Medical Focus - GPH - Vol 3 No 2 250521

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What to expect as COVID-19 vaccine coveragewidensAs global and regional COVID-19 Vaccine coverage increases,one expect that less and less infections would happen andthen the burden on our health system would lessen so thatmore resources can be available for the TB programmes.Take home messages• The burden of HIV/TB infection is high in developing countries• Nigeria has the 7th largest burden of TB, with over 400 000infections among HIV negative people yearly while over60 000 HIV positive people are infected yearly• TB and COVID share some common symptoms, methodsshould be put in place to ensure that both are identifiedearly and treated appropriately• People with previous TB infection is associated with severeCOVID infection. Conversely, the lesions associated withCOVID may increase the risk of TB• Due to the pandemic and lockdown measures and theconsequent disruption in TB services, service providersmust develop innovative means of sustaining servicesConclusionUnlike most acute infections, TB takes a rigorous sometimestortuous path to treat. Resources to treat TB diseases havebeen inadequate so that the arrival of COVID-19 only heraldedglobal TB programme failure. But we must not give in toaccepting failure but to do all we can to navigate the troublewaters created by COVID-19 pandemic, TB-co-infection andthe challenges of multidrug resistant TB.References1. Gray DM, Davies M-A, Githinji L, Levin M, Mapani M,Nowalaza Z et al. COVID-19 and Pediatric Lung Disease:A South African Tertiary Center Experience. Front Pediatr2021; 8: 836.2. Kumar R, Bhattacharya B, Meena V, Soneja M, Wig N.COVID-19 and TB co-infection - ‘Finishing touch’’ in perfectrecipe to ‘severity• or •death’. J Infect 2020; 81: e39–e40.3. Khurana AK, Aggarwal D. The (in)significance of TB andCOVID-19 co-infection. Eur. Respir. J. 2020; 56.4. Stochino C, Villa S, Zucchi P, Parravicini P, Gori A, RaviglioneMC. Clinical characteristics of COVID-19 and active tuberculosisco-infection in an Italian reference hospital. Eur.Respir. J. 2020; 56.5. Chidubem L Ogbudebe, Victor Adepoju, ChristyEkerete-Udofia, Ebere Abu, Ginika Egesemba, NkemChukwueme, Mustapha Gidado Childhood Tuberculosisin Nigeria: Disease Presentation and TreatmentOutcomes PMID: 29511357 PMCID: PMC5826094 DOI:10.1177/11786329187574906. Finn McQuaid C, McCreesh N, Read JM, Sumner T, HoubenRMGJ, White RG et al. The potential impact ofCOVID-19-related disruption on tuberculosis burden. Eur.Respir. J. 2020; 56.7. Gao Y, Liu M, Chen Y, Shi S, Geng J, Tian J. Association betweentuberculosis and COVID-19 severity and mortality:A rapid systematic review and meta-analysis. J. Med. Virol.2021; 93: 194–196.8. Mousquer GT, Peres A, Fiegenbaum M. Pathology of TB/COVID-19 Co-Infection: The phantom menace. Tuberculosis.2021; 126: 102020.9. Ata, F., et al., A 28-Year-Old Man from India with SARS-Cov-2 and Pulmonary Tuberculosis CoInfection with CentralNervous System Involvement. Am J Case Rep, 2020. 4.10. Boulle, A., et al., Risk factors for COVID-19 death in a populationcohort study from the Western Cape Province,South Africa. Clin Infect Dis, 2020. 5.11. Can Sarinoglu, R., et al., Tuberculosis and COVID-19: Anoverlapping situation during pandemic. J Infect Dev Ctries,2020. 14(7): 721-725.12. Chen, T., et al., Clinical Characteristics and Outcomes ofOlder Patients with Coronavirus Disease 2019 (COVID-19)in Wuhan, China: A Single-Centered, Retrospective Study. JGerontol A Biol Sci Med Sci, 2020. 75(9): 1788-1795.13. Faqihi, F., et al., COVID-19 in a patient with active tuberculosis:A rare case-report. Respir Med Case Rep, 2020. 31:101-146.6Vol 3 No 2 - 2021
Overview of Long-COVID or PASC and when is itCOVID and when is it notDr Murray Dryden MBChBNational Institute for Communicable Diseases Division of National Health Laboratory ServicesSouth AfricaDefinitions• The COVID Symptom Study identified six clusters of symptomssuggests that roughly 10% of patients are at risk. 4,5 • Currently there is no laboratory test identified that canThere is currently no universally accepted definition of Long-COVID. However, the National Institute for Health and CareExcellence (NICE) in the UK have put forward the followingdefinitions: 1(persistent cough, hoarse voice, headache, diar-rhoea, skipping meals, and shortness of breath) in the firstweek of acute COVID that may increase one’s risk two tothree times for developing longer term symptoms. 6• Acute COVID-19• Predicting who is likely to develop PASC is currently not––Signs and symptoms of COVID-19 for up to 4 weeks followingfrom symptom onset.possible. However, there are certain groups of people whoappear to be particularly predisposed.• Ongoing symptomatic COVID-19––Pre-existing diagnosis of depression is associated with––Signs and symptoms of COVID-19 from 4 weeks up to severe post-COVID fatigue. 712 weeks.––It is twice as common in women as in men and a slight• Post-COVID-19 syndromeincrease in people who are overweight but not statistically––Signs and symptoms that develop during or after ansignificant. 8infection consistent with COVID-19, continue for morethan 12 weeks and are not explained by an alternativediagnosis.––There seems to be different symptom clusters in differentages, so it could be that there is a different typein younger people compared with the over 65s but a• Long-COVIDmore reliable link can only be established as more data––Described signs and symptoms that continue or developis collected. 8after acute COVID-19. It includes both ongoingsymptomatic COVID-19 (from 4 to 12 weeks) and post• Severity of acute COVID-19 has not shown to be a reliablepredictor of those who will and who will not develop PASC.COVID-19 syndrome (12 weeks or more).PresentationNIH Director Francis Collins has proposed post-acute sequelaeof SARS-CoV-2 infection (PASC) to be used as the formalclinical name for Long COVID.Patients may present with a remarkably wide range of persistentor recurrent symptoms following acute SARS- CoV-2infection, including the following: 1,9,10• Most CommonAetiology––Severe fatigueThe aetiology of PASC is still undefined. Currently available ––Shortness of breath/breathlessnessresearch suggests that it may be as result of the inflammation––Persistent coughand injury that occurs during the acute infectious phase ––Chest pain or heavinessof SARS-CoV-2 infection 2 in a variety of organ systems including––Joint pain or swellingthe brain, heart and the lungs to name a few, but ulti-• Other Symptomsmately the injury may be wide spread throughout all organ ––Cognitive impairment – “brain fog”systems in the body. 3––Muscle pain––HeadacheThe injuries are not as a result of ongoing SARS-COV-2 infection––Intermittent feverbut rather the injury to the body that occurred during ––Palpitationsthe acute infectious period.––Anosmia and/or ageusia––Reduced exercise capacityPatients who may be diagnosed are not infectious and cannot––Vertigo and tinnitusbe spread PASC (or occur in someone who had not been ––Peripheral neuropathyinfected by SARS-COV-2 whether they were formally diagnosed––Metallic or bitter tasteor not.)––Skin rashWho is at risk?The syndrome is often accompanied by anxiety and depression,associated with the protracted and unpredictablePreliminary research seems to suggest that PASC may developin both patients who experienced mild and severe disease course of the symptoms.with no immediately recognisable correlation.• In those who became ill with SARS-COV-2, preliminary data Diagnosis7 Vol 3 No 2 - 2021
Page 1: Volume 3 No 2 - 2021HIV, TB and Men
Page 4 and 5: Outlook of paediatric tuberculosis
Page 8 and 9: be used to diagnose someone with PA
Page 10 and 11: Managing schizophrenia with long-ac
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Page 14 and 15: recent data from the Botswana Tsepa
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