The Impact of the Risk Factors on Generalisation of Tuberculosis Infection During COVID-19 Pandemic

The epidemiological indicators of tubeculosis during the COVID-19 pandemic showed an increased rate of late detected forms of tuberculosis (TB) with multiple sites involvement and unfavourable treatment outcome. Objective — to establish the impact of the risk factors on progression and generalisation of TB infection in epidemiological context of COVID-19 pandemic (2020—2023) for identification of targeted interventions to mitigate the pandemic's impact on healthcare control efforts, addressing both clinical and social determinants of TB. Materials and methods. A prospective, case-control study which included 270 patients with pulmonary TB registered during 2020—2023, when the COVID-19 pandemic was declared in the Republic of Moldova, was conducted. The patients were distributed in two groups: study group included 84 patients diagnosed with pulmonary location with associted at least 2 extrapulmonary locations (generalised TB) and control group — 186 patients, diagnosed with pulmonary TB. Results and discussion. The major risk factors for progression and generalization of TB infection in extrapulmonary sites were: male gender, patient’s disadvantaged social economical state, and harmful habits (tobacco smoking and alcohol abuse). The late detection was caused by the barriers in accessing the healthcare services specific to the COVID-19 pandemic period, lack of health insurance and low rate of microbiologically confirmed cases. A strong correlation was obtained between unfavourable treatment outcome and patient’s disadvantaged social economical state harmful habits, and lung destruction. Conclusions. The risk factors which are involved in the generalisation of tuberculous infection are social economical disadvantaged state with associated harmful habits, and conditions defining low accessibility to healthcare services. It is recommended to screen annually the patients with enumerated risk factors and to facilitate their accessibility to specialised healthcare services for early diagnosis and for ensuring the treatment success.