Impact of SARS-CoV-2 infection history on the clinical features and outcomes of patients with recurrent pulmonary tuberculosis: a retrospective case–control study

Objective The impact of prior SARS-CoV-2 infection on the clinical course of recurrent pulmonary tuberculosis (TB) remains poorly defined. This study aimed to compare clinical features, radiographic evolution, and outcomes in recurrent TB patients with and without a history of SARS-CoV-2 infection.Methods A retrospective case-control study was conducted. Patients diagnosed with recurrent pulmonary TB between January 2019 and January 2025 were consecutively enrolled. A history of SARS-CoV-2 infection was defined by laboratory confirmation (RT-PCR or antigen test). The primary outcome was favorable treatment outcome (cure or treatment completion). The secondary outcome was time to radiographic lung recovery (≥50% lesion resolution). Propensity score matching (PSM), false discovery rate (FDR) correction for multiple comparisons, and multiple imputation by chained equations were applied.Results Of 355 patients with recurrent pulmonary TB, 139 had a history of SARS-CoV-2 infection. After PSM (105 matched pairs), the infection history group had a significantly higher proportion of patients undergoing invasive procedures (51.4% vs 36.2%) and a shorter median time to radiographic lung recovery (93 days vs 108 days). The difference in dyspnea (35.2% vs 25.7%) became non-significant after FDR correction (q = 0.12). No significant difference was observed in favorable treatment outcomes (62.9% vs 67.6%). Multivariable regression identified extra-pulmonary TB (adjusted OR = 5.30, 95%CI: 1.91–14.72) and drug resistance (adjusted OR = 11.92, 95%CI: 1.48–96.23) as independent risk factors for unfavorable outcomes, but not a history of SARS-CoV-2 infection (aOR = 1.18, 95%CI: 0.68–2.05, p = 0.55).Conclusion A history of SARS-CoV-2 infection is associated with a greater need for invasive procedures and faster radiographic recovery, but is not independently associated with treatment outcomes. Enhanced monitoring is warranted, but established risk factors remain the primary prognostic determinants.