Pulmonary Tuberculosis and COVID-19 Coinfection: Hickam's Dictum Revisited

13 Pages Posted: 18 Feb 2022

See all articles by Larry Ellee Nyanti

Larry Ellee Nyanti

Universiti Malaysia Sabah

Zhun Han Wong

affiliation not provided to SSRN

Benjamin Sachdev Manjit Singh

affiliation not provided to SSRN

Andrew Kean Wei Chang

affiliation not provided to SSRN

Ahmad Tirmizi Jobli

Universiti Malaysia Sarawak (UNIMAS)

Hock Hin Chua

Sarawak General Hospital

Abstract

Background: COVID-19 and pulmonary tuberculosis (PTB) co-infection is associated with poorer outcomes and presents a unique diagnostic challenge to the clinician. PTB is endemic in the state of Sarawak, Malaysia. We describe three cases of newly diagnosed PTB in COVID-19 patients treated at our centre and their clinical and radiological features. The challenges associated with diagnosis and management of pulmonary TB and COVID-19 co-infection are also explored.

Case presentations: Patient 1 was a case of smear positive, endobronchial tuberculosis incidentally diagnosed due to CT changes, and eventually made good recovery. Patient 2 was a case of COVID-19 who succumbed but was diagnosed posthumously due to a positive sputum culture for tuberculosis. Patient 3 showed radiographic features of pulmonary tuberculosis and was treated empirically for TB.

Conclusions: In COVID-19 patients living in TB-endemic regions, TB should be suspected in the presence of constitutional symptoms, prior immunocompromised states, prior chronic respiratory symptoms, persisting pyrexia, unresolved radiological abnormalities, or a prolonged dependence on oxygen supplementation. Empirical ATT may be considered for highly suspicious cases.

Note:
Funding: None.

Declaration of Interests: The authors declare that no funding was used for the publication of this manuscript.

Patient Informed Consent Statement: This case series was registered via National Medical Research Register Malaysia (NMRR ID: NMRR ID-21-02248-OBB). Written consent was obtained from the patients for publication of this case series and accompanying images.

Keywords: COVID-19, Pulmonary Tuberculosis, Co-infection, Endobronchial Tuberculosis, Case Series

Suggested Citation

Nyanti, Larry Ellee and Wong, Zhun Han and Sachdev Manjit Singh, Benjamin and Chang, Andrew Kean Wei and Jobli, Ahmad Tirmizi and Chua, Hock Hin, Pulmonary Tuberculosis and COVID-19 Coinfection: Hickam's Dictum Revisited. Available at SSRN: https://ssrn.com/abstract=4038006 or http://dx.doi.org/10.2139/ssrn.4038006

Larry Ellee Nyanti (Contact Author)

Universiti Malaysia Sabah ( email )

P.O. Box 80594
Jalan UMS
Kota Kinabalu, 88999
Malaysia

Zhun Han Wong

affiliation not provided to SSRN ( email )

No Address Available

Benjamin Sachdev Manjit Singh

affiliation not provided to SSRN ( email )

No Address Available

Andrew Kean Wei Chang

affiliation not provided to SSRN ( email )

No Address Available

Ahmad Tirmizi Jobli

Universiti Malaysia Sarawak (UNIMAS) ( email )

94300 Kota Samarahan
Sarawak, Sarawak 94300
Malaysia

Hock Hin Chua

Sarawak General Hospital ( email )

Malaysia

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