ABSTRACT
Introduction: One of the major challenges in hospitalized patients for Tuberculosis has been the association with the nosocomial SARS CoV2 infection. Both, viral infection and tuberculosis are affecting directly the immune response of the host with paraclinical expression - nonspecific inflammatory syndrome. Objective : Dynamic monitoring of the inflammatory syndrome in hospitalized patients with active TB that could suggest a superinfection with SARS CoV2 that requires the repeating of specific test. Method(s): We performed a comparative observational study on 45 patients, 25 diagnosed with TB and 25 with TB and co-infection with SARS CoV2, hospitalized in the Clinical Hospital of Pneumophthysiology Constanta for a 3 months period. At admission, all patients had a negative RT PCR COVID 19 test. The evolution of inflammatory tests was compared. Result(s): In the group with tuberculosis, the average values of ESR, CRP, Fibrinogen were 59.99 mm/h, 96 mcg/l, respectively 578 mg/dl. In the TB-COVID 19 group, blood tests were performed on average at 72-96 hours. We found a rapid increase in inflammatory syndrome between the first 2 sets of blood tests from the diagnosis of COVID 19 (ESR max 105mm/h, Fibrinogen-max 620mg/dl, CRP-max192mcg/l). Approximately 10 days after the diagnosis of COVID 19, after combined antiTB and antiviral treatment, there was a regression of the inflammatory syndrome to the values before co-infection(ESR=61mm/h, Fibrinogen=535mg/dl, CRP=84mcg/l). Conclusion(s): The increase in inflammatory markers during anti-tuberculosis treatment could be an alarm signal for the onset of COVID19 nosocomial infection in the event of a pandemic with OMICRON.
ABSTRACT
SARS-CoV-2 is a new virus belonging to the Betacoronaviruses genus, from the Coronavirus family. The main clinical symptoms encountered in COVID 19 are fever, cough and shortness of breath and they have been affecting more than 80% of patients. Compared to the patients that are infected with MERS Co-V or SARS-Co-V, where diarrheal syndrome was present in approximately 25% of cases, in SARS-Co-V 2 infection, diarrhea syndrome is present in less than 10% of cases. Clinical case: A 59-year-old patient, smoker, known to have a history of cardiovascular disease and type II Diabetes, presented to the emergency unit with fever, productive mucopurulent cough and multiple diarrhea stools. Pulmonary radiography was performed and showed multiple oval opacities with a tendency to confluence disseminated basally bilateral. A RT-PCR SARSCo-V-2 test was performed with a positive result. The patient was admitted to the hospital and received specialized treatment during which the previous symptoms gradually recovered, including diarrhea syndrome. After 4 days of treatment, the diarrhea of the stools reappeared, and it was decided to investigate for Clostridium Difficile. The test proved to be positive. Treatment was established according to the protocol with favorable clinical and biological evolution. Conclusions: The newly diagnosed diarrhea syndrome in a hospitalized patient should constantly raise the suspicion of a Clostridium Difficile infection, which may worsen the prognosis of patients infected with SARS-CoV-2. © 2021 Ionu Valentin Stanciu et al., published by Sciendo.