Management of Atypical TB during the COVID-19 Pandemic

ABSTRACT

Mycobacterium kansasii is a nontuberculous mycobacterium which leads to a chronic pulmonary infection that resembles pulmonary tuberculosis. Symptoms of pulmonary infection with M kansasii may include cough, sputum production, weight loss, breathlessness, chest pain, hemoptysis and fever or sweats.The paper presents the case of a 30-year-old woman, confirmed with moderate SARS-COV2 infection at a county hospital and transferred to "Marius Nasta" Institute for Pneumology for specialty treatment. At admission, the CT exam reveals multiple "tree in bud" lesions and cavity lesions located at the RUL level. Bacteriological examinations for the genus mycobacterium were initially negative, but from the bronchial aspirate, the bacteriological examination was BAAR positive. Genetic testing confirmed mycobacterium infection. Resistance to H, R was not detected. According to the national protocol, antibiotic treatment is initiated with Isoniazid, Rifampicin, Ethambutol and Pyrazinamide. The patient tolerated the treatment well throughout the hospitalization period, as there were no interactions between the treatment for SARS-COV2 and the antibiotic one. Due to the favorable evolution, the patient is discharged one month after starting treatment. As recommendations, the patient must present herself at the territorial TB clinic, in order to continue the antibiotic treatment for up to 6 months.At two months, the culture shows infection with mycobacterium kansassi, thus the treatment is modified by administering Rifampicin, Etambutol and Azithromycin. Following the administration of the new treatment, the lung lesions show regression. In the case of mycobacterium kansassi infections, the treatment will be continued for up to 12 months. The evolution of M. kansassi infection may be influenced by various factors, but in this case the moderate SARS-COV2 infection, cured in 3 weeks, did not influence the favourable evolution. Also, the absence of shortness of breath, as well as the compliance and absence of treatment resistance were keen factors in the evolution under treatment.In conclusion, the patient was initially admitted to the hospital for a moderate COVID-19 infection. The routine CT exam was also suggestive for a possible other pathology, and follow-up tests and examinations led to the discovery of an infection with M. kansassi. The SARS-COV-2 infection had favourable evolution under treatment and was cured in 3 weeks, but the treatment for M. kansassi is long-term and may have effects on the patients' psychology, as well as by the presence of adverse reactions, not following the treatment can be fatal with death occurring in 50% of cases.