Tuberculinum Aviare: The Avian Mycobacterium An integrated perspective and its scope in treatment of COVID 19 disease.

The authors request not to share this work on WhatsApp or other social media as a definite recommendation. This is preliminary work to initiate further research.

Abstract:

Tuberculinum Aviare is prepared from Mycobacterium Avium. In 1895 Dr. Cartier reports treating cases presenting like influenza but which had grave symptoms and suspicious cough, successfully treated with Tuberculinum Aviare.

Anshutz in “New, Old and Forgotten Remedies” summarizes anecdotal cases of influenzal bronchitis effectively treated by Tuberculinum Aviare. Influenzal bronchitis is accompanied by an incessant cough and by grave general symptoms.

There is more frequently acute than passive, obstructive and dyspneic congestion. It is a remedy of long-lasting action, capable in certain cases of modifying the organism, and of bracing a constitution which has become enfeebled from the effects of influenza.

It is suitable for complicated respiratory viral diseases like influenza and measles. C.E. Whiiler in 1957, finds Tuberculinum Av of real value as a prophylactic for this susceptibility to germs of catarrh especially when continuous infection is prevalent for people constantly exposed to it.

In contemporary literature Hypersensitive Pneumonitis caused by Mycobacterium Avium- “hot-lung disease”- has striking similarities with COVID19 including ground-glass opacities on CT scan. In-vitro experiments have found cells infected with mycobacterium avium showing resistance to influenza infection. In Passerines, an inverse relationship between the prevalence of M. avium infection and Avian influenza viruses is observed while the co-infection with both organisms in a single bird is rare.

These observations and the striking similarity between Mycobacterium Avium Disease and COVID19, lead us to hypothesize that Mycobacterium Avium (Tuberculinum Aviare) is homoeopathically indicated and has a scope in treating critical cases of COVID19, and also to examine and test the scope of this remedy as a prophylaxis and to initiate in-vitro studies and vaccine-related research co-using mycobacterium-avium.

April 18, 2020

I am of the firm belief that the essence of homoeopathy lies in individualizing cases. It is an art and science of finding the exact similimum (indicated homoeopathic remedy) after eliciting good characteristic and individualizing traits. Homoeopathy has thrived on these successes.

We already have reports of cases of COVID19 responding to various indicated homoeopathic remedies, like Antimonium-tart, Arsenic Album, Bryonia, Camphora and Phosphorus that have shown good results.  For those who are not conversant, this is often called the classical approach in homoeopathy.

The existing pandemic of Covid-19 has created challenges, where access to difficult and hopeless cases is not easily available for homoeopathy treatment. Hence homoeopathy is not able to clearly prove its efficacy in this serious condition.

Even if we reach in there, it may be difficult with the respirators and intense nursing care, to elicit symptoms or reach/examine those patients on a regular basis. One needs to have proper protective devices to monitor the objective and subjective symptoms of the patients.

Also, complicated cases are not located in one facility. They are scattered all over in different hospitals in different cities and states. Such a team where homoeopaths and modern medicine experts work together on a larger scale is nearly impossible to accomplish.

Coming to the essence of this document, there was an article published in a medical (homoeopathy) journal in 1895. This was found in the chapter ‘Tuberculinum Aviare’ of a book titled ‘New Old and Forgotten remedies’ by Dr. E.P. Anshutz. (an old and well-known book in homeopathy)

In short:  A group of doctors led by Dr Cartier, in their hospital (in France) in 1895 came across cases that were presenting like influenza but had grave symptoms and suspicious cough. These cases caused a tuberculosis-like syndrome in the lungs!

They reported that the homeopathic remedy Tuberculinum Aviare proved to be very effective in these cases. One of the authors in 1896 also presented 10 such difficult cases cured with this remedy. Over a period of years, this remedy has been used by many well-read homeopaths. It has been effective in cases where there are severe pulmonary complications in measles, influenza and other respiratory viral diseases.

Looking at our literature and details, this remedy has a huge potential to instantly increase immunity to such viral infections. I have myself used this remedy and seen good results in complications of respiratory viral infections. Particularly I have used it in measles with a bad cough and threatening pneumonitis-bronchitis. In general, the remedy Tuberculinum bovinum is regularly used in homoeopathy to increase immunity against recurring and febrile respiratory illnesses.

However, Tuberculinum Aviare has a clinically proven sphere of action against complications of influenza and measles virus. This remedy has been used for over 120 years in homeopathy. A remedy that was meant to help tuberculosis, started helping grave complications of influenza and measles, clinically!

One cannot rule out if the original substance contained some virus element also. I just learned that corona virus was first isolated in chickens. Along with my dear colleague and co-author of this article Dr Munjal Thakar, we came across a lot of references from conventional medicine that adds value and credence to what is already documented in homoeopathic literature.

In these circumstances where it is difficult to reach very hopeless looking cases with homoeopathy, a pathological and clinical approach may be useful in effectively helping these cases. These pathological similarities between mycobacterium avian disease and picture of COVID 19 are a very interesting study for homoeopaths.

After reading this article you may see the scope of this remedy as a prophylactic in acute phase of the disease and also in the convalescence period of the viral infection. Some attention and unprejudiced clinical research can make this a useful tool in the fight against COVID19.

There is a scope to use this as a broad-spectrum homoeopathic remedy that can be used along with any homoeopathic or modern medicine remedies. We are used to the idea of prescribing nosodes and intercurrent remedies in homoeopathy.

Cases of Tuberculinum Av from the book: New Old and Forgotten Remedies:  by Dr. Edward Pollock Anshutz:

Case 1: “A young woman entered the Hospital St. Jacques at the end of January, 1895, with feverish influenzal bronchitis. At first, the patient was treated with small doses of Sulphate of quinine and a little later she took Ipecac and Bryonia alternately.

The fever disappeared and the general condition improved considerably, and the sub-crepitant rales became confined to the top of the left lung. The patient continued to expectorate thick nummular and puriform sputa, as in the influenza.

After some days the disease resumed its sway, the bodily forces diminished, the emaciation made great progress, the local and general signs indicated rapid consumption. The cure has been maintained for three months, and the young woman has resumed her employment.” I had prescribed Aviaire 100th, five drops a day, during the whole period of the disease, unaccompanied by any other remedy.

As I have said before, more than a year afterwards the young woman continued in good health. Following this case Dr. Jousset quoted two analogous instances in his practice, both of influenzal bronchitis, in which the sputa contained, for a certain period, Koch’s bacillus. One was cured with Aviaire 6th and strong doses of Sulphate of quinine, and the other with Aviaire 6^th potency……

Discussion^[1]:  In my opinion this patient never had consumption; she was attacked with pseudophymic bronchitis – a complication which is very often found with influenza, and which may very easily be mistaken for tuberculosis; and in spite of the presence in the sputa of Koch’s bacillus I would not register it as a case of tuberculosis, because, in contradiction to that single case, I could mention twenty cases of tuberculosis whose symptoms neither Avian tuberculin nor any other such drug has cured.

“What conclusions must I draw from these facts?” says Dr. Jousset. “That the avian tuberculosis cured the consumption? I have failed too often in the treatment of ordinary consumption with this remedy to admit that.”

In one of the numbers of a La Medicine Moderne of last year there appeared a short article: “Influenza known as pseudophymic.” The writer remarked on the strong analogy with certain complications of pulmonary influenza presented to acute tuberculosis. The influenzal bronchitis which affected one of the summits of the lung, was the most difficult form to diagnose from tuberculosis.

The influenza microbe always imitates to a remarkable degree the microbe of tuberculosis in certain instances; if we wish to effect a cure on the laws laid down by Hahnemann in certain forms of influenzal bronchitis, we must frequently seek for the similimum in the virus of tuberculosis.

I have mentioned “Oppression” as one of the characteristics of Bacillinum. Now influenzal bronchitis is markedly accompanied by an incessant cough and by grave general symptoms. There is more frequently acute than passive, obstructive and dyspneic congestion. I am inclined to prefer Aviaire to Bacillinum in such cases, and I should like to briefly touch upon certain cases in my practice.

Case 2: I have under my care a little girl of twelve years of age who has for two years developed an influenza which rapidly leads to pulmonary symptoms, always distinctly localized in the top of the left lung.

The mother is tuberculous, and the child, who was born with forceps, has her left chest developed than her right. The congestion which accompanies the influenza is sudden and severe; within twenty-four hours the lung is invaded, and fine rales are soon heard.

Twice running, at intervals of a year, Aviaire 100th has stifled the symptoms in a few days. I have seen an analogous case, only with congestion of the base of the lung.^[1]

Summary of other Cases: Ten cases of acute influenzal bronchitis with incessant cough, fever, and expectoration, were rapidly cured with Aviaire. This year I have prescribed it with the same success as at the Hospital St. Jacques in cases of influenzal bronchitis, with active congestion.^[1]

Discussion: It seems that Aviaire does not act in diminishing the cough like an anodyne, but braces up the whole organism. The relief of debility and the return of appetite are the phenomena which I have observed in conjunction with the diminution of the cough.

I have given Aviaire 100th for weeks, and even for a month, regularly every day, without having observed excitement or aggravation. It would thus appear to be a remedy of long-lasting action, capable in certain cases of modifying the organism, and of bracing a constitution which has become enfeebled from the effects of influenza or of suspicious bronchitis.”

One can see how it started way back in 1896, when Dr Cartier, Dr Jousset and Dr Anshutz reported cases of influenza that affected the lungs like in tuberculosis. This remedy also helped in the convalescent stage of the illness as you can see from these long-term experiences.

For some of you not familiar with old terminologies, the word consumption means tuberculosis of the lungs. The documentation clearly shows that the homoeopathic remedy Tuberculinum Aviare helped these cases.

This science of healing with homoeopathy is based on nature’s principle of ‘similars’, that “like cures like”, that what can cause, can cure in minute doses. It is interesting that dilutions and homoeopathic potencies made from mycobacterium avium are known to be working on complications and also the prevention of influenza. Below are some important references from the homoeopathic literature.

We hereby propose to examine the possibility that mycobacterium of avian origin (in homoeopathic potency) helps to boost immunity against difficult and complicated influenza and similar COVID19-like respiratory viruses.

Clinical indications of Tuberculinum Av: From homoeopathic materia medica:

• Sphere of Action: Respiratory organs and also multiple organ-systems.
• It has also done excellently in some cases of bronchitis following measles.^[2]
• Prominently acts on the apices of the lungs.^[2]
• Bronchitis of influenza, which simulates tuberculosis, having cured several hopeless-looking cases.^[2]
• Complicated respiratory viral diseases like influenza and measles.^[1]
• An acute inflammatory, extremely irritating cough, such as one meets with in acute diseases or subacute affections in young people; a cough which fatigues, and which leads to enfeeblement and loss of appetite – in a word, a suspicious cough.^[1]
• Bronchitis or of pulmonary congestion at the top of one of the lungs, or of bronchitis on one side only, or of congestion predominating on one side. These localizations on one side are sufficiently grave symptoms to warrant apprehension of the hatching of tuberculosis. If I were myself attacked, as the result of influenza or measles, or of some weakening malady, with an incessant tickling and stubborn cough, with certain closely localized pulmonary symptoms; if I lost my strength and appetite; if in a word, I were attacked by bronchitis whose upshot was highly doubtful, and which caused apprehension of tuberculosis, I should not hesitate a single moment, with the examples which I have had before me, to try Aviaire 100th upon myself.^[1]
• Acute bronchopulmonary diseases of children; COUGH, acute, inflammatory, irritating, incessant, and tickling; loss of strength and appetite.^[1]
• Measles and its pulmonary and meningeal complications.^[3]
• Capillary bronchitis.^[3]
• Broncho – pneumonia.^[3]
• Pulmonary congestion.^[3]
• Infantile asthma with fever.^[3]
• Acute, rhinitis; acute sinusitis.^[3]
• Acute otitis.^[3]
• Cardio – haemo- vascular system:

Tachycardia with a rapid and bounding pulse.

Circulatory troubles of the extremities, cyanosis.^[3]

• Thermoregulation: General uneasiness accompanied by chill, diffused muscular pain, fever, oscillating between 39 to 40.
• Pulmonary congestion of children and of aged persons.^[3]
• According to P. Jousset the therapeutic results in that affection (tuberculosis) hardly seem fortunate. On the contrary, Cartier specified the prescription of Aviary in Non – tubercular diseases of the respiratory system.^[3]
• INFLAMMATION: Lungs: bronchopneumonia.^[4]
• It has real value as a prophylactic for this susceptibility to germs of catarrh. This may be of advantage when continuous infection is prevalent for people constantly exposed to it (by C.E Whiiler, 1957)
• In my experience in this pandemic, I have found this remedy has a gentle calming effect on people. We know the restlessness of Tuberculinum-type in homoeopathy. It helped the anxiety related to the lockdown in six of ten non-infected patients, where I prescribed this remedy.

Source of Tub Av:

• A preparation of chicken-tuberculosis was introduced by Dr. Cartier and other homeopaths of Paris. 1896.^[2]
• Pathogen cultures of bird tuberculosis. Introduced by Francois Cartier, Paris 1896. – Used is freeze-dried avian tuberculin (DAB 9), without the addition of preservatives.(F, 1896)
• Modern Source:(Homeopathic Pharmacopeia: Pharmacology)
  • Mycobacterium avium, Chester 1901
  • Common name: Avian tubercle Bacillus.
  • Source for the Preparation of Homoeopathic drug: It is isolated from tubercles in
  • Morphology cultural characteristic: Short to long rods. Dilute inoculation inspissated egg media yield usually smooth non pigmented colonies after 7 or more days of incubation at 37^o. On aging, colonies may become yellow. On oleic acid albumin agar smooth, thin, transparent lobed nonpigmented colonies. Occasionally rough strains are encountered.
  • Resistance: It is resistant to usual chemotherapeutic agents like isoniazid, PAS, streptomycin. Thiosemicarbazone and Ethionamide with partial exception of Cycloserine.
  • Biochemical: Niacin test negative, fails to reduce nitrates, amidase test negative for urea, Acetamide. Benzamide. Neutral red reaction positive, Aryl sulphatase test negative.
  • History and authority: Introduced by Cartier; Clarke: A Dictionary of Practical. Materia Medica. Vol. I, 235; Anshutz: New Old and forgotten remedies. 41.
  • Biological distribution: It is widely distributed as the causal agent of tuberculosis in birds, rarely found in soil.
  • *Preparation*

(a) It comes under class II. It is obtained as suspension consisting of twenty billion bacteria per ml. Proceed according to General Instructions for preparation of Nosodes Group N 11 to obtain 1x.

(b) Trituration 2x,

• Drug strength 1/10
• Aviaire 10 g
• Saccharum Lactis 990 g
• To make one thousand grammes of the Trituration.

(c) Potencies: 3x and higher to be triturated in accordance with the method, HPI vol. I, 19, 6x may be converted to liquid 8x, HPI, Vol. I, 20.

• Storage: Preparation below 6x should be stored at a temperature about 50^o but should not be allowed to freeze.
• Caution: Handle with care and follow aseptic condition up to 6x.

Avian Mycobacterium and viral infections:

Further collateral facts related to Tuberculinum Aviare documented in modern medical research:

A. Interferon-induced transmembrane proteins (IFITMs) found in vertebrates restrict infections by specific viruses. IFITM3 is known to be essential for restriction of influenza virus infections in both mice and humans. We examined IFITMs from Mycobacterium aviumand Mycobacterium abscessus for potential antiviral activity. Both of these IFITMs conferred a moderate level of resistance to influenza virus in human cells, identifying them as functional homologues of IFITM3.^[5]

(Note: homoeopathic remedy Tuberculinum Aviare is documented to have significantly helped the immune system to fight difficult or hopeless cases of influenza that simulates tuberculosis. The homoeopathic principle is similar to the principle of vaccination to some extent.)

B. In marsh dwelling-passerines in Slovakia during 2008, surveillance of 650 birds revealed Avian Influenza Virus in 13.6% during Spring, and 17.5% in summer. In the same cluster of birds M. Avium was found to 9.2% during spring and 0.8% in summer. Only 2 birds out of 650, were found to have co-infection of AIV and M. Avium.^[6]

C. One unusual ailment linked to Jacuzzis is “hot tub lung,” Hot tub lung (HTL) is a granulomatous lung disease thought to occur as a result of a hypersensitivity response to non-tuberculous mycobacteria (NTM). It is characterized by an acute flu-like illness similar to COVID19. (More details in the table below)

(Here you can see the relevance of the discussion that Dr Cartier and Anshutz had in 1896! Flu-like illness affecting the lungs like in tuberculosis was helped by the remedy Tuberculinum Av.)

D. Bird flu, influenza and 1918: The case for mutant Avian tuberculosis.^[7]

“Dr. Andrew Noymer and Michel Garenne, UC Berkeley demographers, reported in 2000 convincing statistics showing that undetected tuberculosis may have been the real killer in the 1918 flu epidemic. Roger and others favor suspecting tuberculosis in all cases of acute respiratory failure of unknown origin.” Here one can appreciate the similar discussion we encounter in our homoeopathic literature in 1896! A debate between deadly influenza and avian tuberculosis

E. Mycobacterium Avium are classified into Non-Tuberculosis Mycobacterium (NTM).^[8] NTM disease is a relatively rare disorder, and therefore several medical practitioners do not immediately see the similarity between Pulmonary Non-Tuberculous mycobacterial disease and SARS-CoV2 (i.e. COVID 19).

NTM reveals almost the same symptoms as compared to the later-stage symptoms after a corona virus infection- including ground glass appearance opacities on CT scan.^[9]

F. Present below is the comparative study of the symptoms of NTM & COVID 19:

	Non-tuberculous Mycobacterium Disease-Hypersensitivity Pneumonitis(HP)- Acute & Subacute forms	COVID 19
	Predominantly happens in immunocompromised patients.	Those requiring ICU care were older (median age 66years), had underlying co-morbidities.[10]
Clinical Features Acute Type	Acute HP manifests in 4-8h following exposure to antigen.[8] Intense in nature.[8] Systemic Symptoms: Fever, chills, malaise associated with dyspnea.[8] Resolves in hours or days if no further exposure to antigen.[8]	Fever[10] , Dry cough[10], Fatigue[10]. Dyspnea[10], Anorexia[10], Myalgia[10], Abdominal pain[10], Diarrhea[10]; Nausea[10] Complications: Acute Respiratory Distress[10], Arrhythmia[10], Shock.[10]
Subacute Type	Onset gradual over weeks.[8] Intermittent episodes of acute HP.[8] Severe breathlessness, and respiratory impairment.[8] Resolution takes place in weeks or months.[8]
Chronic Type	Insidious onset.[8] Progressive Dyspnea, cough, fatigue, weight loss, clubbing of digits.[8] Hypoxia & respiratory failure.[8] Resolution doesn’t take place in spite of removal of antigen.[8] Sequelae: Fibrotic Lung Disease (Bird antigens)[8] Emphysematous phenotype (Farmer’s lung)[8]
Other	Can have variability in presentation as well as outcome.[8]	Radiological & pathology examination of patients with COVID19 revealed inflammatory reactions in the lung that resembled what is observed in hypersensitive pneumonitis rather than in other viral pneumonia.[11].
		Pneumonia is usually self-limiting and resolved within a few weeks in people with normal immune status, but may result in varying degree of pulmonary fibrosis.[11]
Radiological features
Acute	Ill-defined micronodular opacities.[8] Hazy ground-glass airspace opacities.[8]	CT scan showed marked increase from subclinical period through the first and second weeks after onset of symptoms. Then gradually decreased from third week.[12] Lung involvement shows slight predilection for right lower lobe.[12] As the disease clinical evolves rapidly so do the radiology changes evolve with equal rapidity. Subclinical stage: Unilateral, multifocal, predominantly ground-glass opacities.(GGO)[12] First Week: Quick progression to bilateral diffuse disease with relative decrease in ground-glass opacity & a  transition to a consolidation and mixed-pattern development. Pleural effusion, and lymphadenopathy (Homeopathy treatment for Tubercular Lymphadenopathy).[12]
Subacute	Ground-glass airspace opacities.[8] Centrilobular nodules.[8] Air trapping due to involvement of small airways, on expiratory images.[8]	Second Week: GGO reduces and is replaced by consolidation as the common pattern. Progressive increase to reticular pattern associated with bronchiolectasis and irregular interlobular or septal thickening- indicative of interstitial fibrosis.[12]
Chronic	Similar to Idiopathic Pulmonary Fibrosis (IPF)	Third Week: predominantly consolidation and mixed pattern, while GGO reduced even further. Bronchiolectasis, thickening of adjacent pleura, and pleural effusion appears at this stage.[12]
Laboratory features	Presence of antigen specific IgG antibodies.[13] Impairment of diffusing capacity. Decreased Oxygen saturation. Restrictive defect in spirometry.	Lymphopenia[10]. It continued to worsening in critically ill.[10] Prolonged Prothrombin time.[10] Elevated Lactate Dehydrogenase[10] Increasing D-Dimer, Creatinine & Blood urea levels were observed in critically ill.[10] Elevated C-Reactive protein.[12] Elevated Amyloid-A protein.[12] Associated with cellular immune deficiency, coagulation activation, myocardial injury, hepatic & renal injury[10]
		Predominant pattern was ground-glass opacity with ill-defined margins, air-bronchograms.[12] Smooth or irregular interlobular or septal thickening and thickening of the adjacent pleura.[12]. Unlike SARS-COV cases, COVID 19 showed pleural effusion, lymphadenopathy and round cystic changes on CT scan.[12]. Round cystic changes on CT scan might be associated with resorption of consolidation: which may be explained by the infection causing damage to the alveolar walls and leading to pneumatocoeles. Crazy-paving pattern.[12] Nodules, lymphadenopathy and pleural effusion are seen with lesser frequency.

Conclusions and the hypothesis:

1. The drug Tuberculinum Aviare in homoeopathy is indicated in “Influenza that simulates tuberculosis and hopeless looking cases!” Dictionary of practical materia-medica by John Henry Clarke and clinical indications and references of Tuberculinum Aviare as discussed above.
2. It is very interesting that Whiller recommended giving this homoeopathic remedy for people who are constantly exposed to these viruses, like doctors, nurses and hospital staff, way back in 1957.
3. A dreaded complication of COVID 19 presents itself as Hypersensitive Pneumonitis. We know Mycobacterium Aviare also presents itself as Hypersensitive Pneumonitis. The similarities are so striking in both. Pathological similarity along with clinical cases in the literature makes a good case for use of Tuberculinum Aviare in COVID 19 cases.
4. We see in Marsh-dwelling Passerines of Slovakia, the prevalence of M. avium infection and Avian influenza viruses are inversely related. While the co-infection with both organisms in a single bird is rare.
5. We have also a reference to that research where mycobacterium Avian, in-vitro produces resistance against influenza viruses.

From the above observation, we hypothesize that Mycobacterium Avium (Tuberculinum Aviare) is homoeopathically indicated and has a scope in treating critical cases of COVID19, where there is a profound lack of reaction (immunocompromised individuals) difficult cough and having pathological and radiological findings very similar to acute or subacute hypersensitivity pneumonitis that is caused by Mycobacteria avium infection.

1.     It is worth a clinical trial with this simple remedy Tuberculinum Aviare in 200c or 30c potency for cases that develop lower respiratory complications during COVID19 infection. Examine and test the scope of this remedy as prophylaxis.

2.     Initiate in-vitro studies and vaccine-related research co-using mycobacterium-avium.

Dose proposition for consideration:

1) Tuberculinum Aviare 200 every 6 hours in cases with very acute lower respiratory symptoms.

2) Same potency three times a day in mild to moderate respiratory symptoms.

3) Tuberculinum Aviare 30c potency in very debilitated, weak, old and symptomatic patients. Treatment may be continued for two weeks to evaluate the results.

4) Tuberculinum Aviare any available potency once a week for four weeks as prophylaxis.

5) It could even be used as an intercurrent remedy along with the indicated remedy, depending on the evaluation of the homoeopath treating the case.

6) The remedy could possibly be useful in asymptomatic cases of COVID19 to help seropositive turn seronegative.

Acknowledgements: We would like to acknowledge Dr Magdalena Pop of Hungary for her initial input and Dr. Manish Bhatia in helping us edit this paper.

References:

1. 1Anshutz. New, Old and Forgotten Remedies. Reference Works 4.5.4.1 Professional. Synergy Homeopathic (formerly KHA), 1986-2018.
2. Clarke, John Henry.  Aviare. In A Dictionary Of Practical Materia Medica. B.Jain Publishers, New Delhi 1990, 235.
3. Julian.O.A. Materia Medica of Nosodes with Repertory. Professional. Synergy Homeopathic (formerly KHA), 1986-2018.
4. Saine, Andre. Additions to Repertory. Reference Works 4.5.4.1 Professional. Synergy Homeopathic (formerly KHA), 1986-2018.
5. Melvin, William J; McMicheal, Temet M; Chesarino, Nicholas M; Hach, Jocelyn C; Yount, Jacob S. IFITMs from Mycobacteria Confer Resistance to Influenza Virus When Expressed in Human Cells. Viruses.2015, 3035-3052.
6. Borovska, Peter; Kabat , Peter; Ficova, Martina; Trnka, Alfred; Svetlikova; Darina;Tatiana,Betakova. Prevelance of Avian Influenza Viruses, Mycobacterium avium, and Mycobacterium avium subsp. paratuberculosis in marsh-dwelling passerines in Slovakia, 2008. Biologica 2011, 282-287.
7. Broxmeyer, L. Bird Flu, Influenza and 1918: The case of mutant Avian Tuberculosis. Med Hypotheses.2006, 1006-15.
8. Steven.M.Holland. Nontuberculous Mycobacterial Infections. In Kasper, Dennis L; Fauci, Anthony S; Hauser, Stephen L; Lango, Dan L; Jameson, Larry J; Loscalzo, Joseph. Harrison’s Principles of Internal Medicine, 19th Edition. Chennai. McGraw Hill Education.2015, 1128-1132.
9. Buchkremer, Ruediger. www.researchgate.net. . 2020. March.
10. Dawei, Wung; Chang, Hu; Fangfang, Zhu; Xing, Liu; Jing, Zhang; Binbin, Wang; Hui, Xiang; Zhenshun, Cheng; Yong, Xiong; Yirong, Li; Xinghuan, Wang; Zhiyong, Peng. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Corona Virus-Infected Pnemonia in Wuhan, China.Journal of American Medical Association (JAMA). 323.11. March17,2020. 1061-1069.
11. Young Goo Song, Hyoung-Shik Shin. COVID-19, A clinical syndrome manifesting as hypersensitive pneumonitis.Infection & Chemotherapy.March.2020.52.1, 110-112.
12. Heshui, Shi; Xiaoyu, Han; Nanchuan, Jiang; Yukun, Cao; Osamah, Alwalid; Jin, Gu; Yanqing, Fan; Chuausheng, Zheng. Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: Descriptive Study. Lancet Infectious Disease. February 24, 2020. 20, 425-34.
13. Yves, Lacasse; Yvon, Cormier. Orphanet Journal of Rare Diseases  1, 25 (2006).