tetano
Editor, Senior Moderator
Pediatr Pulmonol
. 2024 Aug 26.
doi: 10.1002/ppul.27232. Online ahead of print. SARS-CoV-2 coinfection in children with severe airway obstruction due to pulmonary tuberculosis
P Goussard[SUP] 1 [/SUP], L Van Wyk[SUP] 1 [/SUP], S Venkatakrishna[SUP] 2 [/SUP], H Rabie[SUP] 1 [/SUP], P Schubert[SUP] 3 [/SUP], L Frigati[SUP] 1 [/SUP], G Walzl[SUP] 4 [/SUP], C Burger[SUP] 5 [/SUP], A Doruyter[SUP] 5 6 [/SUP], S Andronikou[SUP] 2 7 [/SUP], A G Gie[SUP] 1 [/SUP], D Rhode[SUP] 1 [/SUP], C Jacobs[SUP] 1 [/SUP], M Van der Zalm[SUP] 8 [/SUP]
Affiliations
Introduction: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic had a significant impact on tuberculosis (TB) control globally, with the number of new TB diagnoses decreasing. Coinfection with some viruses, especially measles, could aggravate TB in children. This is presumably a result of depressed cellular immunity. Reports on children with TB and SARS-CoV-2 coinfection are limited.
Methods: A retrospective analysis of children up to 13 years old admitted to Tygerberg Hospital, Cape Town, South Africa, from March 2020 to December 2022 with suspected TB-induced airway compression requiring bronchoscopy. Children were included if they presented with severe intrathoracic airway obstruction and/or radiographic evidence of complicated TB. The patients were divided into two groups based on SARS-CoV-2 respiratory polymerase chain reaction results. Demographics, TB exposure, microbiology, SARS-CoV-2 laboratory data, imaging, inflammatory cytokine levels, and bronchoscopy data were collected. Statistical analyses compared SARS-CoV-2 positive and negative groups.
Results: Of the 50 children undergoing bronchoscopy for TB airway obstruction, 7 (14%) were SARS-CoV-2 positive. Cough was more prevalent in the SARS-CoV-2 positive group (p = 0.04). There was no difference in TB culture yield between groups. However, SARS-CoV-2 positive children showed slower radiological improvement at 1 month (p = 0.01), pleural effusions (p < 0.001), and a higher need for endoscopic enucleation (p < 0.001). FDG PET/CT scans indicated an ongoing inflammation in the SARS-CoV-2 positive group.
Conclusions: Coinfection with SARS-CoV-2 in children with TB airway obstruction appears to complicate the disease course, necessitating more medical interventions and demonstrating a longer duration of the TB inflammatory process. Further research is needed to understand the impact of viral infections on TB progression and outcomes in pediatric patients.
Keywords: SARS‐CoV‐2; TB airway obstruction; bronchoscopy; complicated pulmonary tuberculosis.
. 2024 Aug 26.
doi: 10.1002/ppul.27232. Online ahead of print. SARS-CoV-2 coinfection in children with severe airway obstruction due to pulmonary tuberculosis
P Goussard[SUP] 1 [/SUP], L Van Wyk[SUP] 1 [/SUP], S Venkatakrishna[SUP] 2 [/SUP], H Rabie[SUP] 1 [/SUP], P Schubert[SUP] 3 [/SUP], L Frigati[SUP] 1 [/SUP], G Walzl[SUP] 4 [/SUP], C Burger[SUP] 5 [/SUP], A Doruyter[SUP] 5 6 [/SUP], S Andronikou[SUP] 2 7 [/SUP], A G Gie[SUP] 1 [/SUP], D Rhode[SUP] 1 [/SUP], C Jacobs[SUP] 1 [/SUP], M Van der Zalm[SUP] 8 [/SUP]
Affiliations
- PMID: 39185631
- DOI: 10.1002/ppul.27232
Introduction: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic had a significant impact on tuberculosis (TB) control globally, with the number of new TB diagnoses decreasing. Coinfection with some viruses, especially measles, could aggravate TB in children. This is presumably a result of depressed cellular immunity. Reports on children with TB and SARS-CoV-2 coinfection are limited.
Methods: A retrospective analysis of children up to 13 years old admitted to Tygerberg Hospital, Cape Town, South Africa, from March 2020 to December 2022 with suspected TB-induced airway compression requiring bronchoscopy. Children were included if they presented with severe intrathoracic airway obstruction and/or radiographic evidence of complicated TB. The patients were divided into two groups based on SARS-CoV-2 respiratory polymerase chain reaction results. Demographics, TB exposure, microbiology, SARS-CoV-2 laboratory data, imaging, inflammatory cytokine levels, and bronchoscopy data were collected. Statistical analyses compared SARS-CoV-2 positive and negative groups.
Results: Of the 50 children undergoing bronchoscopy for TB airway obstruction, 7 (14%) were SARS-CoV-2 positive. Cough was more prevalent in the SARS-CoV-2 positive group (p = 0.04). There was no difference in TB culture yield between groups. However, SARS-CoV-2 positive children showed slower radiological improvement at 1 month (p = 0.01), pleural effusions (p < 0.001), and a higher need for endoscopic enucleation (p < 0.001). FDG PET/CT scans indicated an ongoing inflammation in the SARS-CoV-2 positive group.
Conclusions: Coinfection with SARS-CoV-2 in children with TB airway obstruction appears to complicate the disease course, necessitating more medical interventions and demonstrating a longer duration of the TB inflammatory process. Further research is needed to understand the impact of viral infections on TB progression and outcomes in pediatric patients.
Keywords: SARS‐CoV‐2; TB airway obstruction; bronchoscopy; complicated pulmonary tuberculosis.