Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Chulalongkorn University, Bangkok, Thailand.
Division of Infectious Diseases, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Chulalongkorn University, Bangkok, Thailand.
PLoS One. 2024 Oct 16;19(10):e0309392. doi: 10.1371/journal.pone.0309392. eCollection 2024.
Corticosteroids can reduce the mortality rate among patients with severe COVID-19 pneumonia. However, opportunistic infections such as Mycobacterium tuberculosis are of concern, especially among those on high doses of corticosteroids. It is unknown whether the risk of developing subsequent TB infection is high or not among COVID-19 patients on high doses of corticosteroids. Hence, this study was conducted to address this gap of knowledge. We conducted a retrospective, cross-sectional study at the King Chulalongkorn Memorial Hospital from October 12, 2022 to June 30, 2023. Two hundred forty-three participants with documented COVID-19 diagnosis on high dose corticosteroids were enrolled into the study. Baseline characteristics and risk factors of developing TB were collected. The prevalence of TB was significantly different among participants with chronic kidney disease (CKD) stages 2-4 and chronic lung diseases. The incidence of TB post 1-year diagnosis of COVID-19 was 4 out of 243 patients (1.6%) or 1,646 cases per 100,000 person-year. The mortality rate among subsequent TB group was significantly much higher than the non-TB group (50% vs 0.4%; p-value = 0.001). COVID-19 participants on high doses of corticosteroids also were co-infected with other infections such as bacteria (37.1%), fungi (5.3%), and Pneumocystis jirovecii (PJP) (1.2%). We found that the incidence of TB in participants with COVID-19 on high doses of corticosteroids was 11 times higher than the general population. Therefore, we recommend screening for latent TB among these patients to prevent/early diagnose TB disease.
皮质类固醇可以降低重症 COVID-19 肺炎患者的死亡率。然而，人们对分枝杆菌等机会性感染表示担忧，尤其是那些接受大剂量皮质类固醇治疗的患者。目前尚不清楚 COVID-19 患者接受大剂量皮质类固醇治疗后，是否会有很高的患后续结核病感染的风险。因此，开展这项研究是为了填补这一知识空白。我们在 2022 年 10 月 12 日至 2023 年 6 月 30 日期间，在朱拉隆功国王纪念医院进行了一项回顾性、横断面研究。共有 243 名接受大剂量皮质类固醇治疗且确诊 COVID-19 的患者纳入本研究。收集了基线特征和结核病发病的风险因素。慢性肾脏病（CKD）2-4 期和慢性肺部疾病患者之间的结核病患病率存在显著差异。COVID-19 诊断后 1 年的结核病发病率为 243 例患者中有 4 例（1.6%）或每 10 万人中有 1646 例。继发结核病组的死亡率明显高于非结核病组（50% vs 0.4%；p 值=0.001）。接受大剂量皮质类固醇治疗的 COVID-19 患者还合并了其他感染，如细菌（37.1%）、真菌（5.3%）和卡氏肺孢子虫（PJP）（1.2%）。我们发现，COVID-19 患者接受大剂量皮质类固醇治疗后，结核病的发病率比一般人群高 11 倍。因此，我们建议对这些患者进行潜伏性结核病筛查，以预防/早期诊断结核病。
