Clinical and radiological diagnosis of non–SARS‐CoV‐2 viruses in the era of COVID‐19 pandemic

Abstract

Following the announcement of the first coronavirus disease 2019 (COVID-19) case on 11 March 2020 in Turkey, we aimed to report the coinfection rates, and the clinical, laboratory, radiological distinctive features of viral pneumonia caused by viruses other than severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). A cross-sectional study was conducted between 18 and 31 March 2020. COVID-19 suspected cases admitted to pandemic policlinic, who had nasopharyngeal swab specimens tested for both SARS-CoV-2 and other respiratory viral pathogens, were included. Among 112 patients, SARS-CoV-2 was detected in 34 patients (30%). Among the non-SARS-CoV-2 viruses (n = 25, 22%), metapneumovirus (n = 10) was the most frequent agent. There were two coinfections with SARS-CoV-2. Sputum was less in the SARS-CoV-2 group (P = .003). The leukocyte, lymphocyte, and thrombocyte count and C-reactive protein levels were the lowest in the SARS-CoV-2 group (P < .001, P = .04, P < .001, P = .007, respectively). Peripheral involvement (80% vs 20%; P ≤ .001), pure ground-glass opacity (65% vs 33%; P = .04), apicobasal gradient (60% vs 40%; P = .08), involvement of greater than or equal to three lobes (80% vs 40%; odds ratio: 6.0; 95% confidence interval: 1.33-27.05; P = .02), and consolidation with accompanying ground-glass opacity (4% vs 33%; P = .031) were more common in SARS-CoV-2 group. Some clinical, laboratory, and radiological findings may help in the differential diagnosis of non-SARS-CoV-2 viruses from COVID-19. However, coinfections may occur, and a non-SARS-CoV-2 pathogen positivity does not exclude accompanying COVID-19.

Symptom-based early-stage differentiation between SARS-CoV-2 versus other respiratory tract infections—Upper Silesia pilot study

“…The similarities of symptoms that can be found in SARS-CoV-2 infected patients and symptoms in patients with respiratory tract infection caused by other agent was also noticed by Alpaydin et al 12 in their study of 112 patients with respiratory tract infection hospitalised in March 2020, where SARS-CoV-2 infection was confirmed in 30% of cases, remaining cases were caused by metapneumovirus, rhinovirus, adenovirus, respiratory syncytial virus, influenza virus and Mycoplasma pneumoniae . Recent studies in Brazil performed on over 6000 patients show various single symptoms characteristic for SARS-CoV-2, e.g.…”

Respiratory viral co-infections among SARS-CoV-2 cases confirmed by virome capture sequencing

“…In this study, we sequenced the respiratory virome using two hybrid-capture approaches and multiple taxonomic read classification pipelines, demonstrating an 8% rate of co-infection with other respiratory viruses among SARS-CoV-2 cases in Australia. This is less than half the rate reported in Northern California 2 , but greater than the initial estimates from Wuhan (0.0%) 1 and rates of viral co-infection reported from Chicago (1.6%) 20 , New York (2.0%) 21 , Singapore (1.4%) 22 , Barcelona (0.6%) 23 and Turkey (2.0%) 6 . Furthermore, it is higher than the 4.6% of co-infection observed among 175 cases from the same region, diagnosed and tested during a similar time period using multiplex qRT-PCR 7 .…”

“…Despite this evidence supporting the high prevalence of co-infections among SARS-CoV-2 cases and its potentially substantial clinical impacts on COVID-19, existing data on co-infection remain limited by the low representation of the global population and the small number of viruses examined. To date, most studies have tested only a narrow spectrum of viruses using targeted qRT-PCR assays 5 , 6 , and only one reported on the co-infection rate among SARS-CoV-2 cases in the Southern Hemisphere 7 .…”

Co-infection of SARS-CoV-2 with other viral respiratory pathogens in Yogyakarta, Indonesia: A cross-sectional study

“…Our study showed a higher prevalence of viral co-infection (47.2%) compared to the prevalence of 31.5% reported in Jiangsu Province, China [ 14 ]. Additionally, the prevalence was much higher compared to those reported in Northern California (21%) [ 3 ], Australia (8%) [ 15 ], Turkey (2%) [ 16 ], and Singapore (1.4%) [ 17 ]. The latest systematic review estimated that 3% of hospitalized patients with confirmed COVID-19 were also co-infected with another respiratory virus, mostly hRSV and human influenza A virus [ 18 ].…”