Co-infections of SARS-CoV-2 with multiple common respiratory pathogens in infected children

Abstract

Since the outbreak of coronavirus disease 2019 (COVID-19) in Wuhan, considerable attention has been paid on its epidemiology and clinical characteristics in children patients. However, it is also crucial for clinicians to summarize and investigate the co-infection of SARS-CoV-2 in children. We retrospectively reviewed the clinical manifestations, laboratory findings, and imaging characteristics of COVID-19 patients in co-infection group (CI, n = 27) and single infection group (SI, n = 54). Samples were tested for multiple pathogens. A high incidence (27/81, 33%) of co-infection in children with COVID-19 was revealed. The most frequent co-infected pathogen was mycoplasma pneumoniae (MP, 20/81, 25%), followed by virus (6/81, 7%), and bacteria (4/81, 5%). No significant difference in clinical characteristics, laboratory examinations, or hospital stay was observed between the patients with co-infections and those with monomicrobial, only lower in white blood cell counts (CI: 5.54 ± 0.36 vs SI: 7.38 ± 0.37, P = .002), neutrophil counts (CI: 2.20 ± 0.20 vs SI: 2.92 ± 0.23, P = .024) and lymphocyte counts (CI: 2.72 ± 0.024 vs SI: 3.87 ± 0.28, P = .006). Compared with the patients with monomicrobial, chest imaging of those with co-infections showed consolidation in more cases (CI: 29.6% vs SI: 11.1%, P = .038) and duration of positive in nucleic acid was shorter (CI: 6.69 ± 0.82 vs SI: 9.69 ± 0.74, P = .015). Co-infection was relatively common in children with COVID-19, almost 1/3 had co-infection, most commonly caused by MP. Co-infection did not cause a significant exacerbation in clinical manifestations.

Coinfections with Bacteria, Fungi, and Respiratory Viruses in Patients with SARS-CoV-2: A Systematic Review and Meta-Analysis

“…Of the initial 7317 retrieved publications, there were 4609 duplicate articles, and 2080 articles were found to be irrelevant based on their titles and abstracts and were excluded. An additional 1065 articles were excluded after review, meaning that we included 72 articles in the systematic review [ 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , ...…”

“…We reported a higher prevalence of coinfections in hospitalized SARS-CoV-2 patients. The current meta-analysis is more comprehensive and included a total of 71 studies [ 2 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , …”

“…The age-dependent defects in T-cell and B-cell function and the excess production of type 2 cytokines could lead to a deficiency in control of viral replication and more prolonged proinflammatory responses, potentially leading to poorer outcomes [ 103 ]. Yet, SARS-CoV-2 patients of any age may develop such coinfections and experience severe disease, especially in those with comorbidities, even in young people [ 4 , 53 ], children [ 27 , 49 ], and infants [ 40 ].…”

“…Two studies reported conflicting results on the role of bacterial [ 24 , 36 ] or respiratory viral [ 36 ] coinfection in relation to increasing length of hospital stay or ICU admission [ 22 , 24 , 35 ]. It was shown that the patterns of SARS-CoV-2 symptoms and clinical outcomes were not different in the bacterial [ 27 ] and respiratory viral [ 10 , 11 , 27 , 66 , 70 ] co-infected patients. The severity and time of SARS-CoV-2 disease clearance were not different in patients with respiratory viral co-infections [ 19 , 36 ].…”

“…Thus, timely diagnosis is important to initiate appropriate therapy and limit the overuse of antimicrobial agents. Previous studies, including case series [ 2 , 5 , 8 , 11 , 14 , 15 , 16 , 19 , 20 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 ], cohort studies [ 3 , 4 , 6 , 7 , 9 , 10 , 12 , 13 , 17 , 18 , 21 , 22 , 51 , 52 , 53 , 54 , 55 , …”