Diagnosis of community-acquired pneumonia and tuberculosis in a pulmonology department during the decline in the rate of the novel coronavirus infection cases

ntroduction. In the period of pandemic outbreaks of viral infections, such as COVID-19, the problem of differentially diagnosing pulmonary tuberculosis takes new features, especially in lung lesions affecting areas characteristic of tuberculosis and with a history of tuberculosis. Aim of the study was to determine the peculiarities of diagnosing tuberculosis in patients with community-acquired pneumonia during the decline in the rate of the novel coronavirus infection cases. Materials and Methods. Using the continuous sampling method, we selected a total of 120 case histories of patients with a verified diagnosis of pulmonary tuberculosis, admitted for inpatient treatment in the pulmonology department (n=120). The criterion for dividing into groups was the history of pulmonary tuberculosis. Two groups were formed: The first one consisted of 94 patients with a history of tuberculosis (de-registered for a phthisiatrist: 65.9% (62/94) recovered, 21.2% (20/94) were in the clinical cure group, 8.5% (8/94) received treatment on an outpatient basis, and 4.2% (4/94) withdrew from treatment), while the second one consisted of 26 patients with no history of tuberculosis. Inclusion criteria: Hospitalization by ambulance with a diagnosis of community-acquired pneumonia and no MBT on microscopy in the emergency room. Non-inclusion criteria: MBT detected at the level of the emergency room with transfer to a TB dispensary. The findings were processed statistically using the MedCalc 19.2.6. statistical software. Results and Discussion. Among all patients with diagnosed tuberculosis in the pulmonology hospital, 78.3% had a history of previous tuberculosis, and sputum/BALG showed more frequent detection of nonspecific flora (45.7%) vs. (19.2%), p=0.058 and SARS-CoV-2 22.3% vs. 3.9%, p=0.034 compared to those without a history of tuberculosis. HIV-infection was detected in 55.3% in the first group and in 76.9% in the second group (p=0.038). Indications for treatment in the ORIT setting were 37.5% (n=45) with a CURB-65 score of 4; while the remaining patients had a score of 2-3. Conclusions. The factors complicating the diagnosis of tuberculosis in the pulmonology department were concomitant coronavirus infection; concomitant HIV-infection; severe clinical course; multisegmental nature of lung lesions; and absence of decay cavities or sputum. In case of ineffective EP treatment, it is important to remain vigilant and continue diagnostic testing, considering potential mixed infection, especially in persons with HIV-infection.