Activation of tuberculosis in recovered COVID-19 patients: a case report

Abstract

Introduction and Importance: Currently, coronavirus disease 2019 (COVID-19) and tuberculosis (TB) are among the most important causes of respiratory infections around the world. Both of them are sources of concern for human health and life safety. COVID-19 caused the deaths of millions of people, and many of them suffered from what has become known as ‘post-COVID squeal’. Immunosuppression is one of the most important of these symptoms that leave patients susceptible to severe infections like TB. Case Presentation: In these two cases, the authors observed the development of active TB after a period of COVID recovery. Two patients who were admitted to the hospital complained mainly, among other symptoms, of fever and a continuous cough after a period of COVID-19 recovery. Clinical Discussion: Radiological examination revealed a caving density in the two cases, and the Gene-Xpert test proved the presence of Mycobacterium tuberculosis bacteria despite the negative result of the Ziehl–Neelsen stain. The two patients were improved after standard TB treatment. Conclusion: Patients with post‐COVID‐19 chronic respiratory symptoms should be screened for TB, especially in TB-endemic areas, even though the result of the Ziehl–Neelsen stain was negative.

Disseminated tuberculosis after Polatuzumab‐Vedotin based chemoimmunotherapy in a patient with Burkitt's lymphoma

“…A previous case report reported that two patients, aged 68 and 58 years, were subjected to TB reactivation after COVID‐19 infection 24 . It has been highlighted that post‐COVID‐19 tuberculosis signs and symptoms may be neglected because of similarities in clinical presentations 24 . Also, COVID‐19 treatment protocols expose patients to the risk of TB reactivation due to the excessive use of corticosteroids 23,24 .…”

“…COVID‐19 plays a role in provoking a cytokine storm and exhaustion of T cell lymphocytes 23 . A previous case report reported that two patients, aged 68 and 58 years, were subjected to TB reactivation after COVID‐19 infection 24 . It has been highlighted that post‐COVID‐19 tuberculosis signs and symptoms may be neglected because of similarities in clinical presentations 24 .…”

“… 24 It has been highlighted that post‐COVID‐19 tuberculosis signs and symptoms may be neglected because of similarities in clinical presentations. 24 Also, COVID‐19 treatment protocols expose patients to the risk of TB reactivation due to the excessive use of corticosteroids. 23 , 24 This lasting immunosuppression was evident in this patient's immunology workup (15 months after the last PBR), which showed persistent B‐cell and T‐cell depletion.…”

“… 24 Also, COVID‐19 treatment protocols expose patients to the risk of TB reactivation due to the excessive use of corticosteroids. 23 , 24 This lasting immunosuppression was evident in this patient's immunology workup (15 months after the last PBR), which showed persistent B‐cell and T‐cell depletion. However, this workup cannot provide a definite answer as to whether this persistent immunosuppression is the result of rituximab, PV, their combination, disease nature, heavy pre‐treatment, or COVID‐19 infection.…”

The impact of prior SARS-CoV-2 infection on host inflammatory cytokine profiles in patients with TB or other respiratory diseases

“…Therefore, it is reasonable to assume that Mtb and SARS-CoV-2 infections synergistically lead to poorer outcomes, potentially through immune dysregulation as found with previous viral-TB co-infections. Interestingly, emerging clinical and epidemiological data suggest that COVID-19 infection increases susceptibility to TB ( 20 , 21 ). Nonetheless, the immunological mechanisms behind these findings remain unclear, probably due to the novelty of SARS-CoV-2 and the indistinguishable symptoms of TB and COVID-19, leading to underreporting of cases.…”