Infection and Drug Resistance (Dec 2023)

Drug-Resistant TB, HIV and COVID-19 Co-Infection: Case Reviews from Kwa-Zulu Natal, South Africa

  • Hassan-Moosa R,
  • Motsomi KW,
  • Narasimmulu R,
  • Sivro A,
  • Naidu KK,
  • Kharsany ABM,
  • Samsunder N,
  • Perumal R,
  • Naidoo K

Journal volume & issue
Vol. Volume 16
pp. 7663 – 7670

Abstract

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Razia Hassan-Moosa,1,2 Kegaugetswe Wilhemina Motsomi,1 Radhamoney Narasimmulu,1 Aida Sivro,1,3– 5 Kevindra K Naidu,1 Ayesha BM Kharsany,1,3 Natasha Samsunder,1 Rubeshan Perumal,1,2 Kogieleum Naidoo1,2 1Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa; 2MRC-CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa; 3Department of Medical Microbiology, University of KwaZulu-Natal, Durban, South Africa; 4JC Wilt Infectious Disease Research Centre, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada; 5Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, MB, CanadaCorrespondence: Kegaugetswe Wilhemina Motsomi, Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal Nelson R Mandela School of Medicine, Private Bag X7, Congella, Durban, 4013, South Africa, Email [email protected]: Coronavirus disease (COVID-19) potentially exacerbates drug-resistant tuberculosis (DR-TB). We describe the clinical presentation and outcomes of three patients with human immunodeficiency virus (HIV), DR-TB and COVID-19.Case One: A virologically suppressed 31-year-old man on antiretroviral therapy (ART) and multidrug-resistant (MDR)-TB treatment presented with mild COVID-19 and was hospitalised for 10 days of clinical monitoring, despite being clinically stable with normal baseline inflammatory markers. Severe acute respiratory syndrome coronavirus polymerase chain reaction (SARS-CoV-2 PCR) positivity persisted at Day 28.Case Two: A virologically suppressed 37-year-old woman on ART and MDR-TB treatment presented with moderate COVID-19. Baseline inflammatory markers were raised, and dexamethasone and azithromycin were initiated with good clinical improvement. SARS-CoV-2 PCR positivity persisted at Day 28.Case Three: A viraemic 24-year-old woman on second-line ART and MDR-TB treatment, presented with mild COVID-19 disease, normal oxygenation and normal inflammatory markers, and remained clinically stable with negative SARS-CoV-2 PCR at Days 14 and 28.Conclusion: Screening for SARS-CoV-2 infection is advised for DR-TB patients with new or worsening respiratory symptoms.Keywords: HIV, DR-TB, COVID-19, case reviews, screening, transmission

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