A trio of infectious diseases and pulmonary embolism: A developing world’s reality

Abstract

Introduction Human immunodeficiency virus (HIV), Tuberculosis (TB) and coronavirus disease (COVID-19) infections independently possess the ability to trigger formation of venous thromboembolism (VTE) and pulmonary embolism (PE). To the authors’ knowledge, this is the first case report describing the presence of PE in a patient with all three aforementioned infectious co-morbidities. Presentation A patient living with HIV with virological failure secondary to defaulting antiretroviral therapy (ART) presented with hypoxia, clinical and radiological features suggestive of community-acquired pneumonia (CAP) with raised inflammatory markers and D-dimer levels. Management She was commenced on prophylactic anticoagulation, supplemental oxygen and empirical antibiotics targeting CAP and pneumocystis jiroveci pneumonia, swabbed for COVID-19 infection and had sputa sent for Gene Xpert® TB testing. A day later, COVID-19 results returned positive and the patient was transferred to isolation and added onto dexamethasone and therapeutic anticoagulation. Sputa returned positive for mycobacterium TB a day later, and anti-tuberculosis therapy was added. She remained persistently hypoxic, with a Well’s score of 3 placing her at moderate risk for PE, which prompted for a computed tomography pulmonary angiogram (CTPA) being ordered, which demonstrated left lower lobe subsegmental PE. Warfarin was added to her regimen. She was discharged on day 18 with a therapeutic international normalised ratio (INR) and not requiring oxygen therapy. Conclusion This scenario is relevant in low to middle-income countries. The utilisation of a raised D-Dimer in the setting of all four coexisting conditions in arriving at a definite diagnosis remains uncertain. We noted that despite our index patient being on thrombo-prophylaxis, she developed PE highlighting the need for increased vigilance in all COVID-19 patients, even those on prophylactic anticoagulation.

Global prevalence, treatment and outcome of tuberculosis and COVID-19 coinfection: a systematic review and meta-analysis (from November 2019 to March 2021)

“…We identified information concerning treatment after discharge for 10 patients; 8 of them received ATT and 2 received treatment for existing comorbidity. Although there was no doubt that the regimens for TB and COVID-19 coinfected patients were highly heterogeneous, we still could identify four main paradigms about treatment during hospitalisation: (1) simultaneous antiviral treatment and ATT,19–21 23–26 28 30 31 34 35 39–41 43–45 49 51 (2) only ATT,22 26 32 33 35 36 46–48 (3) only antiviral treatment,18 24 26 27 38 44 50 (4) no antiviral treatment and ATT 37. Check online supplemental tables 4 and 5 for detailed information about the treatment.…”

“…Until 19 March 2021, there were 35 case reports from 17 countries, including India,18–22 Indonesia,23 China,24–28 Saudi Arabia,29 30 Qatar,31 32 Singapore,33 Turkey,34 35 Haiti,36 Argentina,37 USA,38–41 Brazil,42 43 Panama,44 Nigeria,45 46 South Africa,47 48 Morocco,49 Italy50 51 and France 52. Totally, 55 cases were described in these 35 reports.…”

Mycobacterium tuberculosis and SARS-CoV-2 Coinfections: A Review

“…Pulmonary TB patients presented with fever, productive cough, night sweating, weight loss, hemoptysis, dyspnea, fatigue, and loss of appetite (Shanmuganathan and Shanmuganathan, 2015). Some people with COVID-19 were referred to the hospital with characteristic TB symptoms, such as fever, night sweats, weight loss, reduced appetite, and cough with occasional blood-streaked sputum, and further evaluations and tests confirmed the simultaneous presence of MTB and SARS-CoV-2 organisms (Cutler et al, 2020;Gbenga et al, 2020;Singh et al, 2020;Tham et al, 2020;Yadav and Rawal, 2020;Baskara et al, 2021;Musso et al, 2021;Pillay and Magula, 2021). As lung damage caused by TB increases the body's susceptibility to getting infected with other airborne infections, it can be considered that TB can be a risk factor for exacerbating the severity of COVID-19 patients (Mousquer et al, 2020).…”