A 28-Year-Old Man from India with SARS-Cov-2 and Pulmonary Tuberculosis Co-Infection with Central Nervous System Involvement

Abstract

Patient: Male, 28-year-old Final Diagnosis: COVID-19 • tuberculosis Symptoms: Dizziness • headache • vomiting Medication:— Clinical Procedure: Craniectomy Specialty: Infectious Diseases • Neurology • Pathology Objective: Rare co-existance of disease or pathology Background: Tuberculosis (TB) is a great mimic of central nervous system (CNS) tumors. This mimicry may pose a challenge, as the management of both diseases is quite different. Furthermore, the temporal association of initiating treatment affects prognosis. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mainly infects the pulmonary system. However, in a patient with concomitant pulmonary tuberculosis, it can be a diagnostic challenge. Case Report: A 28-year-old man of Indian origin presented with headache and vomiting. He had a brain mass on imaging suggestive of a glioma. He also had lung infiltrates and was diagnosed with a co-infection by SARS-CoV-2, by a reverse-transcription polymerase chain reaction (RT-PCR) using the GeneXpert system. The mass was excised and was found to be a tuberculoma, diagnosed by Xpert MTB. He received first-line anti-TB and treatment for COVID-19 pneumonia based on local guidelines. Conclusions: This report highlights that COVID-19 can co-exist with other infectious diseases, such as TB. A high degree of clinical suspicion is required to detect TB with atypical presentation. A co-infection of pulmonary and CNS TB with COVID-19 can present a diagnostic challenge, and appropriate patient management relies on an accurate and rapid diagnosis. Surgery may be necessary if there are compressive signs and symptoms secondary to CNS TB. A diagnosis of COVID-19 should not delay urgent surgeries. Further studies are needed to understand the effects of COVID-19 on the clinical course of TB.

Covid-19 e tuberculose: coinfecção e riscos

“…Quando solicitados exames de imagem, o principal método utilizado foi a tomografia computadorizada (TC) de tórax que mostrou nos pacientes uma sobreposição geralmente bilateral de achados de ambas as condições, como a árvore em brotamento, cavidades ou consolidações da tuberculose com o padrão em vidro fosco ou espessamento intersticial do COVID-19 (Luciani et al 2020;Motta et al 2020;Sarinoglu et al 2020;Tham, et al 2020;Yao et al 2020). O raio X (RX) de tórax também apresentou achados de ambas as patologias, como cavitações, opacificações e derrame pleural (Ata et al 2020;Sarinoglu et al 2020;Tham, et al 2020;Yousaf et al 2020). Nenhum dos trabalhos analisou se o padrão de imagem da TC ou do RX de tórax dos pacientes coinfectados era mais grave que o de pacientes apenas com COVID-19.…”

“…Dois autores relataram complicações neurológicas em pacientes coinfectados (Ata et al 2020;Freij et al 2020) que demandaram intervenção neurocirúrgica. A literatura aponta que os coronavírus apresentam potencial neuroinvasivo e mesmo na ausência de coinfecção por TB podem cursar com sintomas neurológicos como cefaleia, tontura, hiposmia e acidente vascular encefálico isquêmico ou hemorrágico (Freij et al, 2020).…”

“…A duração da hospitalização dos pacientes no estudo de Yao et al (2020) foi de 22 a 27 dias, similar ao encontrado por Ata et al (2020) que foi de 28 dias e Grenho et al (2020), que foi de 10 dias em análise retrospectiva de pacientes internados infectados pelo SARS-CoV-2 com outras morbidades exceto a TB. Quanto maior o tempo de internamento maior o risco de iatrogenias e infecções secundárias, o que pode levar a um aumento da letalidade da doença nesses pacientes.…”

Clinical Characteristics, Diagnosis, Treatment, and Mortality Rate of TB/COVID-19 Coinfectetd Patients: A Systematic Review

“…Bacterial coinfection is a common problem in COVID-19 patients (11). During the outbreak of COVID-19, many cases of TB/COVID-19 coinfection were reported (12)(13)(14)(15)(16). Some studies reported death in coinfected patients with TB and COVID-19 (16)(17)(18).…”

The microbiota-related coinfections in COVID-19 patients: a real challenge

“…Calcagno and coworkers reported coinfections with other respiratory pathogens such as Staphylococcus aureus, Morax-Pseudomonas aeruginosa along with S. pneumoniae, S. aureus and Klebsiella pneumoniae were diagnosed. Also, mycobacterium tuberculosis coinfection was observed in COVID-19 patients[41][42][43], although such coinfections reportedly do not frequently occur. Mohamed and coworkers reported multi-triazole resistant Aspergillus fumigates coinfection in respiratory samples and suggested that early diagnosis would help to understand the antifungal therapy to improve the diseases condition[45].…”