{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T00:43:00Z","timestamp":1793148180541,"version":"4.5.0"},"reference-count":101,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2021,4,6]],"date-time":"2021-04-06T00:00:00Z","timestamp":1617667200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Center for Covid Research and Pandemic Preparedness (CCRP2) of Rutgers University","award":["302211"],"award-info":[{"award-number":["302211"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>On 11 March 2020, the World Health Organization announced the Corona Virus Disease-2019 (COVID-19) as a global pandemic, which originated in China. At the host level, COVID-19, caused by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), affects the respiratory system, with the clinical symptoms ranging from mild to severe or critical illness that often requires hospitalization and oxygen support. There is no specific therapy for COVID-19, as is the case for any common viral disease except drugs to reduce the viral load and alleviate the inflammatory symptoms. Tuberculosis (TB), an infectious disease caused by Mycobacterium tuberculosis (Mtb), also primarily affects the lungs and has clinical signs similar to pulmonary SARS-CoV-2 infection. Active TB is a leading killer among infectious diseases and adds to the burden of the COVID-19 pandemic worldwide. In immunocompetent individuals, primary Mtb infection can also lead to a non-progressive, asymptomatic latency. However, latent Mtb infection (LTBI) can reactivate symptomatic TB disease upon host immune-suppressing conditions. Importantly, the diagnosis and treatment of TB are hampered and admixed with COVID-19 control measures. The US-Center for Disease Control (US-CDC) recommends using antiviral drugs, Remdesivir or corticosteroid (CST), such as dexamethasone either alone or in-combination with specific recommendations for COVID-19 patients requiring hospitalization or oxygen support. However, CSTs can cause immunosuppression, besides their anti-inflammatory properties. The altered host immunity during COVID-19, combined with CST therapy, poses a significant risk for new secondary infections and\/or reactivation of existing quiescent infections, such as LTBI. This review highlights CST therapy recommendations for COVID-19, various types and mechanisms of action of CSTs, the deadly combination of two respiratory infectious diseases COVID-19 and TB. It also discusses the importance of screening for LTBI to prevent TB reactivation during corticosteroid therapy for COVID-19.<\/jats:p>","DOI":"10.3390\/ijms22073773","type":"journal-article","created":{"date-parts":[[2021,4,6]],"date-time":"2021-04-06T03:58:31Z","timestamp":1617681511000},"page":"3773","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":70,"title":["Corticosteroids for COVID-19 Therapy: Potential Implications on Tuberculosis"],"prefix":"10.3390","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8688-4617","authenticated-orcid":false,"given":"Radha","family":"Gopalaswamy","sequence":"first","affiliation":[{"name":"Department of Bacteriology, ICMR-National Institute for Research in Tuberculosis, Chennai 600031, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2021-8632","authenticated-orcid":false,"given":"Selvakumar","family":"Subbian","sequence":"additional","affiliation":[{"name":"Public Health Research Institute at New Jersey Medical School, Rutgers University, 225 Warren Street, Newark, NJ 08854, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,4,6]]},"reference":[{"key":"ref_1","unstructured":"WHO (2021, March 09). WHO Coronavirus Disease (COVID-19) Dashboard. Available online: https:\/\/covid19.who.int\/."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1002\/path.5471","article-title":"Angiotensin-converting enzyme 2 (ACE2), SARS-CoV-2 and the pathophysiology of coronavirus disease 2019 (COVID-19)","volume":"251","author":"Bourgonje","year":"2020","journal-title":"J. Pathol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1016\/j.cell.2020.02.052","article-title":"SARS-CoV-2 Cell Entry Depends on ACE2 and TMPRSS2 and Is Blocked by a Clinically Proven Protease Inhibitor","volume":"181","author":"Hoffmann","year":"2020","journal-title":"Cell"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Arena, F., Pollini, S., Rossolini, G.M., and Margaglione, M. (2021). Summary of the Available Molecular Methods for Detection of SARS-CoV-2 during the Ongoing Pandemic. Int. J. Mol. Sci., 22.","DOI":"10.20944\/preprints202101.0473.v1"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2000607","DOI":"10.1183\/13993003.00607-2020","article-title":"Pathogenesis of COVID-19 from a cell biology perspective","volume":"55","author":"Mason","year":"2020","journal-title":"Eur. Respir. J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e01175-20","DOI":"10.1128\/mBio.01175-20","article-title":"Pathogenesis of COVID-19 from the Perspective of the Damage-Response Framework","volume":"11","author":"Pirofski","year":"2020","journal-title":"mBio"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1016\/j.healun.2020.03.012","article-title":"COVID-19 illness in native and immunosuppressed states: A clinical-therapeutic staging proposal","volume":"39","author":"Siddiqi","year":"2020","journal-title":"J. Heart Lung Transpl."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"108427","DOI":"10.1016\/j.clim.2020.108427","article-title":"COVID-19 pathophysiology: A review","volume":"215","author":"Yuki","year":"2020","journal-title":"Clin. Immunol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"910","DOI":"10.1016\/j.immuni.2020.05.002","article-title":"Immunology of COVID-19: Current State of the Science","volume":"52","author":"Vabret","year":"2020","journal-title":"Immunity"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2137","DOI":"10.1042\/CS20200904","article-title":"Unpuzzling COVID-19: Tissue-related signaling pathways associated with SARS-CoV-2 infection and transmission","volume":"134","author":"Battagello","year":"2020","journal-title":"Clin. Sci. (Lond.)"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.yjmcc.2020.05.007","article-title":"p38 MAPK inhibition: A promising therapeutic approach for COVID-19","volume":"144","author":"Grimes","year":"2020","journal-title":"J. Mol. Cell Cardiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1007\/s10787-020-00773-9","article-title":"The Role and Therapeutic Potential of NF-kappa-B Pathway in Severe COVID-19 Patients","volume":"29","author":"Hariharan","year":"2021","journal-title":"Inflammopharmacology"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1038\/s41392-020-00457-4","article-title":"Longitudinal transcriptome analyses show robust T cell immunity during recovery from COVID-19","volume":"5","author":"Zheng","year":"2020","journal-title":"Signal. Transduct. Target Ther."},{"key":"ref_14","unstructured":"NIH (2021, February 28). COVID-19 Treatment Guidelines\u2014Corticosteroids, Available online: https:\/\/www.covid19treatmentguidelines.nih.gov\/immune-based-therapy\/immunomodulators\/corticosteroids\/."},{"key":"ref_15","unstructured":"NIH (2021, March 10). COVID-19 Treatment Guidelines\u2014The COVID-19 Treatment Guidelines Panel\u2019s Statement on the Emergency Use Authorization of the Bamlanivimab Plus Etesevimab Combination for the Treatment of COVID-19, Available online: https:\/\/www.covid19treatmentguidelines.nih.gov\/statement-on-bamlanivimab-plus-etesevimab-eua\/."},{"key":"ref_16","unstructured":"NIH (2021, March 12). COVID-19 Treatment Guidelines\u2014The COVID-19 Treatment Guidelines Panel\u2019s Statement on the Use of Tocilizumab for the Treatment of COVID-19, Available online: https:\/\/www.covid19treatmentguidelines.nih.gov\/statement-on-tocilizumab\/."},{"key":"ref_17","unstructured":"WHO (2021, February 28). Global Tuberculosis Report 2020. Available online: https:\/\/www.who.int\/tb\/publications\/global_report\/en\/."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Zhai, W., Wu, F., Zhang, Y., Fu, Y., and Liu, Z. (2019). The Immune Escape Mechanisms of Mycobacterium Tuberculosis. Int. J. Mol. Sci., 20.","DOI":"10.3390\/ijms20020340"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e2019716118","DOI":"10.1073\/pnas.2019716118","article-title":"Quantifying asymptomatic infection and transmission of COVID-19 in New York City using observed cases, serology, and testing capacity","volume":"118","author":"Subramanian","year":"2021","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Drain, P.K., Bajema, K.L., Dowdy, D., Dheda, K., Naidoo, K., Schumacher, S.G., Ma, S., Meermeier, E., Lewinsohn, D.M., and Sherman, D.R. (2018). Incipient and Subclinical Tuberculosis: A Clinical Review of Early Stages and Progression of Infection. Clin. Microbiol. Rev., 31.","DOI":"10.1128\/CMR.00021-18"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2541","DOI":"10.4049\/jimmunol.1800993","article-title":"The End of the Binary Era: Revisiting the Spectrum of Tuberculosis","volume":"201","author":"Lin","year":"2018","journal-title":"J. Immunol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"675","DOI":"10.1164\/rccm.201007-1099OC","article-title":"Inhaled corticosteroids and risk of tuberculosis in patients with respiratory diseases","volume":"183","author":"Brassard","year":"2011","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_23","first-page":"PA2969","article-title":"Anti-TNF-alpha therapy in patients with latent tuberculosis incidence","volume":"46","author":"Coskunol","year":"2015","journal-title":"Eur. Respir. J."},{"key":"ref_24","first-page":"PA2975","article-title":"Screening tests for latent tuberculosis prior to anti-TNF alpha therapy\u2014A systematic review and meta-analysis","volume":"54","author":"Ramalho","year":"2019","journal-title":"Eur. Respir. J."},{"key":"ref_25","first-page":"119","article-title":"Pulmonary tuberculosis in dermatological patients on high-dose, long-term steroid therapy","volume":"15","author":"Altaf","year":"2015","journal-title":"J. Pak. Assoc. Dermatol."},{"key":"ref_26","unstructured":"Kufe, D.W., Pollock, R.E., and Weichselbaum, R.R. (2003). Pharmacologic Effects of Corticosteroids. Holland-Frei Cancer Medicine, BC Decker. [6th ed.]."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1097\/NOR.0000000000000595","article-title":"Corticosteroids","volume":"38","author":"Kapugi","year":"2019","journal-title":"Orthop. Nurs."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"655","DOI":"10.4187\/respcare.06314","article-title":"Clinical Pharmacology of Corticosteroids","volume":"63","author":"Williams","year":"2018","journal-title":"Respir. Care"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1038\/nri2470","article-title":"Annexin A1 and glucocorticoids as effectors of the resolution of inflammation","volume":"9","author":"Perretti","year":"2009","journal-title":"Nat. Rev. Immunol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1545","DOI":"10.3389\/fimmu.2019.01545","article-title":"A General Introduction to Glucocorticoid Biology","volume":"10","author":"Timmermans","year":"2019","journal-title":"Front. Immunol."},{"key":"ref_31","first-page":"53","article-title":"GILZ (glucocorticoid-induced leucine zipper), a mediator of the anti-inflammatory and immunosuppressive activity of glucocorticoids","volume":"22","author":"Riccardi","year":"2010","journal-title":"Annali di Igiene"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"31","DOI":"10.3389\/fendo.2016.00031","article-title":"Gene Expression Control by Glucocorticoid Receptors during Innate Immune Responses","volume":"7","author":"Xavier","year":"2016","journal-title":"Front. Endocrinol. (Lausanne)"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/j.jaci.2006.08.027","article-title":"The anti-inflammatory effect of glucocorticoids is mediated by glucocorticoid-induced leucine zipper in epithelial cells","volume":"119","author":"Eddleston","year":"2007","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"2028","DOI":"10.3389\/fimmu.2019.02028","article-title":"More Than Suppression: Glucocorticoid Action on Monocytes and Macrophages","volume":"10","author":"Ehrchen","year":"2019","journal-title":"Front. Immunol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1111\/j.1365-2222.2004.01824.x","article-title":"Glucocorticoids up-regulate constitutive interleukin-10 production by human monocytes","volume":"34","author":"Mozo","year":"2004","journal-title":"Clin. Exp. Allergy"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"8239258","DOI":"10.1155\/2016\/8239258","article-title":"Annexin A1 and the Resolution of Inflammation: Modulation of Neutrophil Recruitment, Apoptosis, and Clearance","volume":"2016","author":"Sugimoto","year":"2016","journal-title":"J. Immunol. Res."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Skytthe, M.K., Graversen, J.H., and Moestrup, S.K. (2020). Targeting of CD163+ Macrophages in Inflammatory and Malignant Diseases. Int. J. Mol. Sci., 21.","DOI":"10.3390\/ijms21155497"},{"key":"ref_38","unstructured":"Group, R.C., Horby, P., Lim, W.S., Emberson, J.R., Mafham, M., Bell, J.L., Linsell, L., Staplin, N., Brightling, C., and Ustianowski, A. (2020). Dexamethasone in Hospitalized Patients with Covid-19\u2014Preliminary Report. N. Engl. J. Med."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1186\/s13054-020-03340-4","article-title":"Corticosteroid therapy for coronavirus disease 2019-related acute respiratory distress syndrome: A cohort study with propensity score analysis","volume":"24","author":"Wu","year":"2020","journal-title":"Crit. Care"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1292","DOI":"10.1001\/jama.2020.16747","article-title":"Corticosteroids in COVID-19 ARDS: Evidence and Hope During the Pandemic","volume":"324","author":"Prescott","year":"2020","journal-title":"JAMA"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1149","DOI":"10.1080\/17476348.2020.1804365","article-title":"Mortality in COVID-19 patients with acute respiratory distress syndrome and corticosteroids use: A systematic review and meta-analysis","volume":"14","author":"Hasan","year":"2020","journal-title":"Expert. Rev. Respir. Med."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Majmundar, M., Kansara, T., Lenik, J.M., Park, H., Ghosh, K., Doshi, R., Shah, P., Kumar, A., Amin, H., and Chaudhari, S. (2020). Efficacy of corticosteroids in non-intensive care unit patients with COVID-19 pneumonia from the New York Metropolitan region. PLoS ONE, 15.","DOI":"10.1101\/2020.07.02.20145565"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"E756","DOI":"10.1503\/cmaj.200645","article-title":"Efficacy and safety of corticosteroids in COVID-19 based on evidence for COVID-19, other coronavirus infections, influenza, community-acquired pneumonia and acute respiratory distress syndrome: A systematic review and meta-analysis","volume":"192","author":"Ye","year":"2020","journal-title":"CMAJ"},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"The WHO Rapid Evidence Appraisal for COVID-19 Therapies (REACT) Working Group, Sterne, J.A.C., Murthy, S., Diaz, J.V., Slutsky, A.S., Villar, J., Angus, D.C., Annane, D., Azevedo, L.C.P., and Berwanger, O. (2020). Association between Administration of Systemic Corticosteroids and Mortality among Critically Ill Patients with COVID-19: A Meta-Analysis. JAMA, 324, 1330\u20131341.","DOI":"10.1001\/jama.2020.17023"},{"key":"ref_45","first-page":"1070","article-title":"Effect of glucocorticoid therapy on the prognosis of patients with severe and critical COVID-19: A single-center retrospective cohort study","volume":"25","author":"Xiong","year":"2021","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1869","DOI":"10.1080\/22221751.2020.1807885","article-title":"Corticosteroid prevents COVID-19 progression within its therapeutic window: A multicentre, proof-of-concept, observational study","volume":"9","author":"Li","year":"2020","journal-title":"Emerg. Microbes Infect."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"943","DOI":"10.1007\/s40121-020-00337-y","article-title":"Effect of Corticosteroid Therapy on the Duration of SARS-CoV-2 Clearance in Patients with Mild COVID-19: A Retrospective Cohort Study","volume":"9","author":"Ding","year":"2020","journal-title":"Infect. Dis. Ther."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"416","DOI":"10.5694\/mja2.50577","article-title":"Corticosteroid treatment of patients with coronavirus disease 2019 (COVID-19)","volume":"212","author":"Zha","year":"2020","journal-title":"Med. J. Aust."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"173947","DOI":"10.1016\/j.ejphar.2021.173947","article-title":"No clinical benefit of high dose corticosteroid administration in patients with COVID-19: A preliminary report of a randomized clinical trial","volume":"897","author":"Jamaati","year":"2021","journal-title":"Eur. J. Pharmacol."},{"key":"ref_50","unstructured":"Jeronimo, C.M.P., Farias, M.E.L., Val, F.F.A., Sampaio, V.S., Alexandre, M.A.A., Melo, G.C., Safe, I.P., Borba, M.G.S., Abreu-Netto, R.L., and Maciel, A.B.S. (2020). Methylprednisolone as Adjunctive Therapy for Patients Hospitalized With COVID-19 (Metcovid): A Randomised, Double-Blind, Phase IIb, Placebo-Controlled Trial. Clin. Infect. Dis."},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Wu, J., Huang, J., Zhu, G., Liu, Y., Xiao, H., Zhou, Q., Si, X., Yi, H., Wang, C., and Yang, D. (2020). Systemic Corticosteroids and Mortality in Severe and Critical COVID-19 Patients in Wuhan, China. J. Clin. Endocrinol. Metab., 105.","DOI":"10.1210\/clinem\/dgaa627"},{"key":"ref_52","unstructured":"WHO (2021, January 20). Corticosteroids for COVID-19. Available online: https:\/\/www.who.int\/publications\/i\/item\/WHO-2019-nCoV-Corticosteroids-2020.1."},{"key":"ref_53","unstructured":"NIH (2021, March 02). Clinical Trials, Available online: https:\/\/www.clinicaltrials.gov\/ct2\/results?recrs=&cond=Covid19&term=corticosteroids&cntry=&state=&city=&dist=."},{"key":"ref_54","unstructured":"Cascella, M., Rajnik, M., Cuomo, A., Dulebohn, S.C., and Di Napoli, R. (2020). Features, Evaluation, and Treatment of Coronavirus. StatPearls, StatPearls Publishing."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"158","DOI":"10.3389\/fcimb.2018.00158","article-title":"Mycobacterium tuberculosis: An Adaptable Pathogen Associated With Multiple Human Diseases","volume":"8","author":"Chai","year":"2018","journal-title":"Front. Cell. Infect. Microbiol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1642","DOI":"10.1016\/S0140-6736(19)30308-3","article-title":"Tuberculosis","volume":"393","author":"Furin","year":"2019","journal-title":"Lancet"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1186\/s12929-020-00667-6","article-title":"Of tuberculosis and non-tuberculous mycobacterial infections\u2014A comparative analysis of epidemiology, diagnosis and treatment","volume":"27","author":"Gopalaswamy","year":"2020","journal-title":"J. Biomed. Sci."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1038\/s41586-020-2008-3","article-title":"A new coronavirus associated with human respiratory disease in China","volume":"579","author":"Wu","year":"2020","journal-title":"Nature"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1016\/j.smim.2014.09.011","article-title":"Pro- and anti-inflammatory cytokines in tuberculosis: A two-edged sword in TB pathogenesis","volume":"26","author":"Etna","year":"2014","journal-title":"Semin. Immunol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"179174","DOI":"10.1155\/2013\/179174","article-title":"Pattern recognition receptors and cytokines in Mycobacterium tuberculosis infection\u2014The double-edged sword?","volume":"2013","author":"Hossain","year":"2013","journal-title":"Biomed. Res. Int."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"2108","DOI":"10.3389\/fimmu.2018.02108","article-title":"The Pathogenesis of Tuberculosis: The Early Infiltrate of Post-primary (Adult Pulmonary) Tuberculosis: A Distinct Disease Entity","volume":"9","author":"Hunter","year":"2018","journal-title":"Front. Immunol."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"1666","DOI":"10.1016\/j.ajpath.2018.04.006","article-title":"Diverse Cavity Types and Evidence that Mechanical Action on the Necrotic Granuloma Drives Tuberculous Cavitation","volume":"188","author":"Ihms","year":"2018","journal-title":"Am. J. Pathol."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1016\/j.jmii.2020.02.011","article-title":"Are children less susceptible to COVID-19?","volume":"53","author":"Lee","year":"2020","journal-title":"J. Microbiol. Immunol. Infect."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"1357983","DOI":"10.1155\/2020\/1357983","article-title":"The Pathogenesis of Coronavirus Disease 2019 (COVID-19): Evaluation and Prevention","volume":"2020","author":"Ouassou","year":"2020","journal-title":"J. Immunol. Res."},{"key":"ref_65","doi-asserted-by":"crossref","unstructured":"Pawlowski, A., Jansson, M., Skold, M., Rottenberg, M.E., and Kallenius, G. (2012). Tuberculosis and HIV co-infection. PLoS Pathog., 8.","DOI":"10.1371\/journal.ppat.1002464"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"54","DOI":"10.11606\/\/s1518-8787.2020054002577","article-title":"Diabetes and covid-19: More than the sum of two morbidities","volume":"54","author":"Pititto","year":"2020","journal-title":"Rev. Saude Publica"},{"key":"ref_67","doi-asserted-by":"crossref","unstructured":"Restrepo, B.I. (2016). Diabetes and Tuberculosis. Microbiol. Spectr., 4.","DOI":"10.1128\/microbiolspec.TNMI7-0023-2016"},{"key":"ref_68","unstructured":"Radius, H. (2021, January 20). COVID-19 May Be Tragic for the Patient with Latent Tuberculosis. Available online: https:\/\/www.healthcareradius.in\/26530-covid-19-may-be-tragic-for-the-patient-with-latent-tuberculosis."},{"key":"ref_69","doi-asserted-by":"crossref","unstructured":"Stochino, C., Villa, S., Zucchi, P., Parravicini, P., Gori, A., and Raviglione, M.C. (2020). Clinical characteristics of COVID-19 and active tuberculosis co-infection in an Italian reference hospital. Eur. Respir. J., 56.","DOI":"10.1183\/13993003.01708-2020"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1016\/j.pulmoe.2020.05.002","article-title":"Tuberculosis, COVID-19 and migrants: Preliminary analysis of deaths occurring in 69 patients from two cohorts","volume":"26","author":"Motta","year":"2020","journal-title":"Pulmonology"},{"key":"ref_71","doi-asserted-by":"crossref","unstructured":"Tadolini, M., Codecasa, L.R., Garcia-Garcia, J.M., Blanc, F.X., Borisov, S., Alffenaar, J.W., Andrejak, C., Bachez, P., Bart, P.A., and Belilovski, E. (2020). Active tuberculosis, sequelae and COVID-19 co-infection: First cohort of 49 cases. Eur. Respir. J., 56.","DOI":"10.1183\/13993003.01398-2020"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"2764","DOI":"10.3201\/eid2611.202752","article-title":"Four Patients with COVID-19 and Tuberculosis, Singapore, April\u2013May 2020","volume":"26","author":"Tham","year":"2020","journal-title":"Emerg. Infect. Dis."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"748","DOI":"10.1164\/rccm.202003-0828IM","article-title":"A Novel Viral Epidemic Collides with an Ancient Scourge: COVID-19 Associated with Tuberculosis","volume":"202","author":"Cutler","year":"2020","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_74","first-page":"101146","article-title":"COVID-19 in a patient with active tuberculosis: A rare case-report","volume":"31","author":"Faqihi","year":"2020","journal-title":"Respir. Med. Case Rep."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"1802","DOI":"10.1002\/jmv.25943","article-title":"COVID-19 in tuberculosis patients: A report of three cases","volume":"92","author":"He","year":"2020","journal-title":"J. Med. Virol."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"747","DOI":"10.5588\/ijtld.20.0163","article-title":"Severe COVID-19 cases with a history of active or latent tuberculosis","volume":"24","author":"Liu","year":"2020","journal-title":"Int. J. Tuberc. Lung Dis."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1186\/s12941-020-00363-1","article-title":"Anticipating the impact of the COVID-19 pandemic on TB patients and TB control programmes","volume":"19","author":"Togun","year":"2020","journal-title":"Ann. Clin. Microbiol. Antimicrob."},{"key":"ref_78","unstructured":"Public Health Agency of Canada (2021, March 10). Canadian Tuberculosis Standards, Available online: https:\/\/cts-sct.ca\/wp-content\/uploads\/2018\/01\/Canadian-Tuberculosis-Standards_7th-edition_Complete.pdf."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"S221","DOI":"10.1164\/ajrccm.161.supplement_3.ats600","article-title":"Targeted tuberculin testing and treatment of latent tuberculosis infection. This official statement of the American Thoracic Society was adopted by the ATS Board of Directors, July 1999. This is a Joint Statement of the American Thoracic Society (ATS) and the Centers for Disease Control and Prevention (CDC). This statement was endorsed by the Council of the Infectious Diseases Society of America. (IDSA), September 1999, and the sections of this statement","volume":"161","author":"Society","year":"2000","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"1741","DOI":"10.1056\/NEJMoa040573","article-title":"Dexamethasone for the treatment of tuberculous meningitis in adolescents and adults","volume":"351","author":"Thwaites","year":"2004","journal-title":"N. Engl. J. Med."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"153","DOI":"10.5005\/ijcdas-52-3-153","article-title":"Role of corticosteroids in the treatment of tuberculosis: An evidence-based update","volume":"52","author":"Kadhiravan","year":"2010","journal-title":"Indian J. Chest. Dis. Allied Sci."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1016\/S1473-3099(12)70321-3","article-title":"Corticosteroids for prevention of mortality in people with tuberculosis: A systematic review and meta-analysis","volume":"13","author":"Critchley","year":"2013","journal-title":"Lancet Infect. Dis."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"2585","DOI":"10.1016\/S0140-6736(16)30770-X","article-title":"Use of corticosteroids in tuberculous meningitis","volume":"387","author":"Donald","year":"2016","journal-title":"Lancet"},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1007\/s15010-018-1235-0","article-title":"Use of steroids for abdominal tuberculosis: A systematic review and meta-analysis","volume":"47","author":"Soni","year":"2019","journal-title":"Infection"},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1378\/chest.38.1.51","article-title":"Reversion and reconversion rate of tuberculin skin reactions in correction with the use of prednisone","volume":"38","author":"Bovornkitti","year":"1960","journal-title":"Dis. Chest."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"261","DOI":"10.7326\/0003-4819-84-3-261","article-title":"The prevalence of tuberculosis and positive tuberculin skin tests in a steroid-treated asthmatic population","volume":"84","author":"Schatz","year":"1976","journal-title":"Ann. Intern. Med."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"1373","DOI":"10.1183\/09031936.00076714","article-title":"Prevalence, screening and treatment of latent tuberculosis among oral corticosteroid recipients","volume":"44","author":"Vozoris","year":"2014","journal-title":"Eur. Respir. J."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"1193","DOI":"10.1111\/ijcp.12459","article-title":"Inhaled corticosteroids and the increased risk of pulmonary tuberculosis: A population-based case-control study","volume":"68","author":"Chung","year":"2014","journal-title":"Int. J. Clin. Pract."},{"key":"ref_89","doi-asserted-by":"crossref","unstructured":"Huang, T.M., Kuo, K.C., Wang, Y.H., Wang, C.Y., Lai, C.C., Wang, H.C., Chen, L., Yu, C.J., and On the behalf of Taiwan Clinical Trial Consortium for Respiratory Diseases (TCORE) (2020). Risk of active tuberculosis among COPD patients treated with fixed combinations of long-acting beta2 agonists and inhaled corticosteroids. BMC Infect. Dis., 20.","DOI":"10.1186\/s12879-020-05440-6"},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"1018","DOI":"10.1378\/chest.12-1225","article-title":"Inhaled corticosteroid is associated with an increased risk of TB in patients with COPD","volume":"143","author":"Kim","year":"2013","journal-title":"Chest"},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"1105","DOI":"10.1136\/thoraxjnl-2012-203175","article-title":"Use of inhaled corticosteroids and the risk of tuberculosis","volume":"68","author":"Lee","year":"2013","journal-title":"Thorax"},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"1197","DOI":"10.1016\/j.jaip.2018.10.007","article-title":"Inhaled Corticosteroid-Related Tuberculosis in the Real World among Patients with Asthma and COPD: A 10-Year Nationwide Population-Based Study","volume":"7","author":"Lee","year":"2019","journal-title":"J. Allergy Clin. Immunol. Pract."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"A560","DOI":"10.1016\/j.chest.2020.08.528","article-title":"Pulmonary Cavitary TB in a patient with SARS COV 2 Pneumonia","volume":"158","author":"Sasson","year":"2020","journal-title":"Chest"},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"A777","DOI":"10.1016\/j.chest.2020.08.724","article-title":"Reactivation TB with Severe COVID-19","volume":"158","author":"Garg","year":"2020","journal-title":"Chest"},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"2219","DOI":"10.2147\/COPD.S209273","article-title":"Inhaled Corticosteroids and Risk of Tuberculosis In Patients with Obstructive Lung Diseases: A Systematic Review and Meta-Analysis of Non-randomized Studies","volume":"14","author":"Castellana","year":"2019","journal-title":"Int. J. Chron. Obstruct. Pulmon. Dis."},{"key":"ref_96","unstructured":"Hospital, M.G. (2021, January 20). Tuberculosis Reactivation Risk Mitigation for Steroids. Available online: https:\/\/www.massgeneral.org\/assets\/MGH\/pdf\/news\/coronavirus\/infection-steroids-on-immunotherapy.pdf."},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"49","DOI":"10.3390\/jor1010005","article-title":"The Abstruse Side of Type I Interferon Immunotherapy for COVID-19 Cases with Comorbidities","volume":"1","author":"Subbian","year":"2021","journal-title":"J. Respir."},{"key":"ref_98","unstructured":"CDC (2021, March 25). Deciding When to Treat Latent TB Infection, Available online: https:\/\/www.cdc.gov\/tb\/topic\/treatment\/decideltbi.htm."},{"key":"ref_99","unstructured":"WHO (2021, March 25). Latent Tuberculosis Infection\u2014Updated and Consolidated Guidelines for Programmatic Management. Available online: https:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/260233\/9789241550239-eng.pdf?sequence=1."},{"key":"ref_100","doi-asserted-by":"crossref","unstructured":"Churchyard, G.J., and Swindells, S. (2019). Controlling latent TB tuberculosis infection in high-burden countries: A neglected strategy to end TB. PLoS Med., 16.","DOI":"10.1371\/journal.pmed.1002787"},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"S31","DOI":"10.1016\/j.ijid.2020.03.011","article-title":"Historical review of studies on the effect of treating latent tuberculosis","volume":"92S","author":"Molhave","year":"2020","journal-title":"Int. J. Infect. Dis."}],"container-title":["International Journal of Molecular Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1422-0067\/22\/7\/3773\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T13:26:24Z","timestamp":1760361984000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1422-0067\/22\/7\/3773"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4,6]]},"references-count":101,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2021,4]]}},"alternative-id":["ijms22073773"],"URL":"https:\/\/doi.org\/10.3390\/ijms22073773","relation":{},"ISSN":["1422-0067"],"issn-type":[{"value":"1422-0067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4,6]]}}}