Is COVID-19 masking or delayed the diagnosis of active pulmonary tuberculosis? A case report from Bangladesh

Abstract

Background: The pandemic corona virus disease 2019 (COVID-19) impacts a major global health crisis in the whole world including Bangladesh. Bangladesh is one of the world's high tuberculosis (TB) burden countries and TB is a major public health concern in the country. It is also observed that respiratory disease present with similar features of coronavirus disease, unfortunately and regrettably overlooked by the physicians worldwide due to the pandemic crisis. We presented a case of pulmonary TB and COVID-19 co-infection which has not been reported much. Case report: A 55 years old female presented with acute respiratory symptoms superimposed on chronic respiratory symptoms as she was suffering from bronchial asthma, diagnosed with severe pneumonia. Oropharyngeal and nasal swabs were found positive for coronavirus by real time polymerase chain reaction (RT-PCR) assay. Assessments of the previous history and clinical scenario also suggested investigations for TB. Sputum was positive for acid fast bacilli (AFB) and Gene Xpert detected Mycobacterium tuberculosis complex with rifampicin sensitivity. Patient was treated concomitantly for COVID-19 pneumonia with starting anti-tubercular drugs. So, physicians should suspect COVID-19 co infections with pulmonary TB while treating the patient presented with respiratory and systemic features. It should be kept in consideration for early diagnosis of pulmonary TB to reduce the morbidity and mortality of patients and to prevent transmission in the community from active sputum positive pulmonary TB.