First case series and literature review of coronavirus disease 2019 (COVID-19) associated pulmonary tuberculosis in Southeast Asia: Challenges and opportunities

Abstract

Background: Subclinical tuberculosis (TB) is accidentally detected by radiologic and microbiologic findings. Transmission by those with subclinical TB could delay prevention effort. However, our study demonstrated positive aspect of COVID-19 outbreak as it could allow subclinical TB to be detected faster through a chest X-Ray (CXR).

Methods: This cross-sectional cohort study aimed to report demographics, comorbidities, and outcomes related to early detection of TB among COVID-19 patients, and to elaborate the association between SARS-CoV-2 and pulmonary TB. Data of patients with SARS-CoV-2 co-infection with Mycobacterium tuberculosis (MTB) diagnosed between March 2020 - March 2022 was collected.

Results: Out of 12,275 COVID-19 patients, 26 were definitively diagnosed with MTB infection (mean age 48.16 ± 20.17 years). All cases that had suspicious CXR that were not typical for COVID-19, were tested for MTB. On average, pulmonary TB was diagnosed after admission 5(3-10) days, the treatment initiation period was 3(1-5) days from the TB diagnosis.

Conclusions: This suggests an early detection of tuberculosis among COVID-19 patients by quicker screening CXR and sputum comparing to previous symptom guided screening. Thereby reducing the chance of TB transmission demonstrated during COVID-19 pandemic. So, clinicians should be aware of pulmonary tuberculosis in COVID-19 patients with atypical radiologic findings.

Keywords: COVID-19; Mycobacterium tuberculosis; SARS-CoV-2; Subclinical tuberculosis.

Fig. 1

A Chest X-Ray of case #4 shows nodular opacity in both lungs. B Chest X-Ray of case #10 showed reticular reticulonodular infiltration at apical region of both lungs, and cavitary lesion at right upper lung.

Fig. 2

A Chest X-Ray of case #14 showed multiple lungs nodules in the right lung, along with reticular infiltration in the right lower lung field. B and 2 C Chest computed tomography of case #14 showed multiple hyperdensity lesions in both lungs (arrow), and bilateral pleural effusion (star).

Fig. 3

A Neck computed tomography of case #23 showed enlarged right supraclavicular lymph node (arrow). B Chest computed tomography of case #23 showed multiple hyperdensity lesions (arrows) in the right lung.