Martínez Orozco José Arturo, Sánchez Tinajero Ángel, Becerril Vargas Eduardo, Delgado Cueva Andrea Iraís, Reséndiz Escobar Héctor, Vázquez Alcocer Eduardo, Narváez Díaz Luis Armando, Ruiz Santillán Danna Patricia
Laboratory of Clinical Microbiology, National Institute of Respiratory Diseases (INER), Mexico City, Mexico.
Am J Case Rep. 2020 Nov 5;21:e927628. doi: 10.12659/AJCR.927628.
BACKGROUND Coinfection with severe acute respiratory syndrome-associated coronavirus 2 (SARS-CoV-2) and Mycobacterium tuberculosis (MBT) has been reported, albeit rarely, in various parts of the world and has received attention from health systems because up to one-third of the world's population has been infected with SARS-CoV-2. Mexico was not included in the first-ever report on a global cohort of patients with this coinfection. We report on a case of SARS-CoV-2/MBT coinfection in a 51-year-old taxi driver from Mexico City that underscores the importance of rapid and accurate laboratory testing, diagnosis, and treatment. CASE REPORT We present the case of a man in the sixth decade of life who was admitted to the National Institute of Respiratory Diseases (INER) with a diagnosis of COVID-19 pneumonia, which was confirmed by nasopharyngeal exudate using real-time polymerase chain reaction (RT-PCR) for the identification of SARS-CoV-2. Findings from imaging studies suggested that the patient might be coinfected with MBT. That suspicion was confirmed with light microscopy of a sputum sample after Ziehl-Neelsen staining and when a Cepheid Xpert MTB/RIF assay, an automated semi-quantitative RT-PCR assay, failed to detect rifampicin resistance. The patient was discharged from the hospital 10 days later. CONCLUSIONS The present report underscores the importance of using validated molecular diagnostic tests to identify coinfections in areas where there is a high prevalence of other causes of pneumonia, such as MBT, as a way to improve clinical outcomes in patients during the COVID-19 pandemic. While it is imperative to control the COVID-19 pandemic, the medical community must not forget about the other pandemics to which populations are still prey, and tuberculosis is one of them. We must remain alert to any clinical subtleties so as to ensure timely and accurate diagnosis and stay one step ahead of COVID-19.
在世界不同地区,已报告了严重急性呼吸综合征冠状病毒2(SARS-CoV-2)与结核分枝杆菌(MBT)的合并感染情况,尽管较为罕见,但由于全球多达三分之一的人口已感染SARS-CoV-2,这一情况受到了卫生系统的关注。墨西哥未被纳入首份关于此类合并感染患者的全球队列报告。我们报告了一例来自墨西哥城的51岁出租车司机发生SARS-CoV-2/MBT合并感染的病例,该病例强调了快速准确的实验室检测、诊断和治疗的重要性。病例报告:我们介绍了一名60岁男性的病例,他因COVID-19肺炎被收治入国家呼吸系统疾病研究所(INER),通过对鼻咽分泌物进行实时聚合酶链反应(RT-PCR)以鉴定SARS-CoV-2,确诊为COVID-19肺炎。影像学研究结果提示该患者可能合并感染了MBT。经萋-尼染色后痰标本的光学显微镜检查以及当赛沛Xpert MTB/RIF检测(一种自动化半定量RT-PCR检测)未能检测到利福平耐药时,该怀疑得到证实。患者10天后出院。结论:本报告强调了在肺炎其他病因(如MBT)高发地区使用经过验证的分子诊断检测来识别合并感染的重要性,以此作为在COVID-19大流行期间改善患者临床结局的一种方式。虽然控制COVID-19大流行势在必行,但医学界绝不能忘记人群仍受其害的其他大流行疾病,结核病就是其中之一。我们必须对任何临床细微之处保持警惕,以确保及时准确的诊断,并在COVID-19防治方面领先一步。