Meningoencephalitis due to SARS-CoV-2 and tuberculosis co-infection: a case report from Indonesia

Retnaningsih Retnaningsih; Bima Purwaamijaya; Dodik Tugasworo; Yovita Andhitara; Rahmi Ardhini; Aditya Kurnianto; Nur Afany; Jacob Bunyamin; Fatiha Sri Utami; Ida Ayu Sogata; Hairuzaman Hairuzaman

doi:10.15562/bmj.v10i2.2235

Meningoencephalitis due to SARS-CoV-2 and tuberculosis co-infection: a case report from Indonesia

Retnaningsih Retnaningsih ,

Bima Purwaamijaya ,

Dodik Tugasworo ,

Yovita Andhitara ,

Rahmi Ardhini ,

Aditya Kurnianto ,

Nur Afany ,

Jacob Bunyamin ,

Fatiha Sri Utami ,

Ida Ayu Sogata ,

Hairuzaman Hairuzaman ,

PDF |
DOI: https://doi.org/10.15562/bmj.v10i2.2235 |
Published: 2021-07-31

Abstract

Introduction: The novel coronavirus which firstly detected in December 2019 in Wuhan, China, has been known to cause neurological dysfunction either by directly or indirectly infecting the brain.

Case: We are reporting a case of meningoencephalitis due to co-infection of M. tuberculosis and SARS-CoV-2 in a hospital in Indonesia. A 26-year-old gentleman working as a courier in a Sars-Cov-2 red zone without adequate protection complained frequent headaches since a month to admission. M. tuberculosis was detected on very low level by GenXpert® and rapid test for SARS-CoV-2 was nonreactive. Repeated GenXpert® showed detected M. tuberculosis with undetected rifampicin resistance. Subsequent CSF SARS-CoV-2 PCR was positive although the oropharyngeal swab was negative.

Conclusion: The report of pulmonary co-infection of TB and SARS-COV-2 has been published, however, to our best knowledge there has been no report of neurological co-infection to date. We are reporting the report of CNS co-infection from our country.

References

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Jia HP, et al. ACE2 Receptor Expression and Severe Acute Respiratory Syndrome Coronavirus Infection Depend on Differentiation of Human Airway Epithelia. J Virol. 2005;79:14614–14621.
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Chen Y. et al. Active or latent tuberculosis increases susceptibility to COVID-19 and disease severity. Cold Spring Harb Lab. 2020. doi:10.1016/j.solener.2019.02.027.

[1] Li Q, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med. 2020;382:1199–1207.

[2] Moriguchi T, et al. A first case of meningitis/encephalitis associated with SARS-Coronavirus-2. Int J Infect Dis. 2020;94:55–58 (2020).

[3] Xia H, Lazartigues E. Angiotensin-converting enzyme 2 in the brain: Properties and future directions. J Neurochem. 2008;107:1482–1494.

[4] Jia HP, et al. ACE2 Receptor Expression and Severe Acute Respiratory Syndrome Coronavirus Infection Depend on Differentiation of Human Airway Epithelia. J Virol. 2005;79:14614–14621.

[5] Kai H, Kai M. Interactions of coronaviruses with ACE2, angiotensin II, and RAS inhibitors-lessons from available evidence and insights into COVID-19. Hypertens Res. 2020;43(7):648-654. doi: 10.1038/s41440-020-0455-8. E

[6] Steardo L, Steardo L Jr, Zorec R, Verkhratsky A. Neuroinfection may contribute to pathophysiology and clinical manifestations of COVID-19. Acta Physiol (Oxf). 2020;229(3):e13473. doi: 10.1111/apha.13473.

[7] Jebril N. Viral Encephalitis Associated with COVID-19: A Review of the Literature and Two Cases. SSRN Electron J. 2020;12:1-6. doi:10.2139/ssrn.3573520

[8] Wu Y, Xu X, Chen Z, Duan J, Hashimoto K, Yang L, Liu C, Yang C. Nervous system involvement after infection with COVID-19 and other coronaviruses. Brain Behav Immun. 2020;87:18-22. doi: 10.1016/j.bbi.2020.03.031.

[9] Thwaites G, Fisher M, Hemingway C, Scott G, Solomon T, Innes J; British Infection Society. British Infection Society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children. J Infect. 2009;59(3):167-87. doi: 10.1016/j.jinf.2009.06.011.

[10] Be NA, Kim KS, Bishai WR, Jain SK. Pathogenesis of central nervous system tuberculosis. Curr Mol Med. 2009;9(2):94-9. doi: 10.2174/156652409787581655.

[11] Donovan J, Figaji A, Imran D, Phu NH, Rohlwink U, Thwaites GE. The neurocritical care of tuberculous meningitis. Lancet Neurol. 2019;18(8):771-783. doi: 10.1016/S1474-4422(19)30154-1.

[12] Chaidir L, Annisa J, Dian S, Parwati I, Alisjahbana A, Purnama F, van der Zanden A, Ganiem AR, van Crevel R. Microbiological diagnosis of adult tuberculous meningitis in a ten-year cohort in Indonesia. Diagn Microbiol Infect Dis. 2018;91(1):42-46. doi: 10.1016/j.diagmicrobio.2018.01.004.

[13] Liu K, Pan M, Xiao Z, Xu X. Neurological manifestations of the coronavirus (SARS-CoV-2) pandemic 2019-2020. J Neurol Neurosurg Psychiatry. 2020;91(6):669-670. doi: 10.1136/jnnp-2020-323177.

[14] Baig AM, Khaleeq A, Ali U, Syeda H. Evidence of the COVID-19 Virus Targeting the CNS: Tissue Distribution, Host-Virus Interaction, and Proposed Neurotropic Mechanisms. ACS Chem Neurosci. 2020;11(7):995-998. doi: 10.1021/acschemneuro.0c00122.

[15] Desforges M, Le Coupanec A, Dubeau P, Bourgouin A, Lajoie L, Dubé M, Talbot PJ. Human Coronaviruses and Other Respiratory Viruses: Underestimated Opportunistic Pathogens of the Central Nervous System? Viruses. 2019;12(1):14. doi: 10.3390/v12010014.

[16] Koyuncu OO, Hogue IB, Enquist LW. Virus infections in the nervous system. Cell Host Microbe. 2013;13(4):379-93. doi: 10.1016/j.chom.2013.03.010.

[17] Lešková V, Jacková A, Vlasáková M, Vil?ek S. Genetic characterization of a border disease virus isolate originating from Slovakia. Acta Virol. 2013;57(1):17-25. doi: 10.4149/av_2013_01_17.

[18] Fu Y, Cheng Y, Wu Y. Understanding SARS-CoV-2-Mediated Inflammatory Responses: From Mechanisms to Potential Therapeutic Tools. Virol Sin. 2020;35(3):266-271. doi: 10.1007/s12250-020-00207-4.

[19] Mehta P, McAuley DF, Brown M, Sanchez E, Tattersall RS, Manson JJ; HLH Across Speciality Collaboration, UK. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet. 2020;395(10229):1033-1034. doi: 10.1016/S0140-6736(20)30628-0.

[20] Lau K, Yu W, Chu C, Lau S, Sheng B. Infection by SARS Coronavirus. Emerg Infect Dis. 2004;10: 2–4.

[21] Zaim S, Chong JH, Sankaranarayanan V, Harky A. COVID-19 and Multiorgan Response. Curr Probl Cardiol. 2020;45(8):100618. doi: 10.1016/j.cpcardiol.2020.100618.

[22] McCray PB, et al. Lethal Infection of K18-hACE2 Mice Infected with Severe Acute Respiratory Syndrome Coronavirus. J Virol. 2007;81:813–821.

[23] Hayashi M, Sahashi Y, Baba Y, Okura H, Shimohata T. COVID-19-associated mild encephalitis/encephalopathy with a reversible splenial lesion. J Neurol Sci. 2020;415:116941. doi: 10.1016/j.jns.2020.116941.

[24] Tadolini M, Codecasa LR, García-García JM, Blanc FX, Borisov S, Alffenaar JW, et al. Active tuberculosis, sequelae and COVID-19 co-infection: first cohort of 49 cases. Eur Respir J. 2020;56(1):2001398. doi: 10.1183/13993003.01398-2020.

[25] Chen Y. et al. Active or latent tuberculosis increases susceptibility to COVID-19 and disease severity. Cold Spring Harb Lab. 2020. doi:10.1016/j.solener.2019.02.027.

Meningoencephalitis due to SARS-CoV-2 and tuberculosis co-infection: a case report from Indonesia

Abstract

References

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