Publicação: 24 de janeiro de 2022
KOLKATA: Two major takeaways from the revised protocol on clinical management of Covid patients — use of steroid and screening for tuberculosis (TB) — could help reducing the misuse of steroids and enhance TB detection, health experts said.
The Government of India on Tuesday had issued a revised guideline on treatment of Covid-19 patients that is expected to be followed by all physicians managing these patients.
The revised guideline has included people suffering from TB into the high risk category of patients developing severe Covid-19 infection. Doctors treating positive patients through the three waves of the pandemic said they had come across sporadic cases of Covid-19 and TB as co-infection in patients.
“In some Covid patients, who were coughing for a longer period, we noticed changes in the chest infection, resembling TB and later the disease was detected in some. Moreover, steroid use can aggravate and unmask cases of tuberculosis. Therefore, the changed protocol is a welcome move,” said infectious diseases specialist Yogiraj Ray of IPGMER.
“This protocol is also a reminder that TB is a major public health issue. We need to catch the cases early for timely intervention that would limit disease progression and transmission,” added Ray.
TB and the coronavirus infections involve the lungs and both are infectious. Doctors said that it would be a double whammy for a person suffering from tuberculosis, known or latent, if infected by the virus.
“In majority of TB patients there already is the issue of lung fibrosis. So, if they get Covid-19 infection they have a bigger risk of developing severe disease resulting in poor treatment outcome. The new guideline could also bolster TB detection. So it is a positive step,” said pulmonologist Raja Dhar, director of pulmonology wing at CMRI.
The new protocol says the patient should be screened for TB and other respiratory ailments if the cough persists for over two to three weeks.
The rampant use of steroid has always been a concern as doctors also said that over indulgence of steroid could cause more harm than benefits in some patients.
For steroid use the new guideline has a rider that there is no evidence of steroid in patients not requiring oxygen support and continuation of it after discharge.
“Steroid has to be used in the lowest possible dosage within the shortest possible duration on selected patients under observation. Otherwise, it causes side effects, including mucormycosis. And also there has been several cases of tuberculosis flaring up post Covid infection. Hence the two paradigm changes in the protocol is much needed,” said Asis Manna, MSVP, Infectious Diseases and Beliaghata General Hospital.