Table 2 describes the demographic characteristics, clinical symptoms, comorbidities, imaging features, laboratory indicators, treatment strategies, and type of TB among the overall group and the COVID-TB non-survivors and survivors. A total of 89 COVID-TB patients were included in the overview of case reports, of which 19 (23.46%) died, and 72 (80.9%) were male. The number and proportion of COVID-TB patients in the 0-14, 15-24, 25-44, 45-64, and 65+ years age groups were 4 (4.49%), 9 (10.11%), 40 (44.94%), 24 (26.97%), and 12 (13.48%), respectively, with an average age of 41.21 +- 17.84 years. The median age of the non-survivor group (53.95 +- 19.78 years) was older than that of the survivor group (37.76 +- 15.54 years) (p < 0.001). The non-survivors were less likely to be 25-44 years old compared with survivors (10.53 vs. 54.29%) but more likely than survivors to be in the 65+ years age group (47.37 vs. 4.29%) (p < 0.01). More than 85% of these cases were from India (n = 31, 4.83%), Italy (n = 26, 29.21%), and China (n = 12, 13.48%).
Among all 89 COVID-TB cases examined, 88.76% involved active TB, 8.99% had previous TB, and 2.25% had latent tuberculosis infection (LTBI). The proportions of pulmonary TB only, extrapulmonary TB only, and pulmonary TB/extrapulmonary TB (>1 site possible) were 79.78, 8.99, and 8.99%, respectively. Moreover, 5.62% were classified as central nervous system TB, 4.49% pleural TB, and 2.25% lymphadenitis. A total of 56.41% (44/78) of the COVID-TB patients had comorbidities, the most common of which was diabetes (24.36%, 19/78), followed by hypertension (17.95%, 14/78), HIV infection (6.41%, 5/78), hepatitis (3.85%, 3/78), epilepsy (3.85%, 3/78), chronic kidney disease (2.56%, 2/78), cerebrovascular disease (2.56%, 2/78), chronic obstructive pulmonary disease (2.56%, 2/78), asthma (2.56%, 2/78), or cancer (2.56%, 2/78). The non-survivors had more complications, such as hypertension (47.06 vs. 17.95%), hepatitis (17.65 vs. 0%), and cancer (11.76% vs. 0%), than survivors (p < 0.05). The 10 most common symptoms of COVID-TB at admission were fever (77.78%), cough (64.2%), dyspnea (35.8%), weight loss (16.05%), fatigue (11.11%), expectoration (9.88%), chest pain (9.88%), headache (8.64%), myalgia (8.64%), and vomiting (7.41%). The non-survivors had a higher percentage of dyspnea than survivors (72.73 vs. 30%) (p = 0.014).
In terms of treatment, 88.52% of the 61 COVID-TB patients received anti-TB therapy, 50.82% received antibiotics, 22.95% received antiviral therapy, 26.23% received hydroxychloroquine, 16.39% received oxygen therapy, 11.48% received corticosteroids, 8.2% received interferon-alpha, 6.56% received traditional Chinese medicine, and 4.92% received intravenous immunoglobulin. The most widely used antibiotic was azithromycin (21.31%), followed by ceftriaxone (14.75%), moxifloxacin (4.92%), amikacin (3.28%), and meropenem (1.64%). The antiviral drugs used included lopinavir/ritonavir (11.48%), umifenovir hydrochloride (9.84%), tenofovir (6.56%), remdesivir (1.64%), lamivudine (1.64%), dolutegravir (1.64%), and favipiravir (1.64%). These treatments did not differ significantly between survivors and non-survivors.
Features of lung imaging among the 89 patients were as follows: 52.81% had bilateral lesions, and 20.22% had unilateral lesions. The 10 most common imaging features included cavities (32.58%), infiltrates (31.46%), ground-glass opacity (19.1%), nodules (16.85%), pleural effusion (11.24%), fibrosis (12.36%), patchy shadows (8.99%), consolidation (8.99%), military lesions (5.62%), and reticules (5.62%). In addition, we found that non-survivors were more likely than survivors to have bilateral lesions (73.68 vs. 47.14%), infiltrates (57.89 vs. 24.29%), or tree in bud (10.53 vs. 0%) features (p < 0.05).
Elevated laboratory findings in COVID-TB patients included neutrophil count (7.60 [6.93-7.60] x 109/L), D-dimer (1.407 [1.09-2.65] mug/ml), C-reactive protein (CRP, 77.10 [29.20-184.70] mg/L), erythrocyte sedimentation rate (ESR, 75.50 [55.75-88.50] mm/h), procalcitonin (PCT, 2.57 [0.50-5.76] ng/ml), ferroprotein (FER, 739.50 [511.50-952.50] ng/ml), aspartate transaminase (46 [27.55-78.50] U/L), lactate dehydrogenase (LDH, 384 [290.25-471.75] U/L), and creatinine (335.92 [189.51-396.92] mumol/L). Reduced laboratory indicators included lymphocyte count (0.99 [0.73-1.31] x 109/L) and hemoglobin (99 [83.5-114] g/L). Leucocyte count, platelet count, and alanine transaminase levels were in the normal range. The nonsurvivors had a higher leucocyte count than the survivors (12.9 [10.5-16.73] vs. 8.015 [4.8-8.97] x 109/L, P = 0.007). There were no significant differences between the survivors and non-survivors regarding the abovementioned laboratory examinations, except for the leucocyte count.