Doctors at two private facilities have seen a rise in cases of tuberculosis (TB) among people who have recently recovered from COVID-19, and have attributed the rise in such instances to diabetes, altered immunity and use of steroids. Moolchand hospital has had a turnout of around 10 cases of active TB patients in the OPD in the last four to six weeks, according to a statement from the hospital.
Dr Bhagwan Mantri, Pulmonologist, Moolchand Hospital stated that up to 60 per cent of them aged below 40 years of age. "All these TB patients had received steroids during their Covid treatment and many had diabetes. Six of them were below 40 years," he said.
Divulging on the clinical diagnosis of the cases, Dr Mantri said, "They presented with complaints of cough many weeks after recovery from Covid and a few of them also had mild low-grade evening fever for three to four weeks post-Covid. X Ray and sputum test showed cavitary pneumonia with sputum positive smear for Acid-Fast Bacillus (AFB)." AFB causes tuberculosis and other infections. Citing a case, the doctor said a young man presented with massive pyo-neumothorax (Air and Pus in the pleural cavity) post Covid which later turned out to be due to tuberculosis.
The senior doctor said multiple factors weighed in the development of the lung disorder among the presented patients. "The reason for increased likelihood of tuberculosis in post-Covid patients can be explained by factors like altered immunity, lung inflammation and stress due to Covid, use of steroids for Covid treatment and worsening of blood sugar control," he explained.
Meanwhile, he suggested that the patients need to look out for certain markers after recovering from Covid for early diagnosis of TB. "A delay in diagnosis of TB also has been reported since symptoms of tuberculosis are similar to symptoms of post covid/Long Covid. So If you are having any symptoms that are persistent after Covid like a low-grade fever, cough, decreased appetite, weight loss, night sweating or any other complaints you need to visit a pulmonologist to rule out active tuberculosis, he added.
Aakash Healthcare has seen a 15 to 20 per cent surge in cases of tuberculosis compared to earlier years. This is a trend of concern rising among adolescents and young adults as these patients are presenting with complications involving more than one part or organs in the body. There is also an increase in recurrent tuberculosis cases (patients who have had tuberculosis earlier and have completed the full course of anti-tubercular treatment).
The reasons can be many, from ignoring the health and attributing the fever or other constitutional symptoms to some other viral fever, to apprehensions regarding going to hospital for the fear of catching Covid. "Many patients had a history of Covid and hence attributed their general poor health to the after effects of Covid. Cases of misdiagnosis can also add on to the increased burden of TB during the pandemic. Many times, people attribute the fever to typhoid-like illness, manifestations for which include prolonged fever and weakness. Hence, a comprehensive evaluation is required for any fever lasting more than two weeks, or weight loss or poor appetite or prolonged cough/diarrhoea any change in health status needs to be monitored by a qualified health professional," the hospital advised in a statement.
The hospital has introduced bi-directional screening of TB-COVID and TB-ILI/SARI as per the new guidelines from the Ministry of Health and Family Welfare. "These tests are being conducted at our normal OPDs and Covid wing to ensure tuberculosis screening for all patients showing persistent cough /fever/ cavitation lesions/new Lung infiltrates in lungs/abdominal symptoms/deteriorating general condition," said Dr Parinita Kaur, senior consultant- internal medicine, Aakash healthcare in Dwarka.