COVID trigger for tuberculosis?

Is COVID-19 leading to a relapse of tuberculosis in the state?

Although there is still no conclusive evidence to prove that COVID-19 can directly cause an increase in tuberculosis, cases of tuberculosis are actually increasing in the state, especially in the post-COVID stage.

Some clinicians feel that many new cases of tuberculosis may be delayed diagnosis during a pandemic. However, new evidence from various studies is that COVID and TB share immune response dysregulation, and COVID-19 activates dormant / latent tuberculosis infection or reappears in those who are recovering from COVID. It suggests that it can actually cause an infection.

Pulmonologists in Kerala are currently reporting new TB infections in humans within 4-6 weeks of recovery from COVID-19. Ten such cases have already been reported, and the Department of Health is currently recommending that all post-COVID clinics require regular TB screening.

Because both tuberculosis and COVID-19 are diseases that primarily attack the lungs, most of the symptoms that appear, such as coughing, fever, and dyspnea, are similar. Therefore, prolonged or persistent respiratory symptoms in people who have recovered from COVID can be mistaken for the remaining problems of COVID or secondary bacterial infections, completely overlooking the diagnosis of tuberculosis.

“Regular TB detection took the backseat during a pandemic. Tuberculosis is a slow-growing illness, and people consider symptoms such as cough and fever to be part of a seasonal illness. If these people are hospitalized with COVID, the patch that appears on the X-ray of the lung is considered to be due to COVID. Therefore, many cases of tuberculosis that are currently emerging are It’s a case we couldn’t pick up from the community before, “said Ajith Bhasker, Calicut’s respiratory practitioner.

Not everyone is exposed to bacteria, Mycobacterium tuberculosis, Will be infected soon. In some people, the infection manifests itself as active tuberculosis, while in other cases the bacteria can live longer in the body without causing active tuberculosis, a condition known as latent tuberculosis. Latent tuberculosis can be activated into active tuberculosis when the body’s immune system is weak.

In Kerala, the prevalence of latent tuberculosis infection is estimated to be 20%. The 10 cases of tuberculosis detected within 4-6 weeks of COVID-19 treatment are just the tip of the iceberg, indicating early on that there may be more cases in the community that need to be investigated. .. Most of these patients had diabetes and were treated with steroids as part of their COVID treatment.

“Further research is needed to determine if COVID actually caused tuberculosis in these patients. Some patients with COVID have corticosteroids at inappropriately high doses, even in the absence of appropriate signs. Some people are being treated with steroids. Such irrational use of steroids can lead to immunosuppression and reactivation of dormant infections such as latent tuberculosis or opportunistic secondary infections such as mucor disease. ”, Said PS Rakesh, a WHO consultant for the National Tuberculosis Eradication Program.

It is argued that the possibility of an increase in tuberculosis infection is not realistic because infection control for aerial infections has been strengthened during COVID in hospitals and the like. However, while airborne infection control can only prevent immediate infections, in Kerala, most new cases of tuberculosis are reactivations of some exposures that these people had received long ago.

The new government’s recommendation states that it is important to evaluate tuberculosis in patients with persistent respiratory symptoms immediately after recovery from COVID. Ten new cases of tuberculosis were detected in the state through systematic screening in the clinic after COVID.

Tuberculosis screening should be routinely performed in all post-COVID clinics, and healthcare professionals are required to check for tuberculosis symptoms in patients they meet in the field or who are recovering from COVID. I will.