A systematic review of reactivation of tuberculosis due to use of corticosteroids for COVID-19 treatment between January 2020 to January 2022

Sachchidanand Tewari, Rahul Yadav


Coronavirus-19 disease became a matter of concern for the whole world and WHO declared it as pandemic on 11 March 2020. Soon a number of clinical trials started to check for the treatment modalities, to compare their efficacy and safety. Out of which corticosteroids in trials showed decrease in mortality in severe COVID-19 patients. However existing diseases such as tuberculosis still remains a leading killer and matter of concern. One out of four individuals are said to be having tuberculosis (mostly in inactive form or latent form) but there remains a threat of reactivation of tuberculosis in presence of risk factors such as corticosteroid administration as it causes immunosuppression. This is a retrospective observational study on reactivation of tuberculosis due to corticosteroids used in COVID-19 treatment. Most commonly given corticosteroid was found to be dexamethasone and the duration of corticosteroid therapy ranged between 5 to 12 days. Majority of patients (5 out of 6) showed reactivation of tuberculosis within 30 days of starting of corticosteroid therapy and most common co-morbidity associated was found to be diabetes mellitus followed by hypertension in such patients. Symptoms of 4 out of 6 patients resolved after starting of anti-tubercular therapy.


COVID-19, Tuberculosis, Reactivation, Corticosteroids, Latent tuberculosis

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WHO. Director General Speech, 2020. Available at: opening-remarks-at-the-media-briefing-on-COVID-19---11-march-2020. Accessed on 18 April 2022.

WHO. COVID-19 Dashboard, 2021. Available at: Accessed on 22 April 2022.

Jain V, Yuan JM. Predictive symptoms and comorbidities for severe COVID-19 and intensive care unit admission: a systematic review and meta-analysis. Int J Public Health. 2020;65(5):533-46.

Recovery Trial. Press Release, 2020. Available at: Accessed on 22 April 2022.

WHO. CST for COVID-19, 2020. Available at: Accessed on 20 April 2022.

WHO. Tuberculosis Fact Sheets, 2021. Available at: Accessed on 18 April 2022.

Lee CH, Kim K, Hyun MK, Jang EJ, Lee NR, Yim JJ. Use of inhaled corticosteroids and the risk of tuberculosis. Thorax. 2013;68(12):1105-13.

Garg N, Im Lee Y. Reactivation TB with severe COVID-19. Chest. 2020;158(4):777.

Sasson A, Aijaz A, Chernyavsky S, Salomon N. A Coronavirus Disease 2019 (COVID-19) Mystery: Persistent Fevers and Leukocytosis in a Patient With Severe COVID-19. Open Forum Infect Dis. 2020;7(12):ofaa558.

Pozdnyakov A, Jin A, Bader M. Reactivation of Pulmonary Tuberculosis in a Patient With COVID-19: Case Report and Review of Literature. Infect Dis Clin Pract (Baltim Md). 2021;29(6):468-70.

Liu WD, Wang JT, Hung CC, Chang SC. Accelerated progression of pulmonary tuberculosis in a COVID-19 patient after corticosteroid treatment. J Microbiol Immunol Infect. 2022;55(2):347-9.

Younes I, Noori MA, Elkattawy S, Viechweg J, Nwachukwu O. Latent mycobacterium TB reactivation in two patients with COVID-19 pneumonia. Chest. 2021;160(4):469.

Gandotra A, Mehtani R, Premkumar M, Duseja A, De A, Mallik N, et al. Invasive Pulmonary Aspergillosis and Tuberculosis Complicated by Hemophagocytic Lymphohistiocytosis - Sequelae of COVID-19 in a Liver Transplant Recipient. J Clin Exp Hepatol. 2022;12(3):1007-11.