Systematic review and meta-analysis of Tuberculosis and COVID-19 Co-infection: Prevalence, fatality, and treatment considerations

Quan Wang; Yanmin Cao; Xinyu Liu; Yaqun Fu; Jiawei Zhang; Yeqing Zhang; Lanyue Zhang; Xiaolin Wei; Li Yang

doi:10.1371/journal.pntd.0012136

Systematic review and meta-analysis of Tuberculosis and COVID-19 Co-infection: Prevalence, fatality, and treatment considerations

PLoS Negl Trop Dis. 2024 May 13;18(5):e0012136. doi: 10.1371/journal.pntd.0012136. eCollection 2024 May.

Authors

Quan Wang^{1

2}, Yanmin Cao³, Xinyu Liu³, Yaqun Fu¹, Jiawei Zhang¹, Yeqing Zhang⁴, Lanyue Zhang¹, Xiaolin Wei⁵, Li Yang¹

Affiliations

¹ School of Public Health, Peking University, Beijing, China.
² Brown School, Washington University in St Louis, St Louis, Missouri, United States of America.
³ Jinan Municipal Center for Disease Control and Prevention, Jinan, Shandong Province, China.
⁴ Centre for Global Health Economics, University College London, London, United Kingdom.
⁵ Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.

Abstract

Background: Tuberculosis (TB) and COVID-19 co-infection poses a significant global health challenge with increased fatality rates and adverse outcomes. However, the existing evidence on the epidemiology and treatment of TB-COVID co-infection remains limited.

Methods: This updated systematic review aimed to investigate the prevalence, fatality rates, and treatment outcomes of TB-COVID co-infection. A comprehensive search across six electronic databases spanning November 1, 2019, to January 24, 2023, was conducted. The Joanna Briggs Institute Critical Appraisal Checklist assessed risk of bias of included studies, and meta-analysis estimated co-infection fatality rates and relative risk.

Results: From 5,095 studies screened, 17 were included. TB-COVID co-infection prevalence was reported in 38 countries or regions, spanning both high and low TB prevalence areas. Prevalence estimates were approximately 0.06% in West Cape Province, South Africa, and 0.02% in California, USA. Treatment approaches for TB-COVID co-infection displayed minimal evolution since 2021. Converging findings from diverse studies underscored increased hospitalization risks, extended recovery periods, and accelerated mortality compared to single COVID-19 cases. The pooled fatality rate among co-infected patients was 7.1% (95%CI: 4.0% ~ 10.8%), slightly lower than previous estimates. In-hospital co-infected patients faced a mean fatality rate of 11.4% (95%CI: 5.6% ~ 18.8%). The pooled relative risk of in-hospital fatality was 0.8 (95% CI, 0.18-3.68) for TB-COVID patients versus single COVID patients.

Conclusion: TB-COVID co-infection is increasingly prevalent worldwide, with fatality rates gradually declining but remaining higher than COVID-19 alone. This underscores the urgency of continued research to understand and address the challenges posed by TB-COVID co-infection.

Copyright: © 2024 Wang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Publication types

Systematic Review
Meta-Analysis
Research Support, Non-U.S. Gov't

MeSH terms

COVID-19* / complications
COVID-19* / epidemiology
COVID-19* / mortality
Coinfection* / epidemiology
Coinfection* / mortality
Humans
Prevalence
SARS-CoV-2*
Tuberculosis* / complications
Tuberculosis* / epidemiology
Tuberculosis* / mortality

Grants and funding

LY was supported by grant from National Natural Science Foundation of China [72174010] and Natural Science Foundation of Beijing Municipality [M22033]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.