Tuberculosis Predicts Increased Mortality in Patients With SARS-CoV-2 Infection

Background: Tuberculosis (TB) remains a major public health issue in high-burden countries like India.During the COVID-19 pandemic, disruption of TB services together with overlapping clinical manifestations complicated timely diagnosis of TB among patients infected with COVID-19.Methods: The prospective observational study was conducted at a North Indian tertiary care centre between April 2020 and June 2021.Laboratory-confirmed COVID-19 patients suspected of TB were evaluated using Ziehl-Neelsen smear microscopy, GeneXpert MTB/RIF (Cepheid, Sunnyvale, CA, USA), in-house PCR, and MGIT-960 culture (Becton Dickinson, Franklin Lakes, NJ, USA).Clinical characteristics, microbiological findings, treatment and outcomes were recorded.Kaplan-Meier survival curves were compared using logrank test.Results: Among 155 hospitalized COVID-19 patients evaluated, TB was microbiologically confirmed in 24 (15.5%).Pulmonary TB constituted 66.7% of cases, while 33.3% had extrapulmonary disease.GeneXpert confirmed TB in 17 patients, PCR in six, and MGIT culture in one patient.Mortality was significantly higher in patients coinfected with TB-COVID than in patients with COVID-19 disease alone (37.5% vs 18.3%).Kaplan-Meier analysis showed significantly poorer survival among coinfected patients (log-rank χ² = 6.678, p = 0.0097).Severe COVID-19 was independently associated with markedly reduced survival (log-rank χ² = 224.82,p < 0.001).Conclusions: COVID-19-hospitalized patients with TB coinfection succumbed more often.To improve early identification and outcomes in high-burden settings, COVID-19 patients with overlapping clinical and radiological symptoms should undergo TB screening.