Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana.
National Tuberculosis Control Programme, Ghana Health Service, Accra, Ghana.
PLoS One. 2021 Dec 28;16(12):e0261849. doi: 10.1371/journal.pone.0261849. eCollection 2021.
Tuberculosis (TB) and COVID-19 pandemics are both diseases of public health threat globally. Both diseases are caused by pathogens that infect mainly the respiratory system, and are involved in airborne transmission; they also share some clinical signs and symptoms. We, therefore, took advantage of collected sputum samples at the early stage of COVID-19 outbreak in Ghana to conduct differential diagnoses of long-standing endemic respiratory illness, particularly tuberculosis.
Sputum samples collected through the enhanced national surveys from suspected COVID-19 patients and contact tracing cases were analyzed for TB. The sputum samples were processed using Cepheid's GeneXpert MTB/RIF assay in pools of 4 samples to determine the presence of Mycobacterium tuberculosis complex. Positive pools were then decoupled and analyzed individually. Details of positive TB samples were forwarded to the NTP for appropriate case management.
Seven-hundred and seventy-four sputum samples were analyzed for Mycobacterium tuberculosis in both suspected COVID-19 cases (679/774, 87.7%) and their contacts (95/774, 12.3%). A total of 111 (14.3%) were diagnosed with SARS CoV-2 infection and six (0.8%) out of the 774 individuals tested positive for pulmonary tuberculosis: five (83.3%) males and one female (16.7%). Drug susceptibility analysis identified 1 (16.7%) rifampicin-resistant tuberculosis case. Out of the six TB positive cases, 2 (33.3%) tested positive for COVID-19 indicating a coinfection. Stratifying by demography, three out of the six (50%) were from the Ayawaso West District. All positive cases received appropriate treatment at the respective sub-district according to the national guidelines.
Our findings highlight the need for differential diagnosis among COVID-19 suspected cases and regular active TB surveillance in TB endemic settings.
结核病（TB）和 COVID-19 大流行都是对全球公共卫生构成威胁的疾病。这两种疾病都是由主要感染呼吸系统的病原体引起的，并且涉及空气传播；它们也有一些共同的临床症状和体征。因此，我们利用在加纳 COVID-19 爆发初期收集的痰液样本，对长期存在的地方性呼吸道疾病，特别是结核病进行鉴别诊断。
通过强化国家调查，从疑似 COVID-19 患者和接触者追踪病例中采集痰液样本进行结核病检测。痰液样本采用 Cepheid 的 GeneXpert MTB/RIF 检测法进行 4 份样本的混合检测，以确定结核分枝杆菌复合体的存在。阳性混合样本随后进行拆分并单独分析。阳性结核样本的详细信息被转发给国家结核病防治计划，以进行适当的病例管理。
在疑似 COVID-19 病例（679/774，87.7%）及其接触者（95/774，12.3%）中，共分析了 774 份痰液样本以检测结核分枝杆菌。共有 111 人（14.3%）被诊断为 SARS-CoV-2 感染，774 名个体中有 6 人（0.8%）检测出肺结核阳性：5 名男性（83.3%）和 1 名女性（16.7%）。药物敏感性分析发现 1 例（16.7%）利福平耐药结核病病例。6 例结核阳性病例中，有 2 例（33.3%）同时检测出 COVID-19 阳性，表明存在合并感染。按人口统计学分层，6 例阳性病例中有 3 例（50%）来自 Ayawaso West 区。所有阳性病例均按照国家指南在各自的分区接受了适当的治疗。
我们的研究结果强调了在 COVID-19 疑似病例中进行鉴别诊断的必要性，以及在结核病流行地区进行常规的活动性结核病监测的必要性。
