A Case of Pleural Tuberculosis vs Latent Tuberculosis Reactivation as a Result of COVID-19 Infection and Treatment.

The reactivation of latent tuberculosis occurs when a patient living with Mycobacterium tuberculosis enters a state where the immune system is suppressed. Since early 2021, the standard of care has been to provide corticosteroids in patients with COVID-19 infection in hospitalized patients receiving supplemental oxygen or mechanical ventilation. The immunomodulatory effects of corticosteroids are potentially detrimental for patients with latent vs active tuberculosis, with concomitant SARS-CoV2 infection. We present one of the first few cases in the literature detailing a case of reactivation of latent tuberculosis vs. pleural tuberculosis as a consequence of COVID-19, and who underwent subsequent corticosteroid treatment.

Update on Adult Vaccinations in the ED with a Focus on SARS-CoV-2/COVID-19

* Emergency departments have a unique role in public health. They care for a disproportionate number of patients who lack access to care in other venues. Emergency departments currently provide tetanus vaccines to millions of patients per year. Many emergency departments are expanding their role to provide COVID-19 vaccine to patients who might not receive it otherwise. Such programs can be carried out without interfering with emergency care for that patient or others in the department. * Emergency departments also can play a role in decreasing vaccine hesitancy, providing information to patients on the vaccine, answering their questions, and correcting misinformation when it is present. * Most of the side effects associated with the COVID-19 vaccines are mild — one to two days of fever, headache, or fatigue. These are most common on the second shot of those vaccines that require two injections. A very rare but serious side effect has been described four to 30 days following the Johnson & Johnson or AstraZeneca vaccines. Vaccine-induced thrombotic thrombocytopenia is similar in many ways to heparin-induced thrombocytopenia. It presents with signs of significant thrombosis, such as central venous sinus thrombosis. Heparin should be avoided. Platelet transfusion may increase clotting, and the physician should consider the risk/benefit to the patient. Patients can receive treatment with intravenous immune globulin and a non-heparin anticoagulant. * Emergency departments should consider vaccine programs for other immunizations depending on their patient population and the local access to other sites. Many emergency departments provide influenza vaccine and some hepatitis A vaccine to specific high-risk populations.