Submitted:
21 November 2024
Posted:
25 November 2024
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Preprints on COVID-19 and SARS-CoV-2
Abstract
Multidrug-resistant tuberculosis (MDR-TB), has been a serious threat to health on a global scale. It becomes much more problematic when examined in the context of the coronavirus disease 2019 (COVID-19) pandemic. On May 19, 2022, a retired black African woman 44 age of year who tested HIV-negative was brought into the emergency room. She admitted with a history of a persistent cough, fever, muscle weakness, and significant weight loss. She explained that she had taken public transportation to get to her family's house without wearing a face mask. Once a polymerase chain reaction (PCR) test from a nasopharyngeal swab confirmed that she had COVID-19. She experienced low-grade fever and cough, lethargy, an additional 25 pounds of weight loss, progressively worsening night sweats. And she also had new-onset dyspnea at rest seven days after the symptoms of her COVID-19 infection had subsided. Mycobacterium tuberculosis with potential rifampin resistance was detected in the GeneXpert sputum test as present. An all-oral daily antituberculous treatment plan was commenced, consisting of bedaquiline (400 mg), levofloxacin (1,000 mg), linezolid (600 mg), clofazimine (100 mg), and pyrazinimide (1,600 mg). She received low molecular weight heparin daily at a dosage of 1 mg/kg as a prophylactic precaution against prothrombotic episodes.
Keywords:
Case Report
; Coronavirus disease 2019
; Emergency room
; Multidrug-resistant tuberculosis
; Polymerase chain reaction
Introduction
There have been various uncommon presentations of common diseases as a result of the coronavirus disease 2019 (COVID-19) pandemic [1]. The most common infectious diseases that cause death right now are tuberculosis (TB) and coronavirus disease 2019 (COVID-19) [2]. The recurrence of MDR-TB throughout the world demonstrates that many disease resistance types make the treatment regimens utilized increasingly ineffective [3]. Health disparities were made clear by the COVID-19 pandemic, particularly with regard to illnesses that are directly linked to socioeconomic circumstances [4]. While multidrug-resistant TB (MDR-TB), or resistance to at least two of the medications used for therapy, isoniazid and rifampicin, is becoming more prevalent, the TB situation is becoming more critical [5]. Age, sex, educational level, behavioral (addiction, smoking, and alcoholism), clinical (HIV), prior treatment history, type of resistance, accessibility to health services, a reduction in social protection policies, and social contexts of poverty and deprivation are some of the determinants linked to MDR-TB [6]. This study depicts how COVID-19 caused MDR-TB in individuals who had already been diagnosed with TB. As well as when, in the course of the infection, how COVID-19 clinical symptoms exaggerated MDR-TB.
Case Description
On May 19, 2022, an HIV-negative retired black African woman in her forten age who had a history of a prolonged cough, fever, muscle weakness, and severe weight loss was brought to the emergency room. She lacked any medical or pharmaceutical history in her family. She previously had pulmonary TB, which was seven years ago. She had previously taken first-line anti-tuberculosis medication, which included two months of intensive phase treatment with rifampicin 150 mg, isoniazid 75 mg, pyrazinamide 400 mg, and ethambutol 275 mg, followed by four months of continuous phase treatment with rifampicin 150 mg and isoniazid 75 mg.
She had rigorously followed her antitubercular treatment plan. She was familiar with recent travel. She explained that she had gone to her family's house without a facemask using public transit. She was transported to an intensive care unit after a COVID-19 positive PCR test from a nasopharyngeal swab was performed based on her primary complaints. An infection with COVID-19 was diagnosed in her. She injected with a nasal cannula and four liters of oxygen when she arrived. To treat her COVID-19 infection-related fever, she was given 500 mg of acetaminophen. In order to prevent prothrombotic episodes, she was given low molecular weight heparin at a dose of 1 mg/kg each day. To address hospital-acquired infections, she underwent a five-day course of a broad-spectrum antibiotic treatment using 1 g of intravenous ceftriaxone administered each day.
She presented with low-grade fever and cough, lethargy, a further 25-pound weight loss, progressive night sweats. And she developed a new-onset dyspnea at rest seven days following the remission of her symptoms from the COVID-19 infection. Her vital signs showed that she had a blood pressure of 124/79 mmHg, a heart rate of 116 beats per minute, a body temperature of 38.3 °C, a respiratory rate of 18 breaths per minute, and an oxygen saturation level of 89% in room air.
Her total blood count showed that she had 11,950 white blood cells, 14% lymphocytes, and a hemoglobin concentration of 15.3 mg/dL. Creatinine was measured at 0.9 mg/dL, blood urea nitrogen at 11 mg/dL, and glucose at 149 mg/dL, alanine aminotransferase at 91 units/L, and aspartate aminotransferase at 84 U/L by the metabolic panel.
On a physical examination, it was discovered that she was cachectic, had diminished breath sounds in her right middle and upper lung, and had edema in both lower extremities. Abdominal examination revealed no pain, rebound tenderness, or lymph nodes that could be seen, but she did have a swollen, tight belly with varying dullness. Reduced breath sounds could be heard in the right middle and upper lungs on chest auscultation. On the chest radiograph (X-ray), the right upper lobe cavity, right hilar fullness, and right middle lobe opacity were all discernible. With a heart rate of 116 beats per minute, her ECG displayed sinus tachycardia and anterior-lateral ST depression.
Mycobacterium tuberculosis with potential rifampin resistance was detected in the GeneXpert sputum test as present. Subsequent liquid and agar culture-based drug susceptibility tests performed on the patient's diagnostic sputum sample revealed that the patient had high levels of isoniazid resistance, rifampin resistance, and susceptibility to all other antitubercular medications. She started receiving 1000 ml of fluid resuscitation (0.9% normal saline) in an intensive care unit of a hospital. She continued to breathe in oxygen at a rate of 4 liters per minute through a nasal cannula. An oral daily antituberculous regimen consisting of bedaquiline (400 mg), levofloxacin (1,000 mg), linezolid (600 mg), clofazimine (100 mg), and pyrazinimide (1,600 mg) was initiated.
Follow-up
A repeat SARS-CoV-19 PCR test was negative three weeks after the patient's diagnosis because they had recovered from COVID-19. Sputum acid-fast bacilli smear tests on her have also yielded two straight negative findings for TB. Her monthly follow-up appointments at the tuberculosis clinic were to continue, as instructed.
Discussion
There has been significant destruction caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2)-induced coronavirus disease 2019 (COVID-19) pandemic so far in both the developed and developing worlds [7]. The patient in this case is suspected of catching COVID-19 from a passenger on a public transit vehicle through airborne droplets created by that person's coughing, sneezing, speaking, or inhaling small liquid particles through their mouth or nose.
Globally, COVID-19 is on the rise, posing a danger to health systems' capacity and having a negative influence on the treatment of other diseases. Patients with tuberculosis (TB) who contract COVID-19 may be more likely to experience negative outcomes since underlying pulmonary illness is linked to higher mortality in individuals with COVID-19 [8]. In this study, fluid is found to be significantly affecting the patient's lungs as a result of leakage from her small blood vessels in the lungs, which reduces the patient's lungs' ability to absorb oxygen and causes dyspnea, coughing, and shortness of breath.
The SARS-2 pandemic, which has spread alarmingly, shares numerous similarities with tuberculosis, an older and considerably more neglected airborne disease. In addition to having a higher risk of contracting SARS-CoV-2, patients with tuberculosis are also more likely to experience negative effects from the infection [9].
It's likely that there is a two-way relationship between COVID-19 and TB. Patients' susceptibilities to COVID-19 and TB may both rise as a result of the transient immunosuppression brought on by tuberculosis [10].
Despite the fact that COVID-19 and tuberculosis can both be transmitted through the air, TB often requires extended contact with an infected patient, in contrast to SARS-CoV-2, which can be distributed more quickly. The three hallmark signs such as cough, fever, and dyspnea are present in both illnesses [11]. Headaches, night sweats, shortness of breath, weak muscles, a fever, a productive cough, and a sore throat were some of the patient symptoms in this study. Additionally, there was lack of appetite. She displayed the clinical symptoms of both tuberculosis and the COVID-19 infection, including fever, coughing, shortness of breath, and weak muscles.
Of course, the speed of onset and progression differs the most immediately. The symptoms of TB, when they manifest, typically have a more gradual onset and proceed over a period of weeks or months [12]. In contrast to COVID-19, where symptoms typically appear after a median of 5 days of exposure to an infected patient, the patient in this study had MDR-TB, and after seven days, signs and symptoms of COVID-19 infection appeared.
DR-TB could be of many types, i.e., isoniazid (H)-resistant TB, rifampicin-resistant (RR)-TB, and multidrug-resistant (MDR)-TB (RR and H-resistant), pre-extensively drug-resistant TB (pre-XDR-TB) that is resistant to rifampicin (MDR/RR-TB) and any fluoroquinolone, and XDR-TB that is resistant to rifampicin (MDR/RR-TB) plus any fluoroquinolone, plus at the minimum to one of the drugs, bedaquiline and linezolid. The most common cause of drug-resistant TB (DRTB) is assumed to be improper management of drug-sensitive TB care [13].
Conclusion
The COVID-19 pandemic may make multidrug-resistant tuberculosis (MDR-TB) an even more serious global concern. Health disparities were made clear by the COVID-19 pandemic, particularly with regard to illnesses that are directly linked to socioeconomic circumstances. After seven days, the patient in this study who had MDR-TB showed signs and symptoms of COVID-19 infection. A daily dose of 1 mg/kg of low molecular weight heparin was also given to the patient to prevent prothrombotic episodes.
Funding
None.
Competing interests
None.
Consent for publication
Written informed consent was obtained from the patient for publication of this case report.
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