoing global TB/COVID-19 study.
