Pulmonary Tuberculosis and COVID-19 Coinfection: Hickam's Dictum Revisited
13 Pages Posted: 18 Feb 2022
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: Suggested Citation