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      On Tuberculosis and COVID-19 co-infection


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          we wish to thank, Alkesh Khurana and Deepak Aggarwal [1] for their interest in our research letter and comments [1].


          COVID-19 may boost tuberculosis given infection and mortality, further studies are needed

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          Most cited references7

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          Active tuberculosis, sequelae and COVID-19 co-infection: first cohort of 49 cases

          The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (COVID-19) pandemic has attracted interest because of its global rapid spread, clinical severity, high mortality rate, and capacity to overwhelm healthcare systems [1, 2]. SARS-CoV-2 transmission occurs mainly through droplets, although surface contamination contributes and debate continues on aerosol transmission [3–5].
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            Tuberculosis, COVID-19 and migrants: preliminary analysis of deaths occurring in 69 patients from two cohorts

            Little is known about the relationship between the COVID-19 and tuberculosis (TB). The aim of this study is to describe a group of patients who died with TB (active disease or sequelae) and COVID-19 in two cohorts. Data from 49 consecutive cases in 8 countries (cohort A) and 20 hospitalized patients with TB and COVID-19 (cohort B) were analysed and patients who died were described. Demographic and clinical variables were retrospectively collected, including co-morbidities and risk factors for TB and COVID-19 mortality. Overall, 8 out of 69 (11.6%) patients died, 7 from cohort A (14.3%) and one from cohort B (5%). Out of 69 patients 43 were migrants, 26/49 (53.1%) in cohort A and 17/20 (85.0%) in cohort B. Migrants: 1) were younger than natives; in cohort A the median (IQR) age was 40 (27-49) VS. 66 (46-70) years, whereas in cohort B 37 (27-46) VS. 48 (47-60) years; 2) had a lower mortality rate than natives (1/43, 2.3% versus 7/26, 26.9%; p-value: 0.002); 3) had fewer co-morbidities than natives (23/43, 53.5 % versus 5/26- 19.2%) natives; p-value: 0.005). The study findings show that: 1) mortality is likely to occur in elderly patients with co-morbidities; 2) TB might not be a major determinant of mortality and 3) migrants had lower mortality, probably because of their younger age and lower number of co-morbidities. However, in settings where advanced forms of TB frequently occur and are caused by drug-resistant strains of M. tuberculosis, higher mortality rates can be expected in young individuals.
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              Clinical characteristics of COVID-19 and active tuberculosis co-infection in an Italian reference hospital

              The coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), emerged in Wuhan, China, in December 2019. In February 2020, an outbreak was detected in Lombardy region, Italy, resulting in the first major outbreak outside Asia [1].

                Author and article information

                Eur Respir J
                Eur. Respir. J
                The European Respiratory Journal
                European Respiratory Society
                25 June 2020
                25 June 2020
                : 2002328
                [1 ]Unit of Infectious Diseases, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
                [2 ]Tuberculosis Research Programme (PII-TB), SEPAR, Barcelona, Spain
                [3 ]Centre Hospitalier Universitaire, Nantes, France
                [4 ]Moscow Research and Clinical Center for TB Control, Moscow, Russian Federation
                [5 ]Translational Research Unit, National Institute for Infectious Diseases “L. Spallanzani”, IRCCS, Rome, Italy
                [6 ]Dipartimento di Scienze Mediche, Clinica Universitaria Malattie Infettive, Ospedale Amedeo di Savoia, Torino, Italia
                [7 ]TB Reference Centre, Villa Marelli Institute, Niguarda Hospital, Milan, Italy
                [8 ]Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
                [9 ]Division of Infection, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
                [10 ]Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
                [11 ]Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy
                Author notes
                Prof. Giovanni Battista Migliori, Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri IRCCS, Via Roncaccio 16, Tradate, Varese, 21049, Italy. E-mail: giovannibattista.migliori@ 123456icsmaugeri.it
                Author information
                Copyright ©ERS 2020

                This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0.

                : 15 June 2020

                Respiratory medicine
                Respiratory medicine


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