ABSTRACT
Intro: Tuberculosis (TB) is an ancient disease in Malaysia and the arrival of COVID-19 has driven TB into an unknown that possibly creates hidden threats to public health. Recently, TB is identified as a socially influenced disease transmitted through people that are easily mobile and dynamically connected. It is critical to develop a data-driven geospatial-based modelling to map tuberculosis (TB) cases in Malaysia for boosting early detection. Method(s): We conducted a retrospective review of TB notified cases in Kuala Lumpur, Malaysia, between the years 2020 and 2021. The data was retrieved from the MyTB database and TB cases trends were examined against the five main series of 2020-2021 Malaysia Movement Control Order (MCO). The examination was extended to the study of social demographic and disease profiles. Locality, sub-locality, and housing type were investigated to measure hotspots in Kuala Lumpur. Finding(s): The number of patients with pulmonary TB (PTB) was high where 51% of them are smear positive and contributed majorly by male dominants. Cases with diabetes tend to be dominated by positive smear PTB that is close to 80%. There is a relatively strong trend that cases diagnosed with diabetes are in the non-smokers group and almost equally distributed between men and women, although the remaining cases are succeeded by men at the rate of 98% as opposed to women. Conclusion(s): The review of Kuala Lumpur TB notification between 2020 and 2021 is presented in this study providing a glance at a retrospective view of TB case notification in the era of the pandemic COVID-19. There are 188 cases per 100,000 population within the area of Kuala Lumpur and several important examinations were conducted to understand the underlying insights of notified TB cases. Several areas have been identified as hotspots according to geospatial modelling to allow targeted TB prevention activities at the community level.Copyright © 2023
ABSTRACT
Mycobacterium indicus pranii (MIP) earlier known as Mw is a soil-borne, non-pathogenic, saprophytic and rapidly growing strain of mycobacteria. MIP is approved as a vaccine/ immunomodulator for various indications including mycobacterium infections like leprosy in humans. Its administration has resulted in satisfactory clinical improvement, accelerated bacillary clearance, and increased immune responses to Mycobacterium leprae antigens, thereby shortening the full recovery time of the patients. It also shares its antigens with M.tuberculosis. In the last decade, RCTs have been done establishing immunotherapeutic properties of MIP in the treatment of leprosy, tuberculosis, warts and experimently in leishmaniasis. Through its immune inducing and cytotoxic property, it has also proved beneficial for human use especially in treating lung cancer. The beneficial role of it is also being explored in breast, cervical, oral, liver, and bladder cancers. Various studies on MIP have shown that it has immune-modulating properties in humans. The curiosity of the human mind has led to it being tried in Covid treatment trials. The results have shown that administering MIP has lowered inflammatory markers in Covid 19 patients, promising us for it to be a potential treatment option. More RCTs with a larger sample size should be done to establish this. Cytokine storm seen in bacterial sepsis is also decreased with MIP administration. Considering the encouraging results in hastening recovery in various diseases it appears that MIP is perhaps not being exploited to its fullest potential. © 2023, Hind Kusht Nivaran Sangh (Indian Leprosy Association). All rights reserved.
ABSTRACT
Tubercuiosis is still a significant problem worldwide. Until the COVID-19 pandemic, tuberculosis was the leading cause of mortality from a single infectious agent. Pulmonary Tubercuiosis patients are more tending to be co-infected with COVID-19 notably when they have a history of exposure. There are some case reports relating to pulmonary TB and COVID-19 coinfection but the information about TB and COVID-19 was still little. We report three coinfected patients. Case one and two were both middle-aged Iranian mans with history of opium addiction, case one presented with dyspnea and weakness and case two presented with progressive weakness. Case three was a healthy young man with history of progressive dyspnea, productive cough and hemoptysis. Case one and case three were improved. In conclusion, COVID-19 is still an important issue and can coexist with other lung infections such as Pulmonary Tubercuiosis, so we should be aware of the advancement of the Tubercuiosis epidemic after the COVID-19 pandemic.Copyright © 2023 Tuberculosis Association of India
ABSTRACT
Tuberculosis (TB) remains a significant health and public issue in many countries. Its incidence and mortality have been decreasing in many countries. The recent COVID-19 could have significant impacts on the transmission and health care for this chronic disease by obligatory facial masking and by affecting healthcare capacities. WHO global tuberculosis in 2021 reported that the TB incidence would rebound at the end of 2020 during COVID-19 pandemic. We wondered if this phenomenon could have existed in Taiwan. We asked whether the trend of TB incidence and mortality would be affected by the COVID-19 epidemic due to their common air transmission route. We also asked whether the incidence of TB in regions with different COVID-19 incidences would be similar. We obtained the yearly new cases of TB and multidrug-resistant TB through Taiwan CDC and estimated the incidence and mortality by the population numbers in 7 administrative regions in Taiwan from 2010 to 2021. The result showed that incidences of TB in recent 10 years show a continuously decreasing trend, even amid the COVID-19 pandemic in 2020-21. Surprisingly, in the low COVID-19 incidence regions of Taiwan, the incidence of TB remained high during the COVID-19 pandemic. We concluded that the decreasing trend of incidence and mortality of TB does not change during the COVID-19 epidemic in Taiwan. The mask-wearing and social distancing could prevent the transmission of COVID-19, however, their effect on the limiting spread of TB may be limited. The health policy decision should take the consideration of the TB rebound, even in the post-COVID-19 era.Copyright © 2023
ABSTRACT
We present a literature review of dermatology features in historical pandemics. A pandemic is an epidemic occurring worldwide, or over a very wide area, crossing international boundaries and affecting a large number of people. Smallpox was the first documented pandemic, around 10 000 BC, spread by the inhalation of airborne droplets. A few days after an initial high fever, headache and fatigue, a mucocutaneous maculopapular eruption appeared, which then developed pustules and erosions. The last outbreak occurred in the USA in 1949. Smallpox was eradicated in 1980, following a vaccination programme. Mycobacterium tuberculosis is the causative agent of tuberculosis (TB), an ongoing global pandemic. The earliest documentations were 3300 years ago. In 2020, the World Health Organization (WHO) provisionally estimated 1.5 million deaths globally. Most commonly affecting the lungs, cutaneous TB may present with inflammatory papules, plaques, suppurative nodules and chronic ulcers. Requiring long, complex antibiotic regimens, multidrug resistant TB is an increasing problem. Now extremely rare, yet still with recent outbreaks in 2021 in Madagascar, bubonic plague arrived in Europe in 1346 causing 75-200 million deaths. It is caused by the bacterium Yersinia pestis, transmitted through fleas that have fed on infected rodents. Clinical features include papules, pustules, ulcers and eschars, tender lymphadenopathy and systemic symptoms, and it responds to antibiotics. Syphilis, caused by the bacterium Treponema pallidum, is sexually transmitted. The first known outbreak was during warfare in 1494-5 in Naples, Italy. In 2020, the WHO estimated that, globally, seven million people had new infections. Primary syphilis typically produces a painless, genital ulcer (or chancre). Secondary syphilis presents with a nonitchy, maculopapular erythema over the trunk, palms and soles. Early recognition and antibiotic treatment usually lead to good outcomes. Estimated by the WHO to affect 37.7 million people in 2020, HIV is thought to have mutated from simian immunodeficiency virus by the 1960s in sub-Saharan Africa, spreading to the Caribbean and USA by the late 1960s. Initial symptoms include a fever, headache and lymphadenopathy. Dermatological features are common, including opportunistic cutaneous infections, nonspecific exanthemas, seborrhoeic dermatitis and Kaposi sarcoma. Advances in antiretroviral therapies mean people with HIV can have an excellent prognosis, although the WHO estimated in 2020 that more than 200 000 people with HIV died from concomitant TB. Since 2019, COVID-19 has had a considerable global impact on healthcare. With more than 300 million cases and 5.5 million deaths to date, some services have been overwhelmed owing to large case numbers, variable vaccine uptake, workplace changes to reduce transmission and staff shortages. Cutaneous features include perniosis, urticarial, purpuric, vesicular or maculopapular eruptions. Pandemics throughout history have been repeatedly shown to present with an element of skin involvement. We can utilize this to promote education and early recognition of these features, to facilitate diagnosis and raise awareness of the potential complications of serious diseases.
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Background: COVID-19 pandemic had led to varied psychological distress among Pulmonary Tuberculosis (PTB) patients. An early assessment of knowledge and attitude of the patient towards COVID-19 can aid us in their psychological counselling and healthy well-being during the ongoing treatment. Aims and objectives: To assess the knowledge and attitude towards COVID-19 of Pulmonary Tuberculosis patients during the pandemic. Method(s): This cross-sectional, hospital-based study included 361 PTB patients. A semi-structured pre-defined questionnaires (designed by D. Roy et al.,) using a non-probability snowball sampling technique was done to evaluate knowledge and attitude related to COVID-19 in PTB patients. Result(s): Among the 361 of the Pulmonary Tuberculosis patients, 69% (n=250) had Drug Resistance PTB (DR-TB). Younger age group, 18 to 30 years constituted majority of the study subjects i.e.,61% (n=220). With the help of Likert scaling the trend of knowledge and attitude of COVID-19 in PTB patients were analysed. In our study most of the patients was well versed about COVID-19 pandemic and showed peak of favourable response during the 1st wave (from May 2020- July 2020) and in the initiation of 2nd wave (from March 2021-April 2021). Among DR-TB patients 51% (n=126) had satisfactory knowledge about COVID-19 pandemic. About 52%(n=130) of DR-TB patients had optimistic attitude toward COVID-19. Conclusion(s): As PTB, itself is a devastating disease, proper management & psychosocial support of such patients should be one of the prime issues. It can also assist us to formulate mitigation protocol in our near future.
ABSTRACT
Background: The impact of SARS-CoV-2 infection in Africa is still unclear. Objective(s): Study the diseases associated with COVID-19 morbidity and mortality in Luanda, Angola. Method(s): A cross-sectional study was conducted with 1,683 patients >=18 years old, treated at the Military Hospital in Luanda, from March 2020 to March 2021. The survey includes sociodemographic and clinical data. The chi-square test, Fisher's exact test or logistic regression were performed and considered significant when p<0.05. Result(s): Patients who tested positive for SARS-CoV-2 (39%) were mostly men (64%), mean age 51.2+/-14.7 years. RT PCR positivity was associated with age >=46 years, arterial hypertension and other cardiovascular diseases (aOR:1.75;p<0.001) and Diabetes Mellitus (aOR:1.96;p<0.001) however, HIV infection (aOR:0.26;p<0.001), pulmonary tuberculosis (aOR:0.33;p=0.037) and its sequelae (aOR:0.34;p=0.025) were associated with a protective effect. There were no significant association between SARS-CoV-2 infection and asthma, allergic rhinitis, chronic obstructive pulmonary disease (COPD) or smoking. Of the 663 positive patients, 14% died. The main comorbidities significantly related to mortality were only malignant diseases (aOR:12.00;p=0.023). There were no significant association between COVID-19 mortality and HIV infection, pulmonary tuberculosis and its sequelae, asthma, allergic rhinitis, COPD, or smoking. Conclusion(s): Infectious diseases were associated with a protective effect for SARS-CoV-2 infection and were not associated with mortality, while chronic respiratory diseases were not associated with infection or mortality by COVID-19. Future studies should be carried out to better understand these aspects.
ABSTRACT
The international biomedical community has been currently facing a need to find a simple and most accessible type of analysis that helps to diagnose tuberculosis (TB) with the maximum reliability even before the onset of clinical manifestations. Tuberculosis results in more deaths than any other pathogen, second only to pneumonia caused by the SARS-CoV-2 virus, but the majority of infected people remain asymptomatic. In addition, it is important to develop methods to distinguish various forms of tuberculosis infection course at early stages and to reliably stratify patients into appropriate groups (persons with a rapidly progressing infection, chronic course, latent infection carriers). Immunometabolism investigates a relationship between bioenergetic pathways and specific functions of immune cells that has recently become increasingly important in scientific research. The host anti-mycobacteria immune response in tuberculosis is regulated by a number of metabolic networks that can interact both cooperatively and antagonistically, influencing an outcome of the disease. The balance between inflammatory and immune reactions limits the spread of mycobacteria in vivo and protects from developing tuberculosis. Cytokines are essential for host defense, but if uncontrolled, some mediators may contribute to developing disease and pathology. Differences in plasma levels of metabolites between individuals with advanced infection, LTBI and healthy individuals can be detected long before the onset of the major related clinical signs. Changes in amino acid and cortisol level may be detected as early as 12 months before the onset of the disease and become more prominent at verifying clinical diagnosis. Assessing serum level of certain amino acids and their ratios may be used as additional diagnostic markers of active pulmonary TB. Metabolites, including serum fatty acids, amino acids and lipids may contribute to detecting active TB. Metabolic profiles indicate about increased indolamine 2.3-di-oxygenase 1 (IDO1) activity, decreased phospholipase activity, increased adenosine metabolite level, and fibrous lesions in active vs. latent infection. TB treatment can be adjusted based on individual patient metabolism and biomarker profiles. Thus, exploring immunometabolism in tuberculosis is necessary for development of new therapeutic strategies.Copyright © 2022 Saint Petersburg Pasteur Institute. All rights reserved.
ABSTRACT
Background and purpose: There are limited studies on co-infection of COVID-19 and tuberculosis (TB). This study aimed to describe the clinical, radiological, laboratory characteristics, treatment and outcome of patients admitted with tuberculosis and COVID 19 co-infection. Material(s) and Method(s): In this retrospective study, we investigated all patients with either active TB or old TB and COVID-19 admitted to Qaemshahr Razi Teaching Hospital between 2020 and 2022. Result(s): A total of 9251 patients with COVID-19 were admitted to our hospital between February 2020 and May 2022. There were eight patients with pulmonary tuberculosis and COVID-19 co-infection, including five (62.5%) male patients. The mean age of these patients was 61.13+/-22.63 years old. The mean time of symptom onset to hospital admission was 15.13+/-30.56 days and 50% were diagnosed with active TB and other half had old TB. Four patients were admitted to the ICU, three of whom required ventilation. Finally, four (50%) patients deceased. In this study, among factors that influence patients' outcomes, only underlying diseases were significantly associated with death. Conclusion(s): Tuberculosis is assumed to cause a higher mortality risk in COVID-19 patients, especially in those with chronic underlying diseases.Copyright © 2023, Mazandaran University of Medical Sciences. All rights reserved.
ABSTRACT
The pandemic of COVID-19 is still rampaging all over the world, so it is urgent to popularize vaccination. Meanwhile, pulmonary tuberculosis is one of the chronic infectious diseases with a high incidence in China. Since these diseases all occur in lung tissue, patients with TB and COVID-19 co-infection show more serious conditions and poorer treatment effects. However, we have limited knowledge about the protective efficacy, immunogenicity and safety of COVID-19 vaccine in patients with TB at present, with a lack of corresponding evidence-based medicine as well. Therefore, this paper reviews the pathogenesis and epidemiology of TB, discusses the immune status of patients with TB and summarizes the existing proposals for vaccination of patients with TB at home and abroad. Furthermore, we analyze the existing clinical trials in TB patients and other special populations, and finally discuss the strategy of vaccination for patients with TB during the COVID-19 pandemic and the necessity of clinical research on COVID-19 vaccines with target population of TB patients.Copyright © 2022, Publication Centre of Anhui Medical University. All rights reserved.
ABSTRACT
Objective Mycobacterium tuberculosis is an immobile aerobic bacillus that causes tuberculosis (TB) disease. We aimed to evaluate the association between coronavirus disease 2019 (COVID-19), COVID-19-related drugs, TB reactivation, and TB incidence during the pandemic. Methods Eight patients who were diagnosed as having TB in Meram Medical Faculty, Necmettin Erbakan University between March 1, 2020, and December 31, 2021, at the beginning of the pandemic, were enrolled in this study. The presence of COVID-19 infection was confirmed using COVID-19 antibody tests and the patients' COVID-19 history. We evaluated the demographic data, laboratory findings, imaging tests, and pathology results of all patients. Results We checked all our patients with TB using COVID-19 antibodies (immunoglobulin [Ig]G + IgM) or polymerase chain reaction. Seven of the eight patients were female (87.5%). The median age was 16 years. Family screening of all patients was negative, and they had bacillus Calmette-Guerin vaccine scars. Two patients had chronic diseases. One was diagnosed as having primary ciliary dyskinesia in our department (patient no. 8) and the second was under follow-up by the rheumatology department with a diagnosis of juvenile idiopathic rheumatoid arthritis. Conclusion There has been an increase in the incidence of TB in children, especially in adolescents, during the pandemic period. This may be due to the pathogenic structure of the COVID-19 virus with an unknown mechanism. In addition, lifestyle changes and changes in health care policies during the pandemic may have caused this. Further research should be performed on this topic.Copyright © 2023 Authors. All rights reserved.
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Background: The evidence for management of severe COVID-19 with persistent respiratory failure (PRF) after acute treatment is scarce, despite some authors reported a good response to corticosteroid in histological proven secondary organising pneumonia (OP). Objective(s): This study aimed to study the disease course of COVID-19 patients with persistent respiratory failure, and its radiological pattern. Method(s): A single centre retrospective cohort study on severe COVID-19 patients was conducted from January 2021 to June 2021. All radiological imaging and data were retrieved from electronic database. Result(s): Severe COVID-19 pneumonia had a 78% (584/750) survival in our cohort. Among the survival, 48% (279/584) had PRF beyond 14 days of illness and 10% of them required oxygen therapy upon discharge. Eighty-six percent (240/279) of patients with PRF had a HRCT performed. Eighty percent (187/240) of them attended clinic follow up with 81% had a radiological pattern consistent with OP. The mean severity CT score was 10 (SD+/-3). [Jin C et al. Front Public Heal.2020;8] Seventy-eight percent of patients were perceived with WHO functional class of 1-2. Sixty-eight percent of patients (128/187) were given short course of prednisolone during admission with tapering doses. The mean prednisolone dose was 0.69mg/kg/day with a mean duration of 47 days (SD+/-18). Seventy-eight percent (146/187) had a follow up chest x-ray (CXR) at 12+/-8 weeks. Only 6.4% (12/187) of them had abnormal CXR findings whereby two patients were later confirmed to have pulmonary tuberculosis. Conclusion(s): Radiological pattern of OP is common in COVID-19 with PRF. HRCT is a non-invasive tool to assess this entity.
ABSTRACT
Introduction: The incidence of Tuberculosis(TB) is 4 times more in patients with Interstitial lung diseases(ILD). Active TB is considered as contraindication for lung transplant. We report a case of a patient with Idiopathic Pulmonary Fibrosis(IPF) with COVID 19 exacerbation who, while being bridged to transplant on ECMO, tested positive for Tuberculosis and underwent a bilateral lung transplantation. Case: 40 year old male, known case of IPF, admitted with severe COVID ARDS was evaluated and listed for Bilateral Lung transplantation. In view of acute deterioration, he was initiated on ECMO as a bridge to transplant. His Broncho Alveolar Lavage(BAL) showed AFB and CBNAAT confirmed Mycobacterium tuberculosis which was rifampicin sensitive. He was initiated on antitubercular drugs and subsequently underwent bilateral lung transplant. He was weaned off ECMO and his further BAL samples did not show evidence of M. Tb. He had a series of postoperative complications including Acute kidney injury, weaning failure and Acute coronary syndrome with LV dysfunction and eventually succumbed. Discussion(s): This case poses a unique ethical challenge of whether or not to proceed for transplant in patients who test positive for pulmonary tuberculosis while on waitlist and on ECMO as bridge to transplant. However, the unfavorable outcome of the transplant reinforces the available data that active tuberculosis is associated with high mortality in lung transplant. Further guidance is required to manage such patients to improve lung transplant survival rates, especially in TB endemic regions such as India.
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Introduction: In developing countries, Post renal-transplant infections is the leading cause of mortality, morbidity and decreased allograft survival. Our aims and objectives was to determine the incidence and prevalence patterns of clinically or microbiologically confirmed infection in the post renal transplant patients of our population and profiling of infections in relation to time period from the Transplant and the induction agent, also to develop strategies to counter risk of post transplant infection. Method(s): This was a retrospective observational study. Time period: January 2020- April 2022. Post renal transplant recipients presenting with infections (with informed consent) was enrolled in this study. Recurrent episodes of infection by different organisms in a same patient treated as a separate event. Data was tabulated using MS excel and all results projected in bar graphs, pie charts, histograms. Differences of quantitative parameters between groups were assessed using the t test(for data that were normally distributed) or nonparametric test (for data that were not normally distributed). Differences of qualitative results were compared using chi2 test. Kaplan-meier was used for survival analysis. P < 0.05 was considered significant. Result(s): 213 incidents of post renal transplant infections were documented in 148 patients between the study period. Of the 85 patients who underwent renal transplant(57 living donor and 28 cadaveric) in this time period 33(38.8%) patients presented with 42 incidents of infections. Majority (74.3%) : Males. Mean age: 36.3+/-5.6 years. Most common cause of native kidney disease was chronic glomerulonephritis(30%). 121 (81.7%) had living donor transplant and 27(8.3%) patients had cadaveric transplant. Induction agent was basiliximab in 97 patients (65.5%) had 133 infections (62.4%) and ATG was used in 51 patients (34.5%) had 80(37.6%) infections. In recent transplant (last 2 yrs) cases-In Basiliximab group: infection rate 4.1 in 100 patient months and in ATG group infection rate was 5.7 in 100 patient months. (p=0.28). 37.5%cases had infections with graft dysfunction most commonly AKI. Immediate post transplant infections (<1 month) were 34 (15.9%), most commonly UTI (44.11%) followed by pneumonia (15.9%). 48(%) infections occurred between 1-6 months, most commonly pneumonia(27.08%) followed by UTI(22.9%) and superficial fungal infection. Pulmonary tuberculosis was in 14 (6.6%) cases. 3 cases had disseminated TB. Infectious diarrhea was in 18(8.4%) cases, most common organism isolated was EAEC and EPEC. CMV colitis found in 3 cases. 27 (18.2%) patients had NODAT/PTDM. ParvoB19 was in 11(5.16%), CMV in 5 and BKVN in 3 cases. 41(19.2%) cases had severe sepsis requiring intensive care support. New baseline s.cr was achieved in 29.1% cases. Infection related death was 24(16.2%). COVID 19 infection was in 41 cases, 31.7% developed graft dysfunction and 18 (43.9%) required hospital admission due to moderate or severe disease. 2 patients had mucormycosis, one of them died after admission. [Formula presented] Conclusion(s): Profiling of infection in our centre is essential to formulate future strategies for infection control especially as the DDKT & ABOi KT is on the rise. Proper survillence, screening protocol, vaccination and patient education are essential to reduce the burden of post transplant infection and for better graft and patient survival. No conflict of interestCopyright © 2023
ABSTRACT
The pandemic of COVID-19 is still rampaging all over the world, so it is urgent to popularize vaccination. Meanwhile, pulmonary tuberculosis is one of the chronic infectious diseases with a high incidence in China. Since these diseases all occur in lung tissue, patients with TB and COVID-19 co-infection show more serious conditions and poorer treatment effects. However, we have limited knowledge about the protective efficacy, immunogenicity and safety of COVID-19 vaccine in patients with TB at present, with a lack of corresponding evidence-based medicine as well. Therefore, this paper reviews the pathogenesis and epidemiology of TB, discusses the immune status of patients with TB and summarizes the existing proposals for vaccination of patients with TB at home and abroad. Furthermore, we analyze the existing clinical trials in TB patients and other special populations, and finally discuss the strategy of vaccination for patients with TB during the COVID-19 pandemic and the necessity of clinical research on COVID-19 vaccines with target population of TB patients.
ABSTRACT
Background and purpose: There are limited studies on co-infection of COVID-19 and tuberculosis (TB). This study aimed to describe the clinical, radiological, laboratory characteristics, treatment and outcome of patients admitted with tuberculosis and COVID 19 co-infection. Materials and methods: In this retrospective study, we investigated all patients with either active TB or old TB and COVID-19 admitted to Qaemshahr Razi Teaching Hospital between 2020 and 2022. Results: A total of 9251 patients with COVID-19 were admitted to our hospital between February 2020 and May 2022. There were eight patients with pulmonary tuberculosis and COVID-19 co-infection, including five (62.5%) male patients. The mean age of these patients was 61.13±22.63 years old. The mean time of symptom onset to hospital admission was 15.13±30.56 days and 50% were diagnosed with active TB and other half had old TB. Four patients were admitted to the ICU, three of whom required ventilation. Finally, four (50%) patients deceased. In this study, among factors that influence patients' outcomes, only underlying diseases were significantly associated with death. Conclusion: Tuberculosis is assumed to cause a higher mortality risk in COVID-19 patients, especially in those with chronic underlying diseases.
ABSTRACT
Coronavirus-19 (COVID-19) infection presents in a many ways, from asymptomatic or mild symptoms to death or serious illness. Coughing, shortness of breath, and fever are the common symptoms. Other symptoms include weakness, muscle discomfort, lethargy, sore throat, breathing problems, and loss of smell and/or taste. COVID-19 is diagnosed using clinical indicators, CT scans or chest x-rays, serological tests, and molecular diagnostics of the viral genome using reverse transcription polymerase chain reaction. This study analyzes the duration of fever, the most important symptom of the disease, and its association with other patient characteristics. The cross-sectional study was conducted in Iraq's Al-Diwaniyah Province, located in the Mid-Euphrates region. The study included 99 COVID-19 cases, 50 males and 49 females aged 16–81 years. Age, gender, white blood cell (WBC) count, lymphocyte percent, lung involvement assessed by CT scan, duration of fever at the time of presentation, and duration until the fever subsides following initiation of treatment were the main variables studied, in addition to the presence of chronic medical illnesses such as diabetes mellitus, systemic hypertension, asthma, and pulmonary tuberculosis. The mean age of all patients was 50.38 ± 16.27 years, with no significant difference between males and females (P = 0.924). There was also no significant difference in mean WBC count and lymphocyte percent between males and females (P > 0.05). Lung involvement from CT scan ranged from 0 to 80% and the mean was 26.77 ± 21.43%, with no significant difference between males and females (P = 0.770). The mean duration of fever at the time of presentation was 6.61 ± 3.60 days and it ranged from 1 to 21 days. The duration of subsiding fever ranged between 2 and 25 days in all patients with a mean of 5.82 ± 3.53 days, with no significant difference between males and females (P = 0.214). The duration needed for the fever to subside was positively and significantly correlated to the WBC count, the duration of fever at presentation, and the presence of diabetes mellitus (P < 0.05). Longer duration of fever after diagnosis and treatment of COVID-19 can be predicted with a high WBC count. Patients with diabetes having a longer duration of fever are at high risk of developing severe complications and death.
ABSTRACT
Background and purpose: There are limited studies on co-infection of COVID-19 and tuberculosis (TB). This study aimed to describe the clinical, radiological, laboratory characteristics, treatment and outcome of patients admitted with tuberculosis and COVID 19 co-infection. Material(s) and Method(s): In this retrospective study, we investigated all patients with either active TB or old TB and COVID-19 admitted to Qaemshahr Razi Teaching Hospital between 2020 and 2022. Result(s): A total of 9251 patients with COVID-19 were admitted to our hospital between February 2020 and May 2022. There were eight patients with pulmonary tuberculosis and COVID-19 co-infection, including five (62.5%) male patients. The mean age of these patients was 61.13+/-22.63 years old. The mean time of symptom onset to hospital admission was 15.13+/-30.56 days and 50% were diagnosed with active TB and other half had old TB. Four patients were admitted to the ICU, three of whom required ventilation. Finally, four (50%) patients deceased. In this study, among factors that influence patients' outcomes, only underlying diseases were significantly associated with death. Conclusion(s): Tuberculosis is assumed to cause a higher mortality risk in COVID-19 patients, especially in those with chronic underlying diseases. Copyright © 2023, Mazandaran University of Medical Sciences. All rights reserved.
ABSTRACT
The pandemic of COVID-19 is still rampaging all over the world, so it is urgent to popularize vaccination. Meanwhile, pulmonary tuberculosis is one of the chronic infectious diseases with a high incidence in China. Since these diseases all occur in lung tissue, patients with TB and COVID-19 co-infection show more serious conditions and poorer treatment effects. However, we have limited knowledge about the protective efficacy, immunogenicity and safety of COVID-19 vaccine in patients with TB at present, with a lack of corresponding evidence-based medicine as well. Therefore, this paper reviews the pathogenesis and epidemiology of TB, discusses the immune status of patients with TB and summarizes the existing proposals for vaccination of patients with TB at home and abroad. Furthermore, we analyze the existing clinical trials in TB patients and other special populations, and finally discuss the strategy of vaccination for patients with TB during the COVID-19 pandemic and the necessity of clinical research on COVID-19 vaccines with target population of TB patients. Copyright © 2022, Publication Centre of Anhui Medical University. All rights reserved.
ABSTRACT
The international biomedical community has been currently facing a need to find a simple and most accessible type of analysis that helps to diagnose tuberculosis (TB) with the maximum reliability even before the onset of clinical manifestations. Tuberculosis results in more deaths than any other pathogen, second only to pneumonia caused by the SARS-CoV-2 virus, but the majority of infected people remain asymptomatic. In addition, it is important to develop methods to distinguish various forms of tuberculosis infection course at early stages and to reliably stratify patients into appropriate groups (persons with a rapidly progressing infection, chronic course, latent infection carriers). Immunometabolism investigates a relationship between bioenergetic pathways and specific functions of immune cells that has recently become increasingly important in scientific research. The host anti-mycobacteria immune response in tuberculosis is regulated by a number of metabolic networks that can interact both cooperatively and antagonistically, influencing an outcome of the disease. The balance between inflammatory and immune reactions limits the spread of mycobacteria in vivo and protects from developing tuberculosis. Cytokines are essential for host defense, but if uncontrolled, some mediators may contribute to developing disease and pathology. Differences in plasma levels of metabolites between individuals with advanced infection, LTBI and healthy individuals can be detected long before the onset of the major related clinical signs. Changes in amino acid and cortisol level may be detected as early as 12 months before the onset of the disease and become more prominent at verifying clinical diagnosis. Assessing serum level of certain amino acids and their ratios may be used as additional diagnostic markers of active pulmonary TB. Metabolites, including serum fatty acids, amino acids and lipids may contribute to detecting active TB. Metabolic profiles indicate about increased indolamine 2.3-di-oxygenase 1 (IDO1) activity, decreased phospholipase activity, increased adenosine metabolite level, and fibrous lesions in active vs. latent infection. TB treatment can be adjusted based on individual patient metabolism and biomarker profiles. Thus, exploring immunometabolism in tuberculosis is necessary for development of new therapeutic strategies. Copyright © 2022 Saint Petersburg Pasteur Institute. All rights reserved.