Skip to main content Skip to main navigation menu Skip to site footer

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


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.


  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.

How to Cite

Retnaningsih, R., Purwaamijaya, B., Tugasworo, D., Andhitara, Y., Ardhini, R., Kurnianto, A., Afany, N., Bunyamin, J., Utami, F. S., Sogata, I. A., & Hairuzaman, H. (2021). Meningoencephalitis due to SARS-CoV-2 and tuberculosis co-infection: a case report from Indonesia. Bali Medical Journal, 10(2), 673–676.




Search Panel