In-hospital diagnosis of tuberculosis (TB) in non-HIV patients: the impact of the COVID-19 pandemic

<b>Introduction:</b> The COVID-19 pandemic brought unprecedented consequences to healthcare systems, deeply affecting the efforts on TB prevention, case detection and management. <b>Aim:</b> To evaluate the impact of the COVID-19 pandemic on in-hospital diagnosis of tuberculosis in non-HIV patients. <b>Methods:</b> Single-center retrospective study comparing adult hospitalised patients with TB not associated with HIV infection, admitted from March 2018 to June 2019 (pre-pandemic) with those admitted from March 2020 to June 2021 (pandemic). <b>Results:</b> From a total of 100 cases, 58 and 42 were admitted in the pre and pandemic periods, respectively. Patients tended to be younger in the pre-pandemic group (54.5 years vs 63.0 years) but in both groups, most were male (75.9% vs 78.6%). Immunosuppression status was significantly higher in the pre-pandemic group (p=0.002). Bilateral lesions were more frequent in the second period (p=0.035)&nbsp;and a&nbsp;significant increase in disseminated tuberculosis cases in immunocompetent patients (p=0.009) was observed in the pandemic group. Concerning patients with negative sputum smears at presentation and patients with numerous (&gt;50/field) bacilli, a statistically significant difference was not achieved (p=0.055). During the pandemic period, the length of stay was longer (median, 19.5 days [IQR 9.75-51.00] vs. 40.5 days [IQR 13.25-67.25]) and mortality was lower (12.1% vs 4.8%). <b>Conclusions:</b> In the pandemic period, less immunocompromised patients hospitalized with TB were seen, there was an increase in extended pulmonary forms, a significant rise of disseminated tuberculosis in immunocompetent patients and a tendency to find a greater proportion of numerous bacilli on smears.