Co-infection of Coronavirus Disease 2019 and Influenza A: A Report from Iran

Abstract

Background: In late December 2019, a viral pneumonia known as coronavirus disease 2019 (COVID-19) originated from China and spread very rapidly in the world. Since then, COVID-19 has become a global concern and health problem. Methods: We present four patients in this study, selected from among patients who presented with pneumonia symptoms and were suspicious for COVID-19. They were referred to the intended centers for COVID-19 diagnosis and management of Shiraz University of Medical Sciences in southern Iran. Two nasopharyngeal and oropharyngeal throat swab samples were collected from each patient and tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) using real-time reverse-transcriptase– polymerase-chain-reaction (RT-PCR). The samples were also tested for influenza viruses and the complete respiratory panel. Results: In the present report, four patients were diagnosed in the starting days of COVID-19 disease in our center in southern Iran with co-infection of SARS-CoV-2 and influenza A virus. Conclusion: This co-infection of COVID-19 and influenza A highlights the importance of considering SARS-CoV-2 PCR assay regardless of other positive findings for other pathogens in the primary test during the epidemic.

Recognition and management of respiratory co-infection and secondary bacterial pneumonia in patients with COVID-19

“…Secondary bacterial pneumonia can follow the initial phase of viral respiratory infection or occur during the recovery phase. 1 Data on SARS-CoV-2 is limited, but thus far, the overall incidence of viral co-infection has varied widely from 0% to 15% in different case series, [2][3][4][5][6][7] and combined viral and bacterial pneumonia rates appear to be low. 3,[8][9][10] There is also a dearth of data on the predisposing factors and causative organisms.…”

“…Co-infection and secondary bacterial infection • Viral co-infection incidence varies based on case series (0% to 15%) [2][3][4][5][6][7] • Combine bacterial and viral infection is rare in COVID-19 patients 3,8-10 • Secondary bacterial infection is not uncommon and leads to signifi cant morbidity and mortality, especially in the elderly 4,9,16 Procalcitonin • Detectable in 2 to 4 hours, peaks at 12 to 24 hours, and has a half-life of 25 to 30 hours • Levels are normal (< 0.5 μg/L) in COVID-19 patients with mild disease and may be elevated (≥ 0.50 μg/L) in patients with severe disease 10,14 • Elevated levels are correlated to a nearly 5-fold higher risk for severe SARS-CoV-2 infection 17 • Elevated levels are not specifi c to bacterial infection because they can also be raised in patients with acute respiratory distress syndrome, end-stage renal disease, cardiogenic shock, and multi-organ failure 18 • A normal level makes bacterial infection less likely and can guide antibiotic discontinuation 19,20 • In bacterial infection, levels may be less affected by IL-6 inhibitors than C-reactive protein (CRP) [21][22][23]…”

Diagnosis of COVID-19: Considerations, Controversies and Challenges in South Africa

“…co-infection with COVID-19 and influenza and/or bacterial organisms. (46) It is possible that co-infection with more than one pathogen may be more frequent in HIV-infected persons or those with advanced immunosuppression. These unanswered questions will only be resolved once more data become available.…”

High viral load suggests increased COVID-19 severity in a longitudinal cohort

“…However, important knowledge gaps remain, particularly regarding the temporal profiles of viral load in association with disease severity of COVID-19. On the other hand, several studies have reported the co-infection of 2019-nCov with other respiratory virus, like Influenza A [7]. The co-infection indicates the possibility of viral interactions bearing on the course of infectious diseases [8,9].…”