Criteria for Distinguishing Pulmonary Tuberculosis from Community-Acquired Pneumonia of Moderate to Severe Course and Associated with COVID-19. Part 1

The COVID-19 pandemic has significantly changed the spectrum of lung pathology. As the lungs are the main organs affected by the SARS-CoV-2, as well as by community-acquired and Mycobacterium tuberculosis infections, their differentiation based on specific clinical, radiological and laboratory tests should be done properly for early initiation of treatment and follow-up. Objective — to establish the distinguishing clinical, radiological and laboratory differential diagnostic criteria between COVID-19-associated pneumonia, moderate to severe community-acquired pneumonia (CAP) and pulmonary infiltrative tuberculosis in the frame of a prospective longitudinal study. Materials and methods. A prospective case-control study was conducted from 1 January 2020 to 31 December 2022. It included 255 patients, distributed into the 1st group — 70 patients diagnosed with SARS-CoV-2 pneumonia, the 2nd group — 65 patients with CAP and the 3rd group — 120 patients with pulmonary infiltrative TB. All patients were aetiologically confirmed through the conventional microbiological or mole­cular genetic tests and clinically managed in specialised clinical services. Statistical analysis was carried out using quantitative and qualitative tests in SPSS Statistics 23.0 software, in which paired sample T-test, Anova and Chi-square tests were performed. The differences were considered statistically significant with a confidence level of more than 95 % and p < 0.05. Results and discussion. The demographic characteristics of the patients showed no significant differences; however, male sex was identified as a high-risk factor for developing TB (Odds Ratio (OR) = 7.6; 95 % Confidence Interval (CI): 3.7—14.9; risk difference: 46 %; χ2 = 37; p < 0.001) compared to SARS-CoV-2 pneumonia. Additionally, male sex was found to be a moderate risk factor for severe CAPs (OR = 2.4; 95 % CI: 1.3—4.8; risk difference: 21 %). Young age (< 45 years) was identified as a high-risk factor for developing TB (OR = 8.1; 95 % CI: 3.6—17.2; risk difference: 20 %). In contrast, age over 45 years was a significant risk factor for severe CAPs (OR = 6.6; 95 % CI: 3.1—14.2; χ2 = 32; p < 0.001; risk difference: 41 %) and SARS-CoV-2 pneumonia (OR = 7.4; 95 % CI: 3.2—8.1; χ2 = 27; p < 0.001; risk difference: 37 %). Conclusions. Demographic characteristics of patients in all study groups showed that male gender was likely a high-risk factor for developing tuberculosis compared with SARS-CoV-2-associated pneumonia. Male gender was found to be a moderate-risk factor for severe community-acquired pneumonia. Young age (< 45 years) was identified as a high-risk factor for developing tuberculosis; age over 45 years was a significant risk factor for severe community-acquired pneumonia and SARS-CoV-2-associated pneumonia.