Is it Covid-19 or tuberculosis? How to differentiate between the symptoms

Do you have persistent cough for more than two-three weeks even after your Covid recovery? As per the latest advisory by Union Health Ministry, people who suffer from prolonged cough post contracting the virus must get tested for tuberculosis. The Union Health Ministry has advised the Covid-19 patients to undergo tests for tuberculosis and other conditions if cough persists for more than two-three weeks.

Some of the common symptoms of active TB, the infectious disease that mainly affects lungs, are coughing for three or more weeks, coughing up blood or mucus, chest pain, or pain with breathing or coughing, unintentional weight loss, fatigue, fever, night sweats, and chills. TB is caused by a bacterium that spreads through tiny droplets released in the air when one coughs and sneezes.

As per the guidelines revised issued by the Health Ministry - ‘Clinical Guidance for Management of Adult Covid-19 Patients’, active tuberculosis is a high-risk factor for severe disease or mortality.

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Considering many symptoms of Covid and TB overlap, it is important to differentiate between the two diseases and know when you must get tested for what.

"Fever, cough, fatigue, weakness, and breathlessness are the symptoms of both tuberculosis and Covid-19 illness. So naturally, one would think it would be a challenge to differentiate between these diseases, but in reality, it is the exact opposite. They differ right from the causative agent to duration of illness and the treatment protocol and duration," Dr Sonam Solanki, MBBS, DNB Pulmonary Medicine, PDDM, HERMES (European Diploma) Consultant Pulmonologist & Bronchoscopist, Masina Hospital, Mumbai

Are you coughing for a week or a month?

One needs to pay attention to the nature of coughing and from how long it has affected a person. Patients with tuberculosis present with a long history with symptoms for a long duration ranging from weeks to months, whereas Covid-19 patients have these symptoms of fever, cough, cold and fatigue of a shorter period - few days. The cough associated with Covid-19 is primarily dry, and there is not much expectoration, but in TB, cough is generally associated with sputum production. Sputum is a mix of saliva and mucus from the throat or lungs.

"In fact, the most crucial test to accurately diagnose TB is to check the sputum. Sputum test for TB helps accurately diagnose it and confirm drug-sensitive and resistant tuberculosis. This is very important to know to treat it correctly. Covid,as we all know, gets diagnosed with nasal and throat swabs," says Dr Solanki.

Weight loss in case of TB, breathlessness if Covid

If you have lost a lot of weight over few months and have reduced appetite, this could be a sign of tuberculosis while sudden breathlessness and low oxygen is a tell-tale sign of Covid-19.

"The breathlessness and reduced oxygen that occurs in Covid is sudden and progressive and occurs in a short duration. There are very few instances where a TB patient would present with breathlessness and reduced oxygen," says the expert.

The difference in X-rays and CT scans

Covid-19 and TB both impact lungs differently and X-rays and CT scans can reveal whether the damage has been done by Covid or tuberculosis.

"Regarding X-rays and CT scans, Covid-19 has typical grey patches scattered around the lung (ground-glass opacities). In contrast, TB has a different pattern of cavitation, lung infiltrates, water filling in lungs (pleural effusions) etc," says Dr Solanki.

Can you have both TB and Covid-19 simultaneously?

The answer is yes.

"One can have tuberculosis and Covid-19 both, and we have come across cases where a CT scan of the chest is done for some reason in Covid-19 illness, and TB has been picked up in an early stage," says Dr Solanki.