Impact of coronavirus disease 2019 in children up to 18 years with tuberculosis

Background: Bidirectional screening of coronavirus disease 2019 (COVID-19) and tuberculosis (TB) was suggested during the COVID-19 pandemic in view of similar clinical presentation and possible interaction between the two. Only few studies are available in the literature suggesting flare up of TB in children with COVID-19 or poorer/equivocal outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children with TB. Hence, we planned to evaluate the outcome in children with TB who were diagnosed with of SARS-CoV-2 infections versus those who did not have any of SARS-CoV-2 infection during the COVID-19 pandemic. Objective: The objective of this study was to evaluate the clinical characteristics and outcomes of patients with TB and COVID-19 coinfection. Methods: We reviewed 102 children up to 18 years of age with TB who were admitted or followed up in a pediatric TB clinic from March 2020 to March 2022. Clinicodemographic characteristics of children with TB who suffered from SARS-CoV-2 infection in comparison to those who did not have SARS-CoV-2 infection were compared. Results: A total of 102 children with TB were enrolled during the study period. Among them, 32 children were diagnosed with SARS-CoV-2 co-infection (28 COVID-19 pneumonia, and 4 multisystem inflammatory syndrome in children), while 70 children had no COVID-19 infection at the time of study. Both groups had comparable mean age, sex, socioeconomic status, site of TB, and presenting symptoms. The mean duration of symptoms at diagnosis was less in children with coexistent SARS-CoV-2 infection (17.9 days) as compared to those without coexistent SARS-CoV-2 (32.6 days), however, no statistical significance was seen (P = 0.13). No significant difference in outcome was noted in patients suffering from TB and COVID coinfection (P = 0.09) though they had higher rates of hospitalization. Conclusion: Early presentation, subsequent hospitalization, and screening in patients with COVID infection might have led to early diagnosis of TB. Whether SARS-CoV-2 infection increases the risk of individuals with latent TB to develop active TB requires further analysis.