Pulmonary Tuberculosis in Post COVID-19 Patients: Occurrence and Clinical Profile

Abstract

Background: Tuberculosis continues to be a major public health disease to date. The mortality of this disease, which was reducing till 2019, was reversed in 2020 and 2021, as per the global tuberculosis report 2022. The novel coronavirus disease 2019(COVID-19) pandemic has af-fected tuberculosis management in various aspects. The transient immunosuppression associated with the disease and the treatment modality has been speculated to activate latent tuberculosis infec-tion as well as increase the infection risk with Mycobacterium Tuberculosis. Objective: The aim of this study was to analyze the clinical characteristics of post-COVID-19 pul-monary tuberculosis patients. Methods: We conducted a retrospective descriptive analysis of post-COVID-19 patients admitted from January 2021 to May 2022 with persistent or new-onset respiratory symptoms. The occurrence of pulmonary tuberculosis in these patients and their clinico- demographic details are summarized. Results: About 31(19.4%) of 160 post-COVID-19 patients with respiratory symptoms were diag-nosed to have pulmonary tuberculosis. About 21(67.7%) had comorbidities, of which the predomi-nant was diabetes mellitus in 14(45%) patients, and the majority (85%) had poorly controlled blood sugar levels. None of the patients had a history of contact with a pulmonary tuberculosis patient in the previous 2 years, but 4(13%) patients had a previous history of tuberculosis. Moreover,.66% of cases had a history of moderate and severe COVID-19 disease, and 70% had received systemic cor-ticosteroids and other immunosuppressive drugs like tocilizumab during the COVID-19 illness treatment. More than 50% of the patients had negative smears for acid-fast bacilli and were diag-nosed using rapid molecular methods like CBNAAT and LPA. Drug-resistant tuberculosis was seen in 6(19%) patients. 4(13%) patients died during the hospitalized course of treatment, and the re-maining 27(87%) were discharged with antituberculous treatment, but their final outcome is un-known. Conclusion: A high index of suspicion and use of rapid molecular diagnostic methods is indicated in post-COVID-19 patients with respiratory symptoms for early diagnosis of tuberculosis and pre-vention of community transmission. Identification of post-COVID-19 patients with latent tuberculo-sis infection and the feasibility of advocation of tuberculosis preventive therapy in such patients, es-pecially those with other risk factors like diabetes mellitus, need to be considered.