Tuberculosis and COVID 19: An epidemic submerged in the pandemic: A case series from Eastern India

Abstract

Purpose: The COVID-19 pandemic caused by the novel SARS-CoV-2 has spread globally causing over eighteen million positive cases and about half-a-million deaths. During the ongoing pandemic, TB diagnosis might be missed or delayed due to similar clinical presentation. While TB-COVID 19 co-infection is uncommon and might be purely incidental; a higher mortality of 12.3% in cases of co-infections is alarming especially in patients with co-morbidities. With resources being diverted towards COVID and fear of handling sputum, TB control has spiralled to what it was a decade ago. Here we are reporting a case series of SARS-CoV– TB co-infection from Eastern India. Methods & Materials: Nasal swab was collected for the diagnosis of COVID -19 and RT-PCR done for the suspected cases. Sputum/ pleural tissue samples were collected from hospitalised suspected patients who did not improve clinically or developed atypical radiological picture and were subjected to staining, Xpert MTB/Rif assay (CBNAAT). Samples that were positive for acid fast bacilli (AFB) and MTB DNA by CBNAAT were considered as Mycobacterium tuberculosis complex. Results: There were four cases of SARS-CoV 2–TB co-infection from our hospital. Two patients presented with COVID-19 before the diagnosis of TB, one with both infections occurring in same week, and one patient with TB followed by COVID-19. Conclusion: We screened the admitted patients who didn't improve clinically and having atypical radiographic pictures. As both the diseases have respiratory symptoms predominantly, but TB takes longer time to develop we might have missed many patients with tuberculosis. It is important to screen patients of TB for COVID 19 and not to miss the possibility of coexistence of both diseases, especially in high-risk individuals.