III Department of Infectious Diseases, ASST Fatebenefratelli-Sacco, Milan, Italy.
Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, Milan, Italy.
Respir Med. 2020 Dec;175:106204. doi: 10.1016/j.rmed.2020.106204. Epub 2020 Nov 6.
COVID-19, the novel coronavirus pandemic, has already spread around the globe affecting more than 18 million people. As previously observed with other coronaviruses, SARS-CoV-2 deeply dysregulate the immune system eliciting respiratory failure and a state of systemic hyperinflammation in severely ill individuals. Immunotherapy is often used to downgrade the detrimental effects of the disease sustained by high-level of cytokines. Those treatments, however, are known to undermine patients' ability to contain tuberculosis (TB) infection. This study aims to describe interferon-γ release assay (IGRA) results in severe COVID-19 patients eligible for immunosuppressive treatment. Aggregate data were gathered from five hospitals in Milan, Italy, from March 1 to May 15, 2020 and retrospectively analyses. Results were summarized using absolute frequencies and percentages and compared using a two-sided Chi-squared test. Overall, 462 COVID-19 patients were eligible for immunosuppressive therapy, among which 335 were tested using IGRA testing. More than one-third of them (122/335; 36.4%) had an indeterminate IGRA result because of insufficient immune response to mitogen control, 19 (5.7%) tested positive and 194 (57.9) negative. The majority of patients with lymphocytopenia (i.e., total lymphocyte count [TLC] below 1000 cells/mm) had indeterminate IGRAs (81/155; 52.3%). The proportion becomes even higher in patients with severe lymphocytopenia (i.e., TLC<500 cells/mm) (36/57; 63%). Our results suggest a possible negative impact of COVID-19 related immune dysregulation on TB infection assessment and management. Close monitoring of individuals with or without retesting of individuals with indeterminate IGRAs and further basic science investigations should to be sought to better comprehend their implication on TB epidemiology.
COVID-19，即新型冠状病毒肺炎，已在全球范围内传播，影响了超过 1800 万人。与其他冠状病毒一样，SARS-CoV-2 严重扰乱了免疫系统，导致严重患者呼吸衰竭和全身炎症反应。免疫疗法常用于减轻由高水平细胞因子引起的疾病的有害影响。然而，这些治疗方法已知会削弱患者控制结核病（TB）感染的能力。本研究旨在描述适合免疫抑制治疗的重症 COVID-19 患者的干扰素-γ释放试验（IGRA）结果。汇总数据来自意大利米兰的五家医院，时间为 2020 年 3 月 1 日至 5 月 15 日，并进行了回顾性分析。结果采用绝对频率和百分比进行总结，并使用双侧卡方检验进行比较。总体而言，462 名 COVID-19 患者有资格接受免疫抑制治疗，其中 335 名接受了 IGRA 检测。由于对有丝分裂原对照的免疫反应不足，其中超过三分之一（122/335；36.4%）的检测结果为不确定，19 例（5.7%）检测结果为阳性，194 例（57.9%）为阴性。大多数淋巴细胞减少症患者（即总淋巴细胞计数 [TLC]低于 1000 个细胞/mm）的 IGRA 结果不确定（81/155；52.3%）。在严重淋巴细胞减少症患者（即 TLC<500 个细胞/mm）中，这一比例甚至更高（36/57；63%）。我们的结果表明，COVID-19 相关免疫失调可能对 TB 感染评估和管理产生负面影响。应密切监测有或无不确定 IGRA 个体的个体，并进一步进行基础科学研究，以更好地理解它们对 TB 流行病学的影响。
