Doctors from Novosibirsk reported about the risk of developing tuberculosis in patients with covid. Tuberculosis is dangerous because it can be asymptomatic for a long time. It can take several months, or even years, from infection to the appearance of specific symptoms.
In the updated manual of the Ministry of Health of the Russian Federation, it is written that after suffering COVID-19, in many patients, pronounced residual changes in the form of fibrosis are formed in the lungs. Doctors believe that these people have an increased risk of developing tuberculosis.
Medical observer of the NGS Maria Tishchenko spoke with Novosibirsk doctors: are there already such cases, why the coronavirus «provokes» tuberculosis and how to distinguish one disease from another, because their symptoms are very similar.
We decipher the training manual
In the latest version — No. 10 — of the temporary recommendations of the Ministry of Health of the Russian Federation on the prevention, diagnosis and treatment of COVID-19, it is indicated that tuberculosis can occur before, simultaneously or after the transferred COVID-19. Therefore, it is initially necessary to conduct laboratory tests in order to exclude tuberculosis or prevent its development.
— The consequences of COVID-19 infection in tuberculosis patients are not completely clear, but the first publications are already appearing, indicating that the presence of tuberculosis infection, including latent, aggravates the course of COVID-19. In patients with pneumonia caused by COVID-19, leukopenia and lymphopenia are noted in blood tests, which can be considered a risk factor for the transition of latent tuberculosis infection to active and attributed the group of patients with COVID-19 to risk groups that require not only the exclusion of active tuberculosis, but also compulsory testing for latent tuberculosis infection while in the hospital, — said in the recommendations.
We translate: if a person with tuberculosis in a «sleeping» form gets sick with a coronavirus infection, then he has a hard time suffering the disease, and tuberculosis can move from the «dormant» stage to a dangerous active one.
There is a threat to those who do not have tuberculosis. The Ministry of Health claims that after suffering COVID-19, many patients develop pronounced residual changes in the lungs in the form of fibrosis (fibrosis is the process of scar tissue formation that makes breathing difficult).
“It can be assumed that this category of patients has an increased risk of developing tuberculosis in the future,” the manual says.
Why is the risk of contracting tuberculosis increased?
Olga Filonenko , a pulmonologist and therapist of the Zdravitsa family medicine center , explains that if a person does not make up for the deficiency of vitamins, minerals and protein in the body after a coronavirus infection, then the risk of contracting tuberculosis really increases:
— Any pneumonia is an immunodeficiency condition, therefore, after a coronavirus infection, there can be not only tuberculosis, but also relapses of pneumonia, including bacterial.
Zdravitsa therapist Irina Amanatova says that among her patients there have been no cases of tuberculosis after COVID-19, but in theory this is possible:
— Often, coronavirus infection is accompanied by pneumonia and subsequent pulmonary fibrosis. It is much easier for the causative agent of tuberculosis to penetrate into the affected lungs, this is especially true for patients with lung damage of more than 50%. Such patients must be dynamically observed, invited for examinations, and CT-controlled so as not to miss anything. There is one more thing: during the pandemic, many activities were suspended, including medical examination. And pulmonary tuberculosis in the initial stages can be detected by fluorography, since clinical manifestations most often appear when the process has already started. Therefore, annual fluorography is still an important and mandatory examination for any person.
Zdravitsa therapist Varvara Veretyuk believes that first of all, the detection rate of tuberculosis will increase, because many people underwent tests due to coronavirus — X-rays, CT scans. And tuberculosis can go unnoticed for several years without any symptoms.
— That is why we are recommended to do FLG once a year: a person can feel great, and characteristic changes are revealed in the picture. It is better to cure tuberculosis before it somehow manifests itself. I think we can expect an increase in tuberculosis cases after the pandemic due to detection. For example, some patients who underwent coronavirus infection showed fibrosis on CT scan, which was associated with other lung diseases. Whether the covid itself is associated with the risk of developing tuberculosis — while there is no such data, there are only assumptions of some experts.
Olga Sbitneva, a therapist of the Smitra multidisciplinary clinic network, is also sure that it’s all about the detectability:
— Tuberculosis is a slow infection that takes months to form, if you do not take into account the situation when a person’s immunity is significantly reduced. Apparently, there were several cases when tuberculosis was found during CT or FLG after covid. People began to be examined more often, therefore, in my opinion, they began to find tuberculosis more often.
Olga Sbitneva says that if a person with covid had pronounced changes in the lungs on FLH or CT, then some minor tuberculous changes could simply not be noticed.
— And when covid cases were resolved, the tuberculosis focus remained on the X-ray, because most antibiotics do not work on it, apparently, that is why such ideas appeared in the guidelines. It seems to me that it is too early to draw conclusions in this matter, because there is still little information, the doctor insists.
Symptoms of Coronavirus and Tuberculosis (Same and Different)
Experts emphasize that TB is often asymptomatic, but can occur if the immune system is busy doing something else.
— For example, if tuberculosis was latent, «dormant», then after covid it can somehow manifest itself against the background of a decrease in immunity. The group of special attention also includes people with altered immune system reactivity, for example, women after childbirth, people with immunodeficiency or receiving drugs that suppress immunity, — gives examples of Varvara Veretyuk.
Zdravitsa therapist Irina Nepomnyashchikh says that the nonspecific symptoms of tuberculosis are low-grade fever (from 37 to 38), weakness, sweating, especially at night, weight loss without justified reasons.
— Then coughing and hemoptysis begins, but these are also nonspecific symptoms: they can even be with pneumonia. In the closed form, the patient does not release bacteria into the environment, such patients are not dangerous to others, not infectious. If FLH raised questions, then the patient is sent to an oncologist, phthisiatrician to clarify the diagnosis. MSCT is often prescribed. The patient also undergoes a general analysis of urine, blood, sputum three times for tuberculosis bacteria and just a general analysis of sputum, — Irina Nepomnyashchikh explains the procedure for suspected tuberculosis.
In the guidelines of the Ministry of Health, it is noted that the symptoms of COVID-19 and tuberculosis can be similar — cough, fever, weakness:
— With tuberculosis, symptoms in most cases develop gradually, but there may be an acute course of the disease. Both diseases can occur simultaneously, making each other worse.
Is it possible to suspect tuberculosis on a blood test
According to the blood test, everything is in order, but sometimes the ESR is increased. There can also be leukocytosis and a shift in the leukocyte formula to the left, which can also be with another bacterial infection.
To exclude tuberculosis, doctors recommend taking other tests, including a threefold study of sputum for the presence of acid-fast bacteria, identification of Mycobacterium tuberculosis DNA markers by PCR.
How to protect yourself from tuberculosis
Varvara Veretyuk says that in any case, prevention of tuberculosis is important, including a healthy lifestyle, proper nutrition, preventive examinations: for adults — fluorography, for children — Mantoux test or Diaskintest (also a skin test, but with a different component), and BCG vaccination as protection against severe forms of the disease.
— The population still has misconceptions about tuberculosis: it is considered a shameful disease of disadvantaged people from the social lower classes. But this is not so: tuberculosis is now very common in our country, and anyone can become infected, the therapist warns.
Olga Sbitneva also notes that in our region there is still a high incidence of tuberculosis, and regardless of whether there was a coronavirus infection or not, everyone is recommended to be regularly examined for this disease.
How many Novosibirsk residents have tuberculosis
According to the regional Ministry of Health, the number of newly diagnosed patients with tuberculosis has been gradually decreasing in the Novosibirsk region since 2018. In 2018, there were 2541 of them, in 2019 — 2449, in 2020 — 2007.
There were 4,418 people with active forms of tuberculosis on dispensary registration in anti-tuberculosis medical organizations in 2020, while 1,193 patients had disabilities.
— According to the data of 2020, of the number of newly diagnosed patients, the main share falls on the young working age of 35–44 years — 35.6%. Five percent are children from 0 to 17 years old, the rest are people over 55 years old. Men — 66.2%, women — 33.8%. In 2018, tuberculosis caused the death of 393 people, in 2019 — 346 people, in 2020 — 282 people, according to the figures in the Ministry of Health.