COVID-19 and tuberculosis co-infection in pregnancy - A case series and review

Perspectives on pregnant women's educational needs to prevent TB complications during pregnancy and the neonatal period. A qualitative study

BACKGROUND

Tuberculosis (TB) during pregnancy could confer a high risk for maternal and infant morbidity. Literature indicates that the global burden of active TB disease among pregnant women is not well researched. Statistics for South Africa from WHO give an estimated incidence of 360, 000 cases of TB in 2019; 14,000 people became ill with multidrug-resistant TB in 2019, with a rate of 615 per 100,000 population, implying that the cohorts included pregnant women with and without a diagnosis of TB infection. Therefore, the study aims to increase the understanding of the educational needs required to prevent TB complications during pregnancy and the neonatal period in women diagnosed with TB infection.

METHODS

The study used cross-sectional qualitative and descriptive designs to collect data in the clinical setting of the primary health care services of Limpopo Province, South Africa. The population comprised pregnant women diagnosed with TB infection. A non-probability purposive sampling technique was used to sample 2 health centers and 5 clinics in each of the three sampled districts. The targeted sample size was 63 and it was achieved even though data saturation was observed. Individual interviews were conducted, audiotaped, and transcribed. Guided by the study questions, a thematic content analysis of the findings was used. Ethical considerations were also observed.

RESULTS

Despite that pregnant women have general knowledge about TB disease, the knowledge and awareness regarding the prevention of TB complications in pregnancy and the neonatal period, information on TB/HIV and COVID-19 co-infections, and participants' knowledge about other non-infectious diseases that may affect the mother with TB infection and foetus showed a deficit.

CONCLUSION

Pregnant women with TB disease need to be educated on the negative effects of non-adherence to TB treatment during pregnancy and the neonatal period. There is a need to educate pregnant women about the variant signs and symptoms of TB, HIV and COVID-19 infections since there is a misconception that the three diseases are similar. It is important that pregnant mothers diagnosed with TB should start treatment as soon as possible.

The COVID-19, tuberculosis and HIV/AIDS: Ménage à Trois

In December 2019, a novel pneumonic condition, Coronavirus disease 2019 (COVID- 19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), broke out in China and spread globally. The presentation of COVID-19 is more severe in persons with underlying medical conditions such as Tuberculosis (TB), Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) and other pneumonic conditions. All three diseases are of global concern and can significantly affect the lungs with characteristic cytokine storm, immunosuppression, and respiratory failure. Co-infections of SARS-CoV-2 with HIV and Mycobacterium tuberculosis (Mtb) have been reported, which may influence their pathogenesis and disease progression. Pulmonary TB and HIV/AIDS patients could be more susceptible to SARS-CoV-2 infection leading to lethal synergy and disease severity. Therefore, the biological and epidemiological interactions of COVID-19, HIV/AIDS, and TB need to be understood holistically. While data is needed to predict the impact of the COVID-19 pandemic on these existing diseases, it is necessary to review the implications of the evolving COVID-19 management on HIV/AIDS and TB control, including therapy and funding. Also, the impact of long COVID on patients, who may have this co-infection. Thus, this review highlights the implications of COVID-19, HIV/AIDS, and TB co-infection compares disease mechanisms, addresses growing concerns, and suggests a direction for improved diagnosis and general management.

Case Report: Congenital disseminated tuberculosis neonate born to tuberculosis- COVID-19 mother

We report a case of a 26-day-old male neonate with high suggestive of congenital disseminated tuberculosis (TB) [tuberculous meningitis (TBM), pulmonary TB, and ocular TB] at term, low birth weight born cesarean section from a confirmed COVID-19 and pulmonary TB mother who hospitalized in the isolation room and never seen her son for three weeks. The baby had a fever for two weeks after birth and a history of seizures. A nasopharyngeal swab for RT-PCR SARS-CoV-2 yielded a negative result. He was initially diagnosed as having a sepsis-like syndrome and then hospitalized. Chest x-ray revealed bilateral infiltrate, cerebrospinal fluid analysis (CSF) showed clear, cell count was 9 with dominant mononuclear cell, and gastric lavages did not yield acid-fast bacilli. X-pert MTB/RIF from gastric lavage specimen detected Mycobacterium tuberculosis rifampicin sensitive. Anti-tuberculosis drugs for TBM were started. Abdominal sonography identified multiple hypoechoic nodules in the liver and spleen. Neuroimaging studies did not identify hydrocephalus, meningeal enhancement, infarct, or tuberculoma. A Video-EEG examination showed electrical seizure after initiation of phenobarbital. Video-EEG evaluation showed no epileptiform discharge. Upon follow-up, he showed slightly delayed motor development, pan-uveitis, retinal detachment, and cataracts. We assumed that ocular TB resulted from a paradoxical reaction following TB treatment. Retinal detachment was improved and lens replacement was done.