1例继发性肺结核合并新型冠状病毒肺炎的病例报道

A case report of secondary pulmonary tuberculosis complicated with COVID-19

探讨继发性肺结核合并新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)的早期诊断和治疗。回顾性分析武汉市肺科医院收治的1例继发性肺结核合并COVID-19患者的临床表现、辅助检查及诊治经过。患者有明确的COVID-19的接触史,临床表现为咳嗽、咳痰,发热及气喘,胸部CT可见双肺散在多发的斑片、结节、斑点、条索及空洞影。通过呼吸道标本新型冠状病毒核酸检测尽早确诊了COVID-19,通过合理的抗结核联合抗病毒治疗后,呼吸道标本新型冠状病毒核酸及痰标本结核细菌涂片转阴,症状缓解出院。在COVID-19流行时期,需注意鉴别继发性肺结核合并COVID-19情况,以及治疗两种疾病药物方案的制定,避免使用肝药酶诱导剂利福平,其会使克力芝(洛匹那韦/利托那韦)、阿比多尔等药效减弱贻误治疗。

To investigate the early diagnosis and treatment of secondary tuberculosis complicated with COVID-19.The clinical manifestation,auxiliary examination,diagnosis and treatment of one case of secondary tuberculosis complicated with COVID-19 admitted to Wuhan Pulmonary Hospital were analyzed retrospectively.The patient had a clear history of COVID-19 exposure.The clinical manifestations were cough,expectoration,fever and gasp.Chest CT showed multiple patch,nodule,spot,strip and cavity shadow in two lungs.COVID-19 was diagnosed as early as possible by detection of SARS-CoV-2 nucleic acid in respiratory specimens.After reasonable anti-tuberculosis combined with antiviral treatment,the detection of SARSCoV-2 nucleic acid in respiratory specimens and acid-fast bacilli smear of sputum specimens turned negative,the symptoms were relieved and discharged.In the epidemic period of COVID-19,we should pay attention to the identification of secondary pulmonary tuberculosis with COVID-19,the formulation of drug programs for the treatment of two diseases,and avoid the use of rifampicin,a liver drug enzyme inducer,so as to avoid missed treatment due to the weakened efficacy of lopinavir/ritonavir and abidol,etc.