Clinical presentation of COVID-19-positive and -negative patients in Lagos Nigeria: A comparative study.

BACKGROUND: A lot has been documented about the pathophysiology and clinical presentation of coronavirus disease 2019 (COVID-19). We compared the clinical features of real-time reverse transcriptase polymerase-chain-reaction (RT-PCR) confirmed COVID-19 positive and negative patients admitted in Lagos State. METHODS: Medical records of all patients admitted in 15 isolation centres across Lagos state between 27th February 2020 and 30th September 2020, were abstracted and reviewed. We compared the clinical features, co-morbidities and clinical outcomes of COVID-19 positive and negative patients. RESULTS: A total of 3157 records of patients admitted in 15 isolation centres in Lagos State were reviewed of which 302 (9.6%) tested negative to RT-PCR COVID-19. There was no gender difference between COVID-19 positive and negative patients (P = 0.687). The average age of the negative patients was higher (46.8 ± 18.3 years) than positive patients (41.9 ± 15.5 years) (P < 0.001). A higher proportion of the COVID-19 negative patients had co-morbidity (38.1% vs. 27.8%), were symptomatic (67.5% vs. 44.6%) and higher mortality (21.9% vs. 6.6%) than positive patients (P < 0.001). The percentages with hypertension (26.2% vs. 21.0%, P = 0.038), diabetes (17.2% vs. 9.4%, P < 0.001), cardiovascular disease (2.3% vs. 0.9%, P < 0.029) and cancer (2.3% vs. 0.5%, P < 0.002) were more among patients without COVID-19. More patients without COVID-19 presented with fever (36.1% vs. 18.8%), cough (33.7% vs. 23.1%) and breathlessness (40.8% vs. 16.1%) than the positive patients (P < 0.001). CONCLUSION: Anosmia and dysgeusia were strongly associated with COVID-19. Clinical decision-making should only be used to prioritise testing and isolation of patients suspected to have COVID-19, especially in settings with limited access to diagnostic kits.

Clinical characteristics, predictors of symptomatic coronavirus disease 2019 and duration of hospitalisation in a cohort of 632 Patients in Lagos State, Nigeria.

OBJECTIVE: The clinical spectrum of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is still evolving. This study describes the clinical characteristics and investigates factors that predict symptomatic presentation and duration of hospitalisation in a cohort of coronavirus disease 2019 (COVID-19) patients managed in Lagos, Nigeria. METHODOLOGY: This was a retrospective assessment of patients hospitalised with COVID-19 disease in six dedicated facilities in Lagos, Nigeria, between April 1st and May 31st 2020. Participants were individuals with laboratory-confirmed SARS-CoV-2 infection. The outcome measures were presence of symptoms and duration of hospitalisation. Demographic and comorbidity data were also obtained. Statistical analysis was done using STATA 15.0 software, with P < 0.05 being considered statistically significant. RESULTS: A total of 632 cases were analysed. The median age was 40 years (IQR: 30.5-49); male patients accounted for 60.1%. About 63% of patients were asymptomatic at presentation. Among the symptomatic, the most common symptoms were cough (47.4%) and fever (39.7%). The most common comorbidities were hypertension (16.8%) and diabetes (5.2%). The median duration of hospitalisation was 10 days (IQR: 8-14). Comorbidities increased the odds of presenting with symptoms 1.6-fold (P = 0.025) for one comorbidity and 3.2-fold (P = 0.005) for ≥2 comorbidities. Individuals aged ≥50 years were twice as likely to be hospitalised for more than 14 days compared to individuals aged <50 years (P = 0.016). CONCLUSION: Most individuals had no symptoms with comorbidities increasing the likelihood of symptoms. Older age was associated with longer duration of hospitalisation. Age and comorbidities should be used for COVID-19 triaging for efficient resource allocation.

Prevalence of rifampicin resistant tuberculosis and associated factors among presumptive tuberculosis patients in a secondary referral hospital in Lagos Nigeria.

BACKGROUND: Nigeria is one of the 30 high burden countries for drug resistant tuberculosis (DR-TB). This study assessed the prevalence and factors associated with rifampicin resistant tuberculosis (RR-TB) in a secondary referral hospital in Lagos State Nigeria. METHODS: A retrospective review of presumptive TB register of patients screened for Mycobacterium tuberculosis (MTB) and RR-TB using Xpert MTB/RIF assay at Mainland hospital between January 1 2012 and December 31 2016 was conducted. RESULTS: A total of 2497 clients were screened for MTB and RR-TB during the study period. The majority (51.4%) were between 25 - 44 years. Male: Female ratio was 1:0.8. Of the 2497 clients screened, MTB was detected in 942 (37.7%) out of which 220 (23.4%) had RR-TB. Age (AOR 1.8, 95%CI 1.3- 2.6, p = 0.001), symptomatic contact with DR-TB patients (AOR 3.3, 95%CI 2.1-5.1, p <0.001) and type of TB (AOR 2.9, 95% CI 1.7 - 5.0, <0.001) were associated with RR-TB after adjusting for age, gender, HIV status and symptomatic contacts with DR-TB patients. CONCLUSION: The prevalence of RR-TB in new and previously treated TB patients was high in this study. Urgent steps are needed to avert an impending RR-TB epidemic.

FACTORS ASSOCIATED WITH TB/HIV CO-INFECTION AMONG DRUG SENSITIVE TUBERCULOSIS PATIENTS MANAGED IN A SECONDARY HEALTH FACILITY IN LAGOS, NIGERIA.

BACKGROUND: This study assessed factors associated with TB/HIV co-infection among TB patients managed in a secondary health facility in Lagos Nigeria. MATERIALS AND METHODS: A retrospective review of treatment cards of patients seen at a secondary referral hospital between January 1 2014 and December 31 2014 was conducted. Treatment outcomes and factors associated with TB/HIV co-infection were assessed. RESULTS: Of the 334 records of patients reviewed, the proportion of patients with TB/HIV co-infection was 21.6%. The odds of having TB/HIV co-infection was 2.7 times higher among patients above 40 years than patients less than 25 years (AOR 2.7 95% CI 1.1 - 6.5, p =0.030). In addition, the odds of having TB/HIV co-infection was 3.3 higher among extra-pulmonary TB cases (AOR 3.3; 95% CI 1.2 - 9.5; p = 0.026) and 2.1 times higher among retreated patients (AOR 2.1; 95% CI 1.1 - 3.9; p = 0.017) than pulmonary TB and new patients respectively. The chance of having TB/HIV co-infection was 2.7-fold more in patients with poor treatment outcomes than patients with treatment success (AOR 2.7; 95%CI 1.3 - 5.4; p =0.006). CONCLUSION: TB/HIV co-infection rate was high in the study area. There is need to put measures in place to improve treatment outcomes of TB/HIV co-infected patients.