Pathology of TB/COVID-19 Co-Infection: The phantom menace

Mousquer, Gabriel Tassi; Peres, Alessandra; Fiegenbaum, Marilu

doi:10.1016/j.tube.2020.102020

Cited by 92 publications

(94 citation statements)

References 71 publications

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“…Our data on coinfected individuals suggests that LTBI is associated with elevated levels of CRP and α-2-M. Finally, LTBI is also associated with enhanced levels of two other biomarkers of disease pathogenesis in COVID-19 – VEGF and TGFα ( 28 ). Our study also reveals that cytokines for the most part (and chemokines, acute phase proteins and growth factors to a lesser extent) are significantly associated with LTBI positivity.…”

Section: Discussionmentioning

confidence: 61%

Latent tuberculosis co-infection is associated with heightened levels of humoral, cytokine and acute phase responses in seropositive SARS-CoV-2 infection

Ray

Kumar

Padmapriyadarsini

et al. 2021

Journal of Infection

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Objectives : Latent Tuberculosis infection (LTBI) is postulated to modulate immune responses and alter disease severity in SARS-CoV-2 co-infection. However, no data exist on the effect of LTBI on the immune responses in SARS-CoV-2 co-infected individuals. Methods : We examined the SARS-CoV-2 specific antibody responses, plasma cytokines, chemokines, acute phase proteins and growth factor levels in LTBI positive and negative individuals with SARS-CoV-2 infection. Results : Our results demonstrated that individuals with LTBI (LTBI+) and seropositive for SARS-CoV-2 infection were associated with elevated SARS-CoV-2 specific IgM, IgG and IgA antibodies, as well as enhanced neutralization activity compared to those negative for LTBI (LTBI-) individuals. Our results also demonstrate that LTBI+ individuals exhibited significantly higher plasma levels of IFNγ, IL-2, TNFα, IL-1α, IL-1β, IL-6, IL-12, IL-15, IL-17, IL-3, GM-CSF, IL-10, IL-25, IL-33, CCL3 and CXCL10 compared to LTBI- individuals. Finally, our results show that LTBI+ individuals exhibit significantly higher levels of C-reactive protein, alpha-2 macroglobulin, VEGF and TGFα compared to LTBI- individuals. Conclusions : Thus, our data clearly demonstrates that LTBI+ individuals seropositive for SARS-CoV2 infection exhibit heightened levels of humoral, cytokine and acute phase responses compared to LTBI- individuals. Thus, LTBI is associated with modulation of antibody and cytokine responses as well as systemic inflammation in individuals seropositive for SARS-CoV2 infection.

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Section: Discussionmentioning

confidence: 61%

Latent tuberculosis co-infection is associated with heightened levels of humoral, cytokine and acute phase responses in seropositive SARS-CoV-2 infection

Ray

Kumar

Padmapriyadarsini

et al. 2021

Journal of Infection

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“…In this patient however, the sudden superinfection with COVID-19 resulted in a rapid worsening of respiratory function and, eventually, death. A recent review 2 suggested that tuberculosis and a previous history of tuberculosis seem to be related to an increased susceptibility to COVID-19, as well as worsening of the infection prognosis possibly because of a synergism between the two pathogens. This could explain the poor prognosis of our patient who, moreover, had already two important co-morbidities (i.e.…”

Section: Discussionmentioning

confidence: 99%

“…1 The ongoing coronavirus disease 2019 (COVID-19) pandemic, which started in December 2019 in China, has overwhelmed healthcare systems globally and proved to be a new menace because of its devastating effect on lung function, especially in the more fragile patient. 2 This report describes the first case of miliary tuberculosis (TB) secondary to intravesical treatment with BCG with sudden worsening of respiratory function caused by COVID-19 superinfection.…”

Section: Introductionmentioning

confidence: 99%

A unique case of miliary pulmonary tuberculosis induced by bacillus Calmette-Guérin intravesical instillation with COVID-19 superinfection

Brandi¹,

Bartalena²,

Mosconi³

et al. 2021

South African Journal of Radiology

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Intravesical instillation of Bacillus Calmette-Guérin (BCG) is used as an adjuvant treatment of bladder cancer. Systemic BCG infection occurs in less than 1% of cases, and pulmonary involvement is even rarer (0.3% – 0.7%), with a favourable prognosis. A 78-year-old male developed miliary tuberculosis (TB) secondary to intravesical BCG treatment and subsequent coronavirus disease 2019 (COVID-19) superinfection that led to patient death. High awareness amongst clinicians is needed to proceed with immediate appropriate therapy in these patients, especially during the COVID-19 pandemic

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“… 52 A synergy of these two infections could result in severe menacing consequences. 53 COVID-19 co-infection with TB has been reported to worsen the prognosis and increase morbidity and mortality in patients affected with this dual infection. 54 – 56 There is a sparsity of data regarding the number of patients who receive antitubercular as well as repurposed COVID-19 drugs simultaneously.…”

Section: Discussionmentioning

confidence: 99%

Prediction of potential drug interactions between repurposed COVID-19 and antitubercular drugs: an integrational approach of drug information software and computational techniques data

Thomas

Birangal

Ray

et al. 2021

Therapeutic Advances in Drug Safety

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Introduction: Tuberculosis is a major respiratory disease globally with a higher prevalence in Asian and African countries than rest of the world. With a larger population of tuberculosis patients anticipated to be co-infected with COVID-19 infection, an ongoing pandemic, identifying, preventing and managing drug–drug interactions is inevitable for maximizing patient benefits for the current repurposed COVID-19 and antitubercular drugs. Methods: We assessed the potential drug–drug interactions between repurposed COVID-19 drugs and antitubercular drugs using the drug interaction checker of IBM Micromedex®. Extensive computational studies were performed at a molecular level to validate and understand the drug–drug interactions found from the Micromedex drug interaction checker database at a molecular level. The integrated knowledge derived from Micromedex and computational data was collated and curated for predicting potential drug–drug interactions between repurposed COVID-19 and antitubercular drugs. Results: A total of 91 potential drug–drug interactions along with their severity and level of documentation were identified from Micromedex between repurposed COVID-19 drugs and antitubercular drugs. We identified 47 pharmacodynamic, 42 pharmacokinetic and 2 unknown DDIs. The majority of our molecular modelling results were in line with drug–drug interaction data obtained from the drug information software. QT prolongation was identified as the most common type of pharmacodynamic drug–drug interaction, whereas drug–drug interactions associated with cytochrome P450 3A4 (CYP3A4) and P-glycoprotein (P-gp) inhibition and induction were identified as the frequent pharmacokinetic drug–drug interactions. The results suggest antitubercular drugs, particularly rifampin and second-line agents, warrant high alert and monitoring while prescribing with the repurposed COVID-19 drugs. Conclusion: Predicting these potential drug–drug interactions, particularly related to CYP3A4, P-gp and the human Ether-à-go-go-Related Gene proteins, could be used in clinical settings for screening and management of drug–drug interactions for delivering safer chemotherapeutic tuberculosis and COVID-19 care. The current study provides an initial propulsion for further well-designed pharmacokinetic-pharmacodynamic-based drug–drug interaction studies. Plain Language Summary Introduction: Tuberculosis is a major respiratory disease globally with a higher prevalence in Asian and African countries than rest of the world. With a larger population of tuberculosis patients predicted to be infected with COVID-19 during this period, there is a higher risk for the occurrence of medication interactions between the medicines used for COVID-19 and tuberculosis. Hence, identifying and managing these interactions is vital to ensure the safety of patients undergoing COVID-19 and tuberculosis treatment simultaneously. Methods: We studied the major medication interactions that could likely happen between the various medicines that are currently given for COVID-19 and tuberculosis treatment using the medication interaction checker of a drug information software (Micromedex®). In addition, thorough molecular modelling was done to confirm and understand the interactions found from the medication interaction checker database using specific docking software. Molecular docking is a method that predicts the preferred orientation of one medicine molecule to a second molecule, when bound to each other to form a stable complex. Knowledge of the preferred orientation may be used to determine the strength of association or binding affinity between two medicines using scoring functions to determine the extent of the interactions between medicines. The combined knowledge from Micromedex and molecular modelling data was used to properly predict the potential medicine interactions between currently used COVID-19 and antitubercular medicines. Results: We found a total of 91 medication interactions from Micromedex. Majority of our molecular modelling findings matched with the interaction information obtained from the drug information software. QT prolongation, an abnormal heartbeat, was identified as one of the most common interactions. Our findings suggest that antitubercular medicines, mainly rifampin and second-line agents, suggest high alert and scrutiny while prescribing with the repurposed COVID-19 medicines. Conclusion: Our current study highlights the need for further well-designed studies confirming the current information for recommending safe prescribing in patients with both infections.

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Pathology of TB/COVID-19 Co-Infection: The phantom menace

Cited by 92 publications

References 71 publications

Latent tuberculosis co-infection is associated with heightened levels of humoral, cytokine and acute phase responses in seropositive SARS-CoV-2 infection

Latent tuberculosis co-infection is associated with heightened levels of humoral, cytokine and acute phase responses in seropositive SARS-CoV-2 infection

A unique case of miliary pulmonary tuberculosis induced by bacillus Calmette-Guérin intravesical instillation with COVID-19 superinfection

Prediction of potential drug interactions between repurposed COVID-19 and antitubercular drugs: an integrational approach of drug information software and computational techniques data

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