Disseminated tuberculosis and diagnosis delay during the COVID-19 era in a Western European country : a case series analysis

Disseminated tuberculosis is frequently associated with delayed diagnosis and a poorer prognosis. To describe case series of disseminated TB and diagnosis delay in a low TB burden country during the COVID-19 period. We consecutively included all patients with of disseminated TB reported from 2019 to 2021 in the reference hospital of the Northern Crown of the Metropolitan Area of Barcelona. We collected socio-demographic information, clinical, laboratory and radiological findings. We included all 30 patients reported during the study period-5, 9, and 16 in 2019, 2020, and 2021 respectively-20 (66.7%) of whom were male and whose mean age was 41 years. Twenty-five (83.3%) were of non-EU origin. The most frequent system involvement was central nervous system (N = 8; 26.7%) followed by visceral (N = 7; 23.3%), gastro-intestinal (N = 6, 20.0%), musculoskeletal (N = 5; 16.7%), and pulmonary (N = 4; 13.3%). Hypoalbuminemia and anemia were highly prevalent (72 and 77%). The median of diagnostic delay was 6.5 months (IQR 1.8-30), which was higher among women (36.0 vs. 3.5 months; p = 0.002). Central nervous system involvement and pulmonary involvement were associated with diagnostic delay among women. We recorded 24 cured patients, two deaths, three patients with post-treatment sequelae, and one lost-to-follow up. We observed a clustering effect of patients in low-income neighborhoods (p < 0.001). There was a substantial delay in the diagnosis of disseminated TB in our study region, which might impacted the prognosis with women affected more negatively. Our results suggest that an increase in the occurrence of disseminated TB set in motion by diagnosis delay may have been a secondary effect of the COVID-19 pandemic

Corrigendum : Disseminated tuberculosis and diagnosis delay during the COVID-19 era in a Western European country: a case series analysis

Disseminated tuberculosis is frequently associated with delayed diagnosis and a poorer prognosis. To describe case series of disseminated TB and diagnosis delay in a low TB burden country during the COVID-19 period. We consecutively included all patients with of disseminated TB reported from 2019 to 2021 in the reference hospital of the Northern Crown of the Metropolitan Area of Barcelona. We collected socio-demographic information, clinical, laboratory and radiological findings. We included all 30 patients reported during the study period-5, 9, and 16 in 2019, 2020, and 2021 respectively-20 (66.7%) of whom were male and whose mean age was 41 years. Twenty-five (83.3%) were of non-EU origin. The most frequent system involvement was central nervous system (N = 8; 26.7%) followed by visceral (N = 7; 23.3%), gastro-intestinal (N = 6, 20.0%), musculoskeletal (N = 5; 16.7%), and pulmonary (N = 4; 13.3%). Hypoalbuminemia and anemia were highly prevalent (72 and 77%). The median of diagnostic delay was 6.5 months (IQR 1.8-30), which was higher among women (36.0 vs. 3.5 months; p = 0.002). Central nervous system involvement and pulmonary involvement were associated with diagnostic delay among women. We recorded 24 cured patients, two deaths, three patients with post-treatment sequelae, and one lost-to-follow up. We observed a clustering effect of patients in low-income neighborhoods (p < 0.001). There was a substantial delay in the diagnosis of disseminated TB in our study region, which might impacted the prognosis with women affected more negatively. Our results suggest that an increase in the occurrence of disseminated TB set in motion by diagnosis delay may have been a secondary effect of the COVID-19 pandemic

Single Nucleotide Polymorphisms in the Wnt and BMP Pathways and Colorectal Cancer Risk in a Spanish Cohort

BACKGROUND: Colorectal cancer (CRC) is considered a complex disease, and thus the majority of the genetic susceptibility is thought to lie in the form of low-penetrance variants following a polygenic model of inheritance. Candidate-gene studies have so far been one of the basic approaches taken to identify these susceptibility variants. The consistent involvement of some signaling routes in carcinogenesis provided support for pathway-based studies as a natural strategy to select genes that could potentially harbour new susceptibility loci. METHODOLOGY/PRINCIPAL FINDINGS: We selected two main carcinogenesis-related pathways: Wnt and BMP, in order to screen the implicated genes for new risk variants. We then conducted a case-control association study in 933 CRC cases and 969 controls based on coding and regulatory SNPs. We also included rs4444235 and rs9929218, which did not fulfill our selection criteria but belonged to two genes in the BMP pathway and had consistently been linked to CRC in previous studies. Neither allelic, nor genotypic or haplotypic analyses showed any signs of association between the 37 screened variants and CRC risk. Adjustments for sex and age, and stratified analysis between sporadic and control groups did not yield any positive results either. CONCLUSIONS/SIGNIFICANCE: Despite the relevance of both pathways in the pathogenesis of the disease, and the fact that this is indeed the first study that considers these pathways as a candidate-gene selection approach, our study does not present any evidence of the presence of low-penetrance variants for the selected markers in any of the considered genes in our cohort

Case-control study for colorectal cancer genetic susceptibility in EPICOLON: previously identified variants and mucins

<p>Abstract</p> <p>Background</p> <p>Colorectal cancer (CRC) is the second leading cause of cancer death in developed countries. Familial aggregation in CRC is also important outside syndromic forms and, in this case, a polygenic model with several common low-penetrance alleles contributing to CRC genetic predisposition could be hypothesized. Mucins and GALNTs (N-acetylgalactosaminyltransferase) are interesting candidates for CRC genetic susceptibility and have not been previously evaluated. We present results for ten genetic variants linked to CRC risk in previous studies (previously identified category) and 18 selected variants from the mucin gene family in a case-control association study from the Spanish EPICOLON consortium.</p> <p>Methods</p> <p>CRC cases and matched controls were from EPICOLON, a prospective, multicenter, nationwide Spanish initiative, comprised of two independent stages. Stage 1 corresponded to 515 CRC cases and 515 controls, whereas stage 2 consisted of 901 CRC cases and 909 controls. Also, an independent cohort of 549 CRC cases and 599 controls outside EPICOLON was available for additional replication. Genotyping was performed for ten previously identified SNPs in <it>ADH1C</it>, <it>APC</it>, <it>CCDN1</it>, <it>IL6</it>, <it>IL8</it>, <it>IRS1</it>, <it>MTHFR</it>, <it>PPARG</it>, <it>VDR </it>and <it>ARL11</it>, and 18 selected variants in the mucin gene family.</p> <p>Results</p> <p>None of the 28 SNPs analyzed in our study was found to be associated with CRC risk. Although four SNPs were significant with a <it>P</it>-value < 0.05 in EPICOLON stage 1 [rs698 in <it>ADH1C </it>(OR = 1.63, 95% CI = 1.06-2.50, <it>P</it>-value = 0.02, recessive), rs1800795 in <it>IL6 </it>(OR = 1.62, 95% CI = 1.10-2.37, <it>P</it>-value = 0.01, recessive), rs3803185 in <it>ARL11 </it>(OR = 1.58, 95% CI = 1.17-2.15, <it>P</it>-value = 0.007, codominant), and rs2102302 in <it>GALNTL2 </it>(OR = 1.20, 95% CI = 1.00-1.44, <it>P</it>-value = 0.04, log-additive 0, 1, 2 alleles], only rs3803185 achieved statistical significance in EPICOLON stage 2 (OR = 1.34, 95% CI = 1.06-1.69, <it>P</it>-value = 0.01, recessive). In the joint analysis for both stages, results were only significant for rs3803185 (OR = 1.12, 95% CI = 1.00-1.25, <it>P</it>-value = 0.04, log-additive 0, 1, 2 alleles) and borderline significant for rs698 and rs2102302. The rs3803185 variant was not significantly associated with CRC risk in an external cohort (MCC-Spain), but it still showed some borderline significance in the pooled analysis of both cohorts (OR = 1.08, 95% CI = 0.98-1.18, <it>P</it>-value = 0.09, log-additive 0, 1, 2 alleles).</p> <p>Conclusions</p> <p><it>ARL11</it>, <it>ADH1C</it>, <it>GALNTL2 </it>and <it>IL6 </it>genetic variants may have an effect on CRC risk. Further validation and meta-analyses should be undertaken in larger CRC studies.</p

The MLH1 c.1852_1853delinsGC (p.K618A) Variant in Colorectal Cancer:Genetic Association Study in 18,723 Individuals

Colorectal cancer is one of the most frequent neoplasms and an important cause of mortality in the developed world. Mendelian syndromes account for about 5% of the total burden of CRC, being Lynch syndrome and familial adenomatous polyposis the most common forms. Lynch syndrome tumors develop mainly as a consequence of defective DNA mismatch repair associated with germline mutations in MLH1, MSH2, MSH6 and PMS2. A significant proportion of variants identified by screening these genes correspond to missense or noncoding changes without a clear pathogenic consequence, and they are designated as "variants of uncertain significance", being the c.1852_1853delinsGC (p.K618A) variant in the MLH1 gene a clear example. The implication of this variant as a low-penetrance risk variant for CRC was assessed in the present study by performing a case-control study within a large cohort from the COGENT consortium-COST Action BM1206 including 18,723 individuals (8,055 colorectal cancer cases and 10,668 controls) and a case-only genotype-phenotype correlation with several clinical and pathological characteristics restricted to the Epicolon cohort. Our results showed no involvement of this variant as a low-penetrance variant for colorectal cancer genetic susceptibility and no association with any clinical and pathological characteristics including family history for this neoplasm or Lynch syndrome

Asociación entre el acúmulo de grasa intraabdominal medido por tomografía computarizada y la gravedad de la fibrosis hepática en pacientes infectados por el virus de la inmunodeficiencia humana y el virus de la hepatitis C

Desde la aparición del tratamiento antirretroviral (TARGA) contra el virus de la inmunodeficiencia humana (VIH), se ha producido una disminución de la mortalidad relacionada con las complicaciones de la infección, pero poca reducción de muertes relacionadas con la hepatopatía. Actualmente, la hepatopatía en estos pacientes es debida a una combinación de causas como la coinfección por el virus de la hepatitis C, el TARGA, la translocación microbiana y alteraciones metabólicas, como la resistencia a la insulina (RI) y el síndrome metabólico. En los pacientes coinfectados VIH/VHC, la asociación de la RI con la fibrosis hepática es especialmente relevante, ya que el VHC y el VIH por sí mismos, el TARGA y el estado de inflamación crónica persistente, provocan dislipemia y RI, así como acúmulo de grasa intraabdominal (AGI) y en los hepatocitos que evolucionará a esteatosis hepática y fibrosis y posterior progresión a cirrosis y carcinoma hepatocelular. La hipótesis de esta tesis es demostrar que la cuantificación del AGI mediante TC es un marcador radiológico de la gravedad de la fibrosis hepática en pacientes con coinfección por VIH/VHC. Se han planteado los siguientes objetivos: a) Objetivo primario: Demostrar una asociación independiente entre el AGI medido por TC y la gravedad de la fibrosis hepática en los pacientes coinfectados VIH/VHC. b) Objetivos secundarios: 1. Determinar la precisión diagnóstica de las variables radiológicas: AGI y la esteatosis hepática en los segmentos III y VI para la predicción de la gravedad de la fibrosis hepática. 2. Obtener el punto de corte óptimo del valor del AGI en la detección de la gravedad de la fibrosis hepática. 3. Demostrar la reproducibilidad de la medición del AGI por TC. Se seleccionaron 120 pacientes consecutivos coinfectados VIH/VHC con replicación viral activa que se visitaron en la Unidad Clínica de VIH del Hospital Universitario Germans Trias i Pujol de Badalona. Se recogieron las variables antropométricas, se practicó una analítica, se realizó la determinación del estadio de fibrosis hepática mediante la elastografía transitoria y se remitió a los pacientes al Servicio de Radiodiagnóstico donde se practicó el mismo día una TC abdominal para la determinación del AGI y de la esteatosis hepática. Se cuantificó la grasa intraabdominal y subcutánea con un programa específico de posprocesado de imágenes. La esteatosis hepática fue valorada mediante la obtención del coeficiente de atenuación del hígado y bazo. Tras una primera fase de lectura y validación de la base de datos, se procedió a distintos análisis estadísticos. En cuanto a los resultados, constatamos que el único factor independiente asociado a fibrosis F2 era el AGI. La albúmina y el IMC estaban asociados a F3. Los factores independientes predictores de cirrosis hepática eran la albúmina y el AGI. En relación a la precisión diagnóstica del AGI y la esteatosis hepática, el AGI se puede considerar útil en la predicción de fibrosis hepática, en pacientes con cirrosis. En el diagnóstico de cirrosis, se obtuvieron puntos de corte óptimos (cm2) de AGI. Se constató una significativa variabilidad interobservador en la valoración de la esteatosis hepática, sin apreciarse en la valoración del AGI. No se evidenció variabilidad intraobservador en la valoración de ninguna de las variables. Como conclusión, este trabajo de tesis confirma que el AGI medido por TC es un factor independiente asociado a la gravedad de la fibrosis hepática en los pacientes coinfectados VIH/ VHC, que la mayor exactitud diagnóstica para la predicción de cirrosis hepática se alcanza en mujeres con un punto de corte de valor de AGI de 144 cm2 y que la medición del AGI por TC es una técnica reproducible con escasa variabilidad intra e interobservador.Since the emergence of highly active antiretroviral therapy (HAART) against HIV, there has been a substantial decline in mortality related to complications of HIV infection and acquired immunodeficiency syndrome (AIDS), however, little impact on reducing deaths related to liver disease. Currently, liver disease in HIV patients is due to a combination of causes such as coinfection with hepatitis C virus, HAART-related hepatotoxicity, microbial translocation and metabolic disorders, such as insulin resistance (IR) and metabolic syndrome (MS). In HIV/HCV co-infected patients, the association of IR with liver fibrosis is especially relevant, since both HCV and HIV infection per se, as well as antiretroviral therapy and persistent chronic inflammation, cause dyslipidemia and IR, as well as intra-abdominal fat accumulation (IFA) and in the hepatocytes, that will evolve to hepatic steatosis and fibrosis and subsequent progression to cirrhosis and hepatocellular carcinoma. The hypothesis of this thesis is that quantification of IFA by abdominal CT is a radiological marker of the severity of hepatic fibrosis in patients with HIV/HCV coinfection. The following objectives are proposed: a) Primary objective: To demonstrate an independent association between CT-measured IFA and the severity of hepatic fibrosis in patients with HIV/HCV coinfection. b) Secondary objectives: 1. To determine the diagnostic accuracy of the radiological variables studied: IFA and quantification of hepatic steatosis in segments III and VI, in order to predict the severity of liver fibrosis. 2. To obtain the optimal cut-off point of the IFA value in detecting the severity of liver fibrosis. 3. To demonstrate the reproducibility of the IFA measurement by CT. 120 consecutive HIV infected and HCV coinfected patients with active viral replication were selected and assessed at the HIV Clinical Unit of the Germans Trias i Pujol University Hospital in Badalona. Anthropometric variables were collected, a blood test was performed, the stage of liver fibrosis was determined by transient elastography and patients were referred to the Radiology Service where they performed the same day an abdominal CT to determine IFA and hepatic steatosis. Quantification of intra-abdominal and subcutaneous fat was carried out with the help of a specific post-processing program. Hepatic steatosis was assessed by obtaining the attenuation coefficient of the liver and spleen. After a first phase of reading and validation of the database, different statistical analyzes were carried out. As for the results, we could confirm that the only independent factor associated with stage F2 fibrosis was IFA. Albumin and body mass index (BMI) were associated with F3. The independent predictors of hepatic cirrhosis were albumin concentration and IFA. Regarding the diagnostic accuracy of IFA and hepatic steatosis, IFA may be considered useful in the prediction of liver fibrosis, in patients with fibrosis. In the diagnosis of cirrhosis, an optimum cutoff point (cm2) for IFA was obtained. Regarding reproducibility, no intraobserver variability was observed in the assessment of all variables, nor interobserver in the assessment of IFA, instead, a significant interobserver variability in the assessment of hepatic steatosis was observed. In conclusion, this thesis confirms that CT-measured IFA is an independent factor associated with the severity of liver fibrosis in HIV / HCV co-infected patients, that the highest diagnostic accuracy for the prediction of liver cirrhosis is reached in women with a cut-off point of IFA value of 144 cm2 and that the measurement of the IFA by CT is a reproducible technique with little intra and interobserver variability

Asociación entre el acúmulo de grasa intraabdominal medido por tomografía computarizada y la gravedad de la fibrosis hepática en pacientes infectados por el virus de la inmunodeficiencia humana y el virus de la hepatitis C /

Desde la aparición del tratamiento antirretroviral (TARGA) contra el virus de la inmunodeficiencia humana (VIH), se ha producido una disminución de la mortalidad relacionada con las complicaciones de la infección, pero poca reducción de muertes relacionadas con la hepatopatía. Actualmente, la hepatopatía en estos pacientes es debida a una combinación de causas como la coinfección por el virus de la hepatitis C, el TARGA, la translocación microbiana y alteraciones metabólicas, como la resistencia a la insulina (RI) y el síndrome metabólico. En los pacientes coinfectados VIH/VHC, la asociación de la RI con la fibrosis hepática es especialmente relevante, ya que el VHC y el VIH por sí mismos, el TARGA y el estado de inflamación crónica persistente, provocan dislipemia y RI, así como acúmulo de grasa intraabdominal (AGI) y en los hepatocitos que evolucionará a esteatosis hepática y fibrosis y posterior progresión a cirrosis y carcinoma hepatocelular. La hipótesis de esta tesis es demostrar que la cuantificación del AGI mediante TC es un marcador radiológico de la gravedad de la fibrosis hepática en pacientes con coinfección por VIH/VHC. Se han planteado los siguientes objetivos: a)Objetivo primario: Demostrar una asociación independiente entre el AGI medido por TC y la gravedad de la fibrosis hepática en los pacientes coinfectados VIH/VHC. b)Objetivos secundarios: 1.Determinar la precisión diagnóstica de las variables radiológicas: AGI y la esteatosis hepática en los segmentos III y VI para la predicción de la gravedad de la fibrosis hepática. 2.Obtener el punto de corte óptimo del valor del AGI en la detección de la gravedad de la fibrosis hepática. 3.Demostrar la reproducibilidad de la medición del AGI por TC. Se seleccionaron 120 pacientes consecutivos coinfectados VIH/VHC con replicación viral activa que se visitaron en la Unidad Clínica de VIH del Hospital Universitario Germans Trias i Pujol de Badalona. Se recogieron las variables antropométricas, se practicó una analítica, se realizó la determinación del estadio de fibrosis hepática mediante la elastografía transitoria y se remitió a los pacientes al Servicio de Radiodiagnóstico donde se practicó el mismo día una TC abdominal para la determinación del AGI y de la esteatosis hepática. Se cuantificó la grasa intraabdominal y subcutánea con un programa específico de posprocesado de imágenes. La esteatosis hepática fue valorada mediante la obtención del coeficiente de atenuación del hígado y bazo. Tras una primera fase de lectura y validación de la base de datos, se procedió a distintos análisis estadísticos. En cuanto a los resultados, constatamos que el único factor independiente asociado a fibrosis F2 era el AGI. La albúmina y el IMC estaban asociados a F3. Los factores independientes predictores de cirrosis hepática eran la albúmina y el AGI. En relación a la precisión diagnóstica del AGI y la esteatosis hepática, el AGI se puede considerar útil en la predicción de fibrosis hepática, en pacientes con cirrosis. En el diagnóstico de cirrosis, se obtuvieron puntos de corte óptimos (cm2) de AGI. Se constató una significativa variabilidad interobservador en la valoración de la esteatosis hepática, sin apreciarse en la valoración del AGI. No se evidenció variabilidad intraobservador en la valoración de ninguna de las variables. Como conclusión, este trabajo de tesis confirma que el AGI medido por TC es un factor independiente asociado a la gravedad de la fibrosis hepática en los pacientes coinfectados VIH/ VHC, que la mayor exactitud diagnóstica para la predicción de cirrosis hepática se alcanza en mujeres con un punto de corte de valor de AGI de 144 cm2 y que la medición del AGI por TC es una técnica reproducible con escasa variabilidad intra e interobservador.Since the emergence of highly active antiretroviral therapy (HAART) against HIV, there has been a substantial decline in mortality related to complications of HIV infection and acquired immunodeficiency syndrome (AIDS), however, little impact on reducing deaths related to liver disease. Currently, liver disease in HIV patients is due to a combination of causes such as coinfection with hepatitis C virus, HAART-related hepatotoxicity, microbial translocation and metabolic disorders, such as insulin resistance (IR) and metabolic syndrome (MS). In HIV/HCV co-infected patients, the association of IR with liver fibrosis is especially relevant, since both HCV and HIV infection per se, as well as antiretroviral therapy and persistent chronic inflammation, cause dyslipidemia and IR, as well as intra-abdominal fat accumulation (IFA) and in the hepatocytes, that will evolve to hepatic steatosis and fibrosis and subsequent progression to cirrhosis and hepatocellular carcinoma. The hypothesis of this thesis is that quantification of IFA by abdominal CT is a radiological marker of the severity of hepatic fibrosis in patients with HIV/HCV coinfection. The following objectives are proposed: a) Primary objective: To demonstrate an independent association between CT-measured IFA and the severity of hepatic fibrosis in patients with HIV/HCV coinfection. b) Secondary objectives: 1. To determine the diagnostic accuracy of the radiological variables studied: IFA and quantification of hepatic steatosis in segments III and VI, in order to predict the severity of liver fibrosis. 2. To obtain the optimal cut-off point of the IFA value in detecting the severity of liver fibrosis. 3. To demonstrate the reproducibility of the IFA measurement by CT. 120 consecutive HIV infected and HCV coinfected patients with active viral replication were selected and assessed at the HIV Clinical Unit of the Germans Trias i Pujol University Hospital in Badalona. Anthropometric variables were collected, a blood test was performed, the stage of liver fibrosis was determined by transient elastography and patients were referred to the Radiology Service where they performed the same day an abdominal CT to determine IFA and hepatic steatosis. Quantification of intra-abdominal and subcutaneous fat was carried out with the help of a specific post-processing program. Hepatic steatosis was assessed by obtaining the attenuation coefficient of the liver and spleen. After a first phase of reading and validation of the database, different statistical analyzes were carried out. As for the results, we could confirm that the only independent factor associated with stage F2 fibrosis was IFA. Albumin and body mass index (BMI) were associated with F3. The independent predictors of hepatic cirrhosis were albumin concentration and IFA. Regarding the diagnostic accuracy of IFA and hepatic steatosis, IFA may be considered useful in the prediction of liver fibrosis, in patients with fibrosis. In the diagnosis of cirrhosis, an optimum cutoff point (cm2) for IFA was obtained. Regarding reproducibility, no intraobserver variability was observed in the assessment of all variables, nor interobserver in the assessment of IFA, instead, a significant interobserver variability in the assessment of hepatic steatosis was observed. In conclusion, this thesis confirms that CT-measured IFA is an independent factor associated with the severity of liver fibrosis in HIV / HCV co-infected patients, that the highest diagnostic accuracy for the prediction of liver cirrhosis is reached in women with a cut-off point of IFA value of 144 cm2 and that the measurement of the IFA by CT is a reproducible technique with little intra and interobserver variability

Modelling the dynamics of tuberculosis lesions in a virtual lung: role of the bronchial tree in endogenous reinfection

Tuberculosis (TB) is an infectious disease that still causes more than 1.5 million deaths annually. The World Health Organization estimates that around 30% of the world’s population is latently infected. However, the mechanisms responsible for 10% of this reserve (i.e., of the latently infected population) developing an active disease are not fully understood, yet. The dynamic hypothesis suggests that endogenous reinfection has an important role in maintaining latent infection. In order to examine this hypothesis for falsifiability, an agent-based model of growth, merging, and proliferation of TB lesions was implemented in a computational bronchial tree, built with an iterative algorithm for the generation of bronchial bifurcations and tubes applied inside a virtual 3D pulmonary surface. The computational model was fed and parameterized with computed tomography (CT) experimental data from 5 latently infected minipigs. First, we used CT images to reconstruct the virtual pulmonary surfaces where bronchial trees are built. Then, CT data about TB lesion’ size and location to each minipig were used in the parameterization process. The model’s outcome provides spatial and size distributions of TB lesions that successfully reproduced experimental data, thus reinforcing the role of the bronchial tree as the spatial structure triggering endogenous reinfection. A sensitivity analysis of the model shows that the final number of lesions is strongly related with the endogenous reinfection frequency and maximum growth rate of the lesions, while their mean diameter mainly depends on the spatial spreading of new lesions and the maximum radius. Finally, the model was used as an in silico experimental platform to explore the transition from latent infection to active disease, identifying two main triggering factors: a high inflammatory response and the combination of a moderate inflammatory response with a small breathing amplitude.Peer Reviewe

Disseminated tuberculosis and diagnosis delay during the COVID-19 era in a Western European country: a case series analysis

BackgroundDisseminated tuberculosis is frequently associated with delayed diagnosis and a poorer prognosis.ObjectivesTo describe case series of disseminated TB and diagnosis delay in a low TB burden country during the COVID-19 period.MethodologyWe consecutively included all patients with of disseminated TB reported from 2019 to 2021 in the reference hospital of the Northern Crown of the Metropolitan Area of Barcelona. We collected socio-demographic information, clinical, laboratory and radiological findings.ResultsWe included all 30 patients reported during the study period—5, 9, and 16 in 2019, 2020, and 2021 respectively—20 (66.7%) of whom were male and whose mean age was 41 years. Twenty-five (83.3%) were of non-EU origin. The most frequent system involvement was central nervous system (N = 8; 26.7%) followed by visceral (N = 7; 23.3%), gastro-intestinal (N = 6, 20.0%), musculoskeletal (N = 5; 16.7%), and pulmonary (N = 4; 13.3%). Hypoalbuminemia and anemia were highly prevalent (72 and 77%). The median of diagnostic delay was 6.5 months (IQR 1.8–30), which was higher among women (36.0 vs. 3.5 months; p = 0.002). Central nervous system involvement and pulmonary involvement were associated with diagnostic delay among women. We recorded 24 cured patients, two deaths, three patients with post-treatment sequelae, and one lost-to-follow up. We observed a clustering effect of patients in low-income neighborhoods (p &lt; 0.001).ConclusionThere was a substantial delay in the diagnosis of disseminated TB in our study region, which might impacted the prognosis with women affected more negatively. Our results suggest that an increase in the occurrence of disseminated TB set in motion by diagnosis delay may have been a secondary effect of the COVID-19 pandemic