Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran.
Department of Internal Medicine, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
BMC Infect Dis. 2024 Sep 27;24(1):1043. doi: 10.1186/s12879-024-09947-0.
Tuberculosis (TB), caused by Mycobacterium tuberculosis, remains a significant global health threat. It results in substantial mortality and may be underrecognized due to insufficient screening and diagnostic challenges. Furthermore, TB's impact is closely linked to complex socioeconomic and healthcare factors. The COVID-19 pandemic has exacerbated these challenges due to similarities in clinical presentation and transmission dynamics with TB. Socioeconomic factors such as limited access to healthcare services, resource constraints, and social stigma further complicate TB management. Historically, TB faced increased burdens during natural disasters, wars, and pandemics. This study analyzes TB incidence changes, emphasizing the crucial need for timely diagnosis within the context of COVID-19 measures.
This cross-sectional study, conducted at Shiraz's TB referral center in Southern Iran, covered the period from January 1, 2018, to December 31, 2022. We analyzed patient data, including epidemiological and demographic factors, clinical and radiological features, and treatment outcomes. Data were compared between the pre-COVID-19 pandemic era and the COVID-19 pandemic era (from March 2020), using standard and regression analyses. A P-value of less than 0.05 was considered statistically significant.
We analyzed 388 TB patients with a mean age of 48.38 ± 20.53 years, including 264 pulmonary cases (68.0%). The highest incidence of TB was recorded in 2019, representing 27.6% of the cases. During the COVID-19 era, logistic regression analysis identified significant associations with higher education levels (P = 0.032; OR = 1.380; 95% CI: 1.028-1.851), a decrease in symptoms such as sputum production (P = 0.004; OR = 0.342; 95% CI: 0.166-0.705) and chills (P = 0.036; OR = 0.282; 95% CI: 0.087-0.919), and an increase in symptoms of fatigue (P = 0.006; OR = 2.856; 95% CI: 1.358-6.005).
The COVID-19 pandemic has had a prolonged impact on TB cases in our country, resulting in a reduction in reported cases due to challenges in quarantine and screening. However, it has also led to a shift in TB patterns and a potential increase in latent TB cases and future mortality rates. Addressing the repercussions requires enhanced control strategies, prioritized service delivery, and secured funding for intensified case finding, expanded contact-tracing, community engagement, digital health tools, and uninterrupted access to medications.
结核病（TB）是由结核分枝杆菌引起的，仍然是全球重大的健康威胁。它导致大量死亡，由于筛查和诊断方面的不足，可能被低估。此外，结核病的影响与复杂的社会经济和医疗保健因素密切相关。由于 COVID-19 在临床表现和传播动力学方面与结核病相似，COVID-19 大流行加剧了这些挑战。社会经济因素，如获得医疗服务的机会有限、资源限制和社会耻辱感，进一步使结核病的管理复杂化。历史上，结核病在自然灾害、战争和大流行期间面临更大的负担。本研究分析了结核病发病率的变化，强调了在 COVID-19 措施背景下及时诊断的迫切需要。
本横断面研究在伊朗南部设拉子的结核病转诊中心进行，时间范围为 2018 年 1 月 1 日至 2022 年 12 月 31 日。我们分析了患者的流行病学和人口统计学因素、临床和放射学特征以及治疗结果等数据。使用标准和回归分析比较了 COVID-19 大流行前时代和 COVID-19 大流行时代（2020 年 3 月起）的数据。P 值小于 0.05 被认为具有统计学意义。
我们分析了 388 名结核病患者，平均年龄为 48.38±20.53 岁，包括 264 例肺部病例（68.0%）。结核病发病率最高的年份是 2019 年，占病例的 27.6%。在 COVID-19 时代，逻辑回归分析发现与较高教育水平显著相关（P=0.032；OR=1.380；95%CI：1.028-1.851），与痰液产生（P=0.004；OR=0.342；95%CI：0.166-0.705）和寒战（P=0.036；OR=0.282；95%CI：0.087-0.919）等症状减少以及疲劳（P=0.006；OR=2.856；95%CI：1.358-6.005）等症状增加相关。
COVID-19 大流行对我国结核病病例产生了持久影响，由于检疫和筛查方面的挑战，导致报告病例减少。然而，它也导致了结核病模式的转变，潜在地增加了潜伏性结核病病例和未来的死亡率。应对这些影响需要加强控制策略，优先提供服务，并确保获得资金，以加强病例发现、扩大接触者追踪、社区参与、数字健康工具和不间断获得药物。
