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This deleterious synergism of viral and bacterial infections increases the risk of influenza-associated mortality, and patients with PTB may increase the severity of influenza disease and death due to chronic lung disease and immunosuppression.
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Specifically, influenza can impair T-cell immunity and weaken innate immune responses against secondary bacterial infections. Both influenza and tuberculosis hinder host immune responses. Influenza infection may promote the progression of latent Mycobacterium tuberculosis (MTB) infection to active TB, alter the clinical presentation of TB, and also possibly exacerbate pulmonary TB (PTB). TB mortality in Romania has followed the same course as the incidence, with a peak in 2002 and an elevation of XDR-TB cases between 20, with a threefold increase.
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A series of factors augmented the severity of TB endemic in Romania, namely, a large number of severe forms, cases with multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant TB (XDR-TB), HIV coinfection, and (TB-related) mortality in children. The incidence of TB increased in Romania after 1990, peaking in 2002 (142.2%), with a downward trend since then, 54.5/100 000 in 2016, and 54.2% lower than in 2002. TB remains of great significance for the public health in Eastern Europe (e.g., Romania), which has the highest TB incidence in the European Union (EU) (4 times higher than the average), accounting for a quarter of the TB burden in the EU. The incidence of TB is slowly declining but remains a significant issue worldwide (ranked as the ninth leading cause of death worldwide and the leading cause of a single infectious agent ), especially in most middle-income and emerging-economy countries.
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Most data and all predictions concerning global epidemiology of TB are based on “ real-life” analysis (surveys and national surveillance programs) conducted by the World Health Organization (WHO). The global threat of contagious infectious diseases, particularly tuberculosis (TB), has long concerned authorities in charge of public health policies. Despite the rapidly growing number of cases, the data needed to predict the impact of the COVID-19 pandemic on patients with latent TB and TB sequelae still lies ahead. Because viral respiratory infections and TB impede the host’s immune responses, it can be assumed that their lethal synergism may contribute to more severe clinical evolution.
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Finally, we addressed the issues of vaccination and diagnostic reliability in the context of coinfection. Second, although challenging due to data scarcity, investigating the pathological pathways linking TB and SARS-CoV-2 leads to the idea that their coexistence might yield a more severe clinical evolution. First, lessons from past outbreaks (other coronaviruses) and influenza pandemic/seasonal outbreaks have taught the importance of infection control to avoid the severe impact on TB patients. Few essential elements about TB and SARS-CoV coinfections were discussed. We aimed to answer the following questions: What can be learned from other coronavirus outbreaks (focusing on TB patients)? Is coinfection (TB and SARS-CoV-2) more severe? Is there a vaccine for SARS-CoV-2? How does the TB vaccine affect COVID-19? How does one diagnosis affect the other? Discussions. Using a data mining approach, we also queried the COVID-19 Open Research Dataset (CORD-19). The PubMed electronic database was systematically searched for relevant articles linking TB, influenza, and SARS-CoV viruses and subsequently assessed eligibility according to inclusion criteria. Of particular interest is the aftermath of superimposing viral epidemics (especially SARS-CoV-2) over long-standing diseases, such as tuberculosis (TB), which remains a significant disease for public health worldwide and especially in emerging economies. The threat of contagious infectious diseases is constantly evolving as demographic explosion, travel globalization, and changes in human lifestyle increase the risk of spreading pathogens, leading to accelerated changes in disease landscape.