Neuro-tuberculosis in COVID: Our experience

OBJECTIVES: To highlight the significant increase, varied presentation and poor outcomes of neuro-tuberculosis were noted during the COVID-19 pandemic. METHODOLOGY: Retrospective assessment of all cases of neuro-tuberculosis from August 2020 – December 2021 was analyzed. Clinical presentation, neuroimaging findings, drug resistance, systemic involvement and outcomes were assessed in association with COVID-PCR and antibody status. RESULTS: 16 cases of neuro-tuberculosis were diagnosed and treated. Female: Male ratio was 3:1 with maximum patients in adolescent age group (0-5 years: 4/16, 5-10 years: 2/16 and 10-18 years: 10/16 respectively). 9/16(56.25%) had multiple organ involvement including bone, Lungs and Abdomen. A positive family history of TB was present in 4/16 patients. 3/16 patients had COVID RT-PCR positive. COVID Antibody was positive in 5/16, negative in 5/16, not done in 6/16 as antibody tests were available only after second wave. Gene X-pert was positive in all patients with 5/16 having MDR-TB and no cases of XDR-TB. Critical condition requiring ICU admission at presentation was common (13/16) with 10 requiring mechanical ventilation. 11/16 had hydrocephalus with 9 requiring a shunt. 11/16 had infarcts. 12/16 improved and were discharged on AKT, 4/16 died. CONCLUSION: All forms of tuberculosis have seen an increase in incidence during COVID pandemic. We have seen a spate of new and atypical neuro-tuberculosis cases, especially among previously healthy adolescent females. It may be postulated that co-existing TB and COVID-19 infection can have devastating outcomes. The reason for this may be patients confined in closed spaces, delayed admissions and immunocompromised status.
Keywords: Neurotuberculosis, TBM, COVID-19, CNS infections