A case of pleural tuberculosis vs latent tuberculosis reactivation as a result of COVID-19 infection and treatment

Abstract

The reactivation of latent tuberculosis occurs when a patient living with Mycobacterium tuberculosis enters a state where the immune system is suppressed. Since early 2021, the standard of care has been to provide corticosteroids in patients with COVID-19 infection in hospitalized patients receiving supplemental oxygen or mechanical ventilation. The immunomodulatory effects of corticosteroids are potentially detrimental for patients with latent vs active tuberculosis, with concomitant SARS-CoV2 infection. We present one of the first few cases in the literature detailing a case of reactivation of latent tuberculosis vs. pleural tuberculosis as a consequence of COVID-19, and who underwent subsequent corticosteroid treatment.

Initial immune response after exposure to Mycobacterium tuberculosis or to SARS-COV-2: similarities and differences

“…The findings from case reports indicate the presence of similarities in the immunopathogenesis of the two diseases, which may exacerbate disease severity during co-infection. Subclinical and clinical TB disease may increase the risk of severe COVID-19 disease and also SARS-CoV-2 co-infection may induce the progression to TB disease ( 309 ), as reported above ( 321 – 326 ). In this regard, IFN-I which is strongly induced by viral infection may be detrimental in the context of Mtb by inhibiting B cell responses, inducing the release of immunosuppressive molecules or reducing the macrophagic activation induced by IFN-γ ( 145 ), Also, the hyperinflammatory milieu caused by Mtb may raise the risk of severe COVID-19 and vice versa ( 331 ).…”

“…Furthermore, several recent case studies have raised concerns regarding the Mtb reactivation in TB-infected subjects following SARS-CoV-2 co-infection. These reports suggest that since the control of both Mtb and SARS-CoV-2 replication depends on cellular immunity, it is possible that the immune dysregulation caused by SARS-CoV-2 or the immunomodulatory therapies used for COVID-19 treatment may increase the risk for TB reactivation ( 321 – 326 ).…”

Pathophysiological, immunological, and inflammatory features of long COVID

“…Reactivation of latent infections related to COVID-19 extends beyond viral diseases. Notably, cases of tuberculosis (TB) reactivation following SARS-CoV-2 infection have been documented (295)(296)(297)(298)(299). The possible immunosuppressive effects of the disease, which remains controversial, and the treatments may contribute to infectious disease reactivation.…”