Clinical and virological impact of single and dual infections with influenza A (H1N1) and SARS-CoV-2 in adult inpatients

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mimics the influenza A (H1N1) virus in terms of clinical presentation, transmission mechanism, and seasonal coincidence. Comprehensive data for the clinical severity of adult patients co-infected by both H1N1 and SARS-CoV-2, and, particularly, the relationship with PCR cycle threshold (Ct) values are not yet available. All participants in this study were tested for H1N1 and SARS-CoV-2 simultaneously at admission. Demographic, clinical, treatment, and laboratory data were extracted from electronic medical records and compared among adults hospitalized for H1N1 infection, SARS-CoV-2 infection and co-infection with both viruses. Ct values for viral RNA detection were further compared within SARS-CoV-2 and co-infection groups. Score on seven-category ordinal scale of clinical status at day 7 and day 14 were assessed. Among patients with monoinfection, H1N1 infection had higher frequency of onset symptoms but lower incidence of adverse events during hospitalization than SAR-CoV-2 infection (P < 0.05). Co-infection had an increased odds of acute kidney injury, acute heart failure, secondary bacterial infections, multilobar infiltrates and admittance to ICU than monoinfection. Score on seven-category scale at day 7 and day 14 was higher in patients with coinfection than patients with SAR-CoV-2 monoinfection (P<0.05). Co-infected patients had lower initial Ct values (referring to higher viral load) (median 32) than patients with SAR-CoV-2 monoinfection (median 36). Among co-infected patients, low Ct values were significantly and positively correlated with acute kidney injury and ARDS (P = 0.03 and 0.02, respectively). Co-infection by SARS-CoV-2 and H1N1 caused more severe disease than monoinfection by either virus in adult inpatients. Early Ct value could provide clues for the later trajectory of the co-infection. Multiplex molecular diagnostics for both viruses and early assessment of SAR-CoV-2 Ct values are recommended to achieve optimal treatment for improved clinical outcome.

The role of respiratory co-infection with influenza or respiratory syncytial virus in the clinical severity of COVID-19 patients: A systematic review and meta-analysis

“…The total number of SARS-CoV-2 patients co-infected with influenza/RSV and mono-infected patients per study ranged from 22 to 4501. Nine studies were mainly conducted in Asia, six of which were from China [ 16 , 17 , 21 - 23 , 25 ]. For viral detection method, SARS-CoV-2 was detected using PCR for all studies whereas influenza and / or RSV co-infection was confirmed by PCR, serological testing, or antigen assays.…”

Inhibition of Human Respiratory Influenza A Virus and Human Betacoronavirus-1 by the Blend of Double-Standardized Extracts of Aronia melanocarpa (Michx.) Elliot and Sambucus nigra L.

“…Different extracts of black elderberry ( S. nigra ) [ 19 , 20 ] and black chokeberry ( A. melanocarpa ) [ 21 ] are known for their health-promoting antimicrobial properties that have been used for a long time in folk medicine and in the food industry. These plants owe their properties mainly to the high content of various polyphenols [ 22 , 23 , 24 ]. Here, we demonstrate the antiviral activity of an originally developed blend of double-standardized extracts of A. melanocarpa and S. nigra (EAM-ESN) and its individual components against the human respiratory viruses influenza virus A/H1N1 and betacoronavirus HCoV-OC43, belonging to the β-coronaviruses as the current pandemic SARS-CoV-2.…”

“…Coronavirus infections and influenza share similar “influenza-like” clinical manifestations usually of mild or moderate course. However, simultaneous infections might result in a big challenge in controlling both diseases, as it is currently observed for the COVID-19 pandemic and seasonal influenza [ 24 ]. Betacoronaviruses and influenza viruses are droplet-borne pathogens that invade the upper or lower respiratory tract by binding to specific cell surface receptors [ 28 ].…”

“…In severe cases, these viruses might cause pneumonia and other serious complications, especially in the presence of bacterial infections. Importantly, co-infection may occur easily [ 24 ]. Natural compounds would provide considerable support to encourage the course of the disease and healing process.…”

SARS-CoV-2/influenza A (H3N2) virus coinfection: epidemiological surveillance in Northeast Brazil

“…Despite the relatively low prevalence (approximately 2.0%) in the State of Sergipe, our findings add to the growing body of evidence on the severity of SARS-CoV-2 and influenza A (H3N2) virus coinfection. Recent observational studies reported that coinfection with SARS-CoV-2 and influenza A (H1N1) predominantly affected older people and were associated with poorer clinical outcomes 4 , 5 . However, mortality data from meta-analyses showed conflicting results because of between-study heterogeneity 6 , 7 .…”