Diagnosis of a Spectrum of Pulmonary Tuberculosis at Islam Hospital Sukapura, Jakarta, Indonesia: A Retrospective Study of 317 Cases

Correlations between comorbidities, chest x-ray findings, and C-Reactive protein level in patients with COVID-19

Background

Patients with comorbidities have an increased risk for severe coronavirus disease (COVID-19) symptoms, including abnormal inflammation. Chest X-rays and C-reactive protein (CRP) level are frequently used to evaluate the severity of inflammation. The aim of this study was to investigate the correlation between comorbidities, chest X-ray findings, and CRP level in patients with COVID-19.

Materials and methods

This was a cross-sectional, analytic, observational study performed using a quantitative approach. The study population included in patients with confirmed COVID-19. Secondary data from the medical records of the patients were analysed to determine the correlations between comorbidities, chest X-rays, and CRP level.

Results

The data of 167 patients (87 [52.1%] females and 80 [47.9%] males) were evaluated. Regarding comorbidities, 86 (51.5%) patients had hypertension, 66 (39.5%) had diabetes mellitus, and 17 (10.2%) had dyspepsia. Chest X-rays showed that 144 (86.2%) patients had pneumonia, whereas 23 (13.8%) did not. A total of 143 (85.6%) patients showed increased CRP levels, whereas 24 (14.4%) did not show any increase. Patients who showed pneumonia on chest X-rays tended to have increased CRP levels. The results also showed that chest X-ray findings were correlated with CRP level. Diabetes mellitus and hypertension were significantly correlated with CRP level (p = 0.05), whereas dyspepsia did not show a significant relationship with CRP level (p > 0.05). Patients with hypertension had a 2.709-fold risk of having increased CRP level compared with patients without hypertension. Patients with pneumonia had a 2.953-fold increased risk for increased CRP level compared to those without pneumonia.

Conclusion

Hypertension and diabetes mellitus are significantly correlated with CRP level. Chest X-ray finding is also significantly correlated with CRP level.

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The most common comorbidity in COVID-19 patients is hypertension.

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Most COVID-19 patients with pneumonia tend to increase CRP value.

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Only hypertension and diabetes mellitus have a significant correlation with the CRP value.

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The chest x-ray result has a significant correlation with the CRP value.

Comparison TLR2 and TLR4 serum levels in children with pulmonary and extrapulmonary tuberculosis with and without a Bacillus Calmette-Guérin (BCG) scar

The formation of a scar after Mycobacterium bovis Bacillus Calmette-Guérin (BCG) vaccination influences the effectiveness of protection against Mycobacterium tuberculosis (MTB) infection. The innate immunity plays a critical role both in the pathophysiology of tuberculosis (TB) and BCG vaccination protection mechanism. Parts of innate immunity: macrophages, dendritic cells, and neutrophils, have microbial recognition surface receptors called Toll-like receptors (TLR) 2 and 4. The objective of this study is to compare the serum levels of TLR2 and TLR4 in BCG-vaccinated pediatric patients with pulmonary and extrapulmonary TB. This cross-sectional study included children aged less than 18 years old with contracted TB disease and had received BCG vaccination. The subjects were recruited by convenience sampling from both outpatient and inpatient care at Bhakti Medicare and Jakarta Islamic Hospital, from November 2018 to December 2019. Serum TLR2 and TLR4 levels measured using ELISA of the two groups of subjects: children with pulmonary TB (PTB) and extrapulmonary TB (EPTB), were then compared. The presence of BCG scars was included in the analysis. Independent T-test, ANOVA test, and Kolmogorov-Smirnov normality tests on the SPSS program were used to statistically analyze the results. Serum TLR2 and TLR4 levels were higher in EPTB group, but the difference was not significant (TLR2 p = 0.758 and TLR4 p = 0.646, respectively). Subjects with BCG scars in both groups have significantly higher serum TLR2 and TLR4 levels than those without BCG scars in the EPTB group (EPTB p = 0.001 and p = 0.004, respectively); (PTB p < 0.001 and p < 0.001, respectively). BCG vaccination and MTB infection stimulate better innate immune response in EPTB than in PTB and serum TLR2 and TLR4 levels in those with BCG scars were higher when compared to those without BCG scars.