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Muflihah H, Yulianto FA, Rina, Sampurno E, Ferdiana A, Rahimah SB. Tuberculosis Coinfection among COVID-19 Patients: Clinical Presentation and Mortality in a Tertiary Lung Hospital in Indonesia. Int J Mycobacteriol 2024; 13:58-64. [PMID: 38771281 DOI: 10.4103/ijmy.ijmy_19_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/12/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Tuberculosis (TB) and coronavirus disease 2019 (COVID-19) are the top two killers of infectious disease. We aimed to determine the association of TB coinfection with the inhospital mortality of COVID-19 patients in Indonesia as a TB-endemic country. METHODS We conducted a retrospective cohort study in a tertiary lung hospital in Indonesia. All TB-coinfected COVID-19 patients who were hospitalized between January 2020 and December 2021 were included in the study. COVID-19 patients without TB were randomly selected for the control group. Clinical characteristics and laboratory results were assessed. Survival analysis was performed to determine the estimated death rate and median survival time (MST). Multivariate Cox regression analysis was conducted to define the association of TB coinfection with the in-hospital mortality of COVID-19. RESULTS We included 86 (8.3%) TB coinfections among 1034 confirmed COVID-19 patients. TB coinfection patients had younger age, malnutrition, and different symptoms compared to the COVID-19 group. TB-coinfected patients had a lower estimated death rate than the COVID-19 group (6.5 vs. 18.8 per 1000 population). MST in the COVID-19 group was 38 (interquartile range 16-47) days, whereas the same observation time failed to determine the MST in the TB coinfection group. TB coinfection had a crude hazard ratio of mortality 0.37 (95% confidence interval [CI] 0.15-0.94, P = 0. 004). The final model analysis including age, sex, and lymphocyte as confounding factors resulted in an adjusted HR of mortality 0.31 (95% CI 0.1-0.9). CONCLUSION This study showed TB coinfection was negatively associated with the in-hospital mortality of COVID-19.
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Affiliation(s)
- Heni Muflihah
- Department of Pharmacology, Universitas Islam Bandung, Bandung, Indonesia
| | - Fajar A Yulianto
- Department of Public Health, Faculty of Medicine, Universitas Islam Bandung, Bandung, Indonesia
| | - Rina
- Department of Human Resource Development and Education, Dr. H. A. Rotinsulu Lung Hospital, Bandung, Indonesia
| | - Edi Sampurno
- Department of Human Resource Development and Education, Dr. H. A. Rotinsulu Lung Hospital, Bandung, Indonesia
| | - Astri Ferdiana
- Department of Public Health, Faculty of Medicine, University of Mataram, Mataram, Indonesia
- Center for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Santun B Rahimah
- Department of Pharmacology, Universitas Islam Bandung, Bandung, Indonesia
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Boosting BCG with recombinant influenza A virus tuberculosis vaccines increases pulmonary T cell responses but not protection against Mycobacterium tuberculosis infection. PLoS One 2021; 16:e0259829. [PMID: 34793507 PMCID: PMC8601556 DOI: 10.1371/journal.pone.0259829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 10/27/2021] [Indexed: 11/19/2022] Open
Abstract
The current Mycobacterium bovis BCG vaccine provides inconsistent protection against pulmonary infection with Mycobacterium tuberculosis. Immunity induced by subcutaneous immunization with BCG wanes and does not promote early recruitment of T cell to the lungs after M. tuberculosis infection. Delivery of Tuberculosis (TB) vaccines to the lungs may increase and prolong immunity at the primary site of M. tuberculosis infection. Pulmonary immunization with recombinant influenza A viruses (rIAVs) expressing an immune-dominant M. tuberculosis CD4+ T cell epitope (PR8-p25 and X31-p25) stimulates protective immunity against lung TB infection. Here, we investigated the potential use of rIAVs to improve the efficacy of BCG using simultaneous immunization (SIM) and prime-boost strategies. SIM with parenteral BCG and intranasal PR8-p25 resulted in equivalent protection to BCG alone against early, acute and chronic M. tuberculosis infection. Boosting BCG with rIAVs increased the frequency of IFN-γ-secreting specific T cells (p<0.001) and polyfunctional CD4+ T cells (p<0.05) in the lungs compared to the BCG alone, however, this did not result in a significant increase in protection against M. tuberculosis compared to BCG alone. Therefore, sequential pulmonary immunization with these rIAVs after BCG increased M. tuberculosis-specific memory T cell responses in the lung, but not protection against M. tuberculosis infection.
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Ashhurst AS, Flórido M, Lin LCW, Quan D, Armitage E, Stifter SA, Stambas J, Britton WJ. CXCR6-Deficiency Improves the Control of Pulmonary Mycobacterium tuberculosis and Influenza Infection Independent of T-Lymphocyte Recruitment to the Lungs. Front Immunol 2019; 10:339. [PMID: 30899256 PMCID: PMC6416161 DOI: 10.3389/fimmu.2019.00339] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 02/08/2019] [Indexed: 11/13/2022] Open
Abstract
T-lymphocytes are critical for protection against respiratory infections, such as Mycobacterium tuberculosis and influenza virus, with chemokine receptors playing an important role in directing these cells to the lungs. CXCR6 is expressed by activated T-lymphocytes and its ligand, CXCL16, is constitutively expressed by the bronchial epithelia, suggesting a role in T-lymphocyte recruitment and retention. However, it is unknown whether CXCR6 is required in responses to pulmonary infection, particularly on CD4+ T-lymphocytes. Analysis of CXCR6-reporter mice revealed that in naïve mice, lung leukocyte expression of CXCR6 was largely restricted to a small population of T-lymphocytes, but this population was highly upregulated after either infection. Nevertheless, pulmonary infection of CXCR6-deficient mice with M. tuberculosis or recombinant influenza A virus expressing P25 peptide (rIAV-P25), an I-Ab-restricted epitope from the immunodominant mycobacterial antigen, Ag85B, demonstrated that the receptor was redundant for recruitment of T-lymphocytes to the lungs. Interestingly, CXCR6-deficiency resulted in reduced bacterial burden in the lungs 6 weeks after M. tuberculosis infection, and reduced weight loss after rIAV-P25 infection compared to wild type controls. This was paradoxically associated with a decrease in Th1-cytokine responses in the lung parenchyma. Adoptive transfer of P25-specific CXCR6-deficient T-lymphocytes into WT mice revealed that this functional change in Th1-cytokine production was not due to a T-lymphocyte intrinsic mechanism. Moreover, there was no reduction in the number or function of CD4+ and CD8+ tissue resident memory cells in the lungs of CXCR6-deficient mice. Although CXCR6 was not required for T-lymphocyte recruitment or retention in the lungs, CXCR6 influenced the kinetics of the inflammatory response so that deficiency led to increased host control of M. tuberculosis and influenza virus.
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Affiliation(s)
- Anneliese S Ashhurst
- Tuberculosis Research Program Centenary Institute, The University of Sydney, Camperdown, NSW, Australia
| | - Manuela Flórido
- Tuberculosis Research Program Centenary Institute, The University of Sydney, Camperdown, NSW, Australia
| | - Leon C W Lin
- Tuberculosis Research Program Centenary Institute, The University of Sydney, Camperdown, NSW, Australia
| | - Diana Quan
- Tuberculosis Research Program Centenary Institute, The University of Sydney, Camperdown, NSW, Australia
| | - Ellis Armitage
- Tuberculosis Research Program Centenary Institute, The University of Sydney, Camperdown, NSW, Australia
| | - Sebastian A Stifter
- Tuberculosis Research Program Centenary Institute, The University of Sydney, Camperdown, NSW, Australia.,Central Clinical School Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - John Stambas
- School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Warwick J Britton
- Tuberculosis Research Program Centenary Institute, The University of Sydney, Camperdown, NSW, Australia.,Central Clinical School Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
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Flórido M, Muflihah H, Lin LCW, Xia Y, Sierro F, Palendira M, Feng CG, Bertolino P, Stambas J, Triccas JA, Britton WJ. Pulmonary immunization with a recombinant influenza A virus vaccine induces lung-resident CD4 + memory T cells that are associated with protection against tuberculosis. Mucosal Immunol 2018; 11:1743-1752. [PMID: 30115996 DOI: 10.1038/s41385-018-0065-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 07/04/2018] [Accepted: 07/05/2018] [Indexed: 02/04/2023]
Abstract
The lung is the primary site of infection with the major human pathogen, Mycobacterium tuberculosis. Effective vaccines against M. tuberculosis must stimulate memory T cells to provide early protection in the lung. Recently, tissue-resident memory T cells (TRM) were found to be phenotypically and transcriptional distinct from circulating memory T cells. Here, we identified M. tuberculosis-specific CD4+ T cells induced by recombinant influenza A viruses (rIAV) vaccines expressing M. tuberculosis peptides that persisted in the lung parenchyma with the phenotypic and transcriptional characteristics of TRMs. To determine if these rIAV-induced CD4+ TRM were protective independent of circulating memory T cells, mice previously immunized with the rIAV vaccine were treated with the sphingosine-1-phosphate receptor modulator, FTY720, prior to and during the first 17 days of M. tuberculosis challenge. This markedly reduced circulating T cells, but had no effect on the frequency of M. tuberculosis-specific CD4+ TRMs in the lung parenchyma or their cytokine response to infection. Importantly, mice immunized with the rIAV vaccine were protected against M. tuberculosis infection even when circulating T cells were profoundly depleted by the treatment. Therefore, pulmonary immunization with the rIAV vaccine stimulates lung-resident CD4+ memory T cells that are associated with early protection against tuberculosis infection.
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Affiliation(s)
- Manuela Flórido
- Tuberculosis Research Program, Centenary Institute, The University of Sydney, Newtown, NSW, Australia
| | - Heni Muflihah
- Tuberculosis Research Program, Centenary Institute, The University of Sydney, Newtown, NSW, Australia
| | - Leon C W Lin
- Tuberculosis Research Program, Centenary Institute, The University of Sydney, Newtown, NSW, Australia
| | - Yingju Xia
- School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Frederic Sierro
- Liver Immunology Program, Centenary Institute, The University of Sydney, Newtown, NSW, Australia.,Department of Pathology, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Mainthan Palendira
- Tuberculosis Research Program, Centenary Institute, The University of Sydney, Newtown, NSW, Australia.,Department of Infectious Diseases and Immunology, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Carl G Feng
- Tuberculosis Research Program, Centenary Institute, The University of Sydney, Newtown, NSW, Australia.,Department of Infectious Diseases and Immunology, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Patrick Bertolino
- Liver Immunology Program, Centenary Institute, The University of Sydney, Newtown, NSW, Australia.,AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - John Stambas
- School of Medicine, Deakin University, Geelong, VIC, Australia
| | - James A Triccas
- Tuberculosis Research Program, Centenary Institute, The University of Sydney, Newtown, NSW, Australia.,Department of Infectious Diseases and Immunology, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Warwick J Britton
- Tuberculosis Research Program, Centenary Institute, The University of Sydney, Newtown, NSW, Australia. .,Department of Infectious Diseases and Immunology, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia. .,Department of Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
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Zimmermann P, Curtis N. The influence of BCG on vaccine responses – a systematic review. Expert Rev Vaccines 2018; 17:547-554. [DOI: 10.1080/14760584.2018.1483727] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Petra Zimmermann
- Department of Paediatrics, The University of Melbourne, Parkville, Australia
- Infectious Diseases Unit, The Royal Children’s Hospital Melbourne, Parkville, Australia
- Infectious Diseases & Microbiology Research Group, Murdoch Children’s Research Institute, Parkville, Australia
- Infectious Diseases Unit, University of Basel Children’s Hospital, Basel, Switzerland
| | - Nigel Curtis
- Department of Paediatrics, The University of Melbourne, Parkville, Australia
- Infectious Diseases Unit, The Royal Children’s Hospital Melbourne, Parkville, Australia
- Infectious Diseases & Microbiology Research Group, Murdoch Children’s Research Institute, Parkville, Australia
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