Barsosio Hellen C, Tangara Brian, Ongalo Joshua, Achieng Morine, Marlais Tegwen, McCarthy Kimberly D, Otieno Kephas, Wanjiku Miriam, Matthewman Julian, Allen David, Hannan Luke, Date Anand, Lesosky Maia, Kariuki Simon, Samuels Aaron M, Drakeley Chris, Ter Kuile Feiko O, Samandari Taraz
Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.
Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
PLOS Glob Public Health. 2025 Apr 30;5(4):e0004372. doi: 10.1371/journal.pgph.0004372. eCollection 2025.
Whilst a quarter of the world's population is estimated to be infected with Mycobacterium tuberculosis, it is unknown whether TB infection (TBI) increases the risk of severe COVID-19, which is relevant in TB-endemic settings, especially where HIV co-infection is also common. A convenience cohort of symptomatic and asymptomatic COVID-19 patients aged 8-80 years in western Kenya was followed daily for 14 days to assess disease progression using the validated inFLUenza-Patient-Reported-Outcome Plus signs and symptom tool. Nasal swabbing for SARS-CoV-2 was conducted to confirm the virus using polymerase chain reaction. QuantiFERON-TB Gold Plus was used to diagnose TBI. HIV status was based on self-reports. Between January 3, 2021, and January 20, 2022, 373 out of 387 participants had conclusive QuantiFERON results. At baseline, 5.9% (22/373) had self-reported severe COVID-19, 33.2% (124/373) had TBI, and 11.1% (38/341) reported being HIV-infected. Median follow-up of the cohort was 105 days (range 0-368). Self-reported severe COVID-19 was experienced by 10 of 124 (8.1%) participants compared with 12 of 249 (4.8%) without TBI (odds ratio [OR] 1.73, 95% CI 0.73-4.12, p = 0.21). HIV was not associated with self-reported severe COVID-19 (OR 3.13, 0.96-8.77, p = 0.039, adjusted OR 2.77, 95%CI 0.84-7.93, p = 0.070), but age ≥ 50 years was associated with self-reported severe COVID-19 (OR 3.73, 1.47-9.07, p = 0.004, adjusted OR 2.91, 95%CI 1.02-7.69, p = 0.035). One participant died of COVID-19 three days after diagnosis, and another participant developed active TB 128 days after his COVID-19 diagnosis and was successfully treated. Both were QuantiFERON positive. Self-reported severe COVID-19 was associated with older age and not TBI. Our finding that increased age was associated with self-reported severe COVID-19 is consistent with findings in multiple settings around the world.
据估计，全球四分之一的人口感染了结核分枝杆菌，但尚不清楚结核感染（TBI）是否会增加重症 COVID-19 的风险，这在结核病流行地区具有重要意义，尤其是在 HIV 合并感染也很常见的地区。在肯尼亚西部，对一组年龄在 8 至 80 岁之间有症状和无症状的 COVID-19 患者进行了便利样本队列研究，每天随访 14 天，使用经过验证的流感患者报告结局加体征和症状工具来评估疾病进展。通过鼻拭子采集样本，采用聚合酶链反应检测 SARS-CoV-2 以确认病毒感染。使用全血干扰素-γ释放试验（QuantiFERON-TB Gold Plus）诊断 TBI。HIV 状态基于自我报告。在 2021 年 1 月 3 日至 2022 年 1 月 20 日期间，387 名参与者中有 373 人获得了确定性的全血干扰素-γ释放试验结果。基线时，5.9%（22/373）的患者自我报告患有重症 COVID-19，33.2%（124/373）患有 TBI，11.1%（38/341）报告感染了 HIV。该队列的中位随访时间为 105 天（范围 0 - 368 天）。124 名（8.1%）患有 TBI 的参与者中有 10 人自我报告患有重症 COVID-19，而 249 名未患 TBI 的参与者中有 12 人（4.8%）自我报告患有重症 COVID-19（优势比[OR]为 1.73，95%置信区间为 0.73 - 4.12，p = 0.21）。HIV 与自我报告的重症 COVID-19 无关（OR 为 3.13，0.96 - 8.77，p = 0.039，调整后的 OR 为 2.77，95%置信区间为 0.84 - 7.93，p = 0.070），但年龄≥50 岁与自我报告的重症 COVID-19 相关（OR 为 3.73，1.47 - 9.07，p = 0.004，调整后的 OR 为 2.91，95%置信区间为 1.02 - 7.69，p = 0.035）。一名参与者在诊断后三天死于 COVID-19，另一名参与者在 COVID-19 诊断后 128 天发展为活动性结核病并成功治愈。两人的全血干扰素-γ释放试验均为阳性。自我报告的重症 COVID-19 与年龄较大有关，而非与 TBI 有关。我们发现年龄增加与自我报告的重症 COVID-19 相关，这与世界各地多个研究环境中的发现一致。
