Severe Acute Respiratory Syndrome Coronavirus-2 and Pulmonary Tuberculosis Coinfection: Double Trouble

Abstract

The ongoing pandemic of novel coronavirus Severe Acute Respiratory Syndrome Coronavirus - 2 (SARS-CoV-2) has received worldwide attention by becoming a major global health threat. We encountered one case of SARS-CoV-2 and pulmonary tuberculosis (TB) coinfection which has not been frequently reported. A 76 year old female presented with acute respiratory symptoms superimposed on chronic symptoms, suggestive to have pneumonia. Oropharyngeal throat swab sample for SARS-CoV-2 infection was positive as detected by real-time reverse-transcriptase–polymerase-chain-reaction (RT-PCR) assay. Sputum smear staining was positive for acid fast bacilli. Clinicians should suspect coinfection with pulmonary TB while treating Coronavirus disease 2019 (COVID-19) during ongoing pandemic as therapeutic strategies need to be determined accordingly to improve outcome and prevent transmission in community.

Implications of COVID-19 in high burden countries for HIV/TB: A systematic review of evidence

“…This needs careful interpretation due to a wide overall 95% CI as well as due to studies with different designs. This evidence is supported by two large cohort studies conducted in Spain and South Africa, showing that the risks for PCR-con rmed COVID-19 diagnosis, hospitalization, Intensive Care Unit (ICU) admission, and death among HIVpositive persons receiving ART were greater in men compared to old age [42][43][44][45][46][47][48]. However, the risk for hospitalization varied by the nucleoside transcriptase inhibitor (NRTI) regimen and was lower in patients receiving TDF/FTC versus those receiving other regimens [42][43][44][45][46][47][48].…”

“…Each article that met selection criteria was fundamentally assessed for Author/Country, Population/Study design, Exposures, Comparators, Treatments, TB occurrence and SARS/MERS/COVID-19 severity, recovery and mortality rate. [28][29][30][31], one case control study [32] and four case series [33][34][35][36] were conducted in China, two case series [37][38] were done in Singapore, one case series [39] and one case control study [40] were undertaken in Saudi Arabia, a case series [41] was conducted in Italy, one cohort study was done in South Africa [42] and another in the Philippines [43], one case study was conducted in the United State of America [44], other three case studies were found in Turkey [45], Hong Kong [46] and India [47] respectively.…”

“…SARS-CoV and HIV may decrease conjunctly CD4 count and lymphocytes, adding high corticosteroids [33] as a treatment for SARS-CoV may be TB precipitant factors [33]. Following this, SARS-CoV or COVID-19 patients may-be more susceptible to active and latent TB as proven by different studies [27,33,[44][45][46][47]. It is important to realize that lung lesions due to SARS and/or TB may increase signi cantly the likelihood of SARS-CoV and TB.…”

“…Eight out of fourteen had severe/critical disease course among which one case of SARS-CoV, one of MERS-CoV and six cases of COVID-19 and had a long recovery process. SARS-CoV or COVID-19 cases with PTB co-infection: Seven studies (an observational study, two case series and four case studies) [27,33,35,[44][45][46][47] diagnosed PTB (positive acid-fast bacilli smear on sputum samples or IGRA), while cases were admitted for SARS-CoV (two cases) and COVID-19 (twelve cases). SARS-CoV and COVID-19 were con rmed by RT-PCR, and microscopy as well as medical imaging diagnosed TB.…”

Implications of COVID-19 in high burden countries for HIV/TB: A systematic review of evidence

“…Each article that met selection criteria was fundamentally assessed for Author/Country, Population/Study design, Exposures, Comparators, Treatments, TB occurrence and SARS/MERS/COVID-19 severity, recovery and mortality rate. [28][29][30][31], one case control study [32] and four case series [33][34][35][36] were conducted in China, two case series [37][38] were done in Singapore, one case series [39] and one case control study [40] were undertaken in Saudi Arabia, a case series [41] was conducted in Italy, one cohort study was done in South Africa [42] and another in the Philippines [43], one case study was conducted in the United State of America [44], other three case studies were found in Turkey [45], Hong Kong [46] and India [47] respectively. Lastly, a retrospective cohort was undertaken in eight countries (Italy, Belgium, Brazil, France, Russia, Singapore, Spain, and Switzerland) [27].…”