Coinfección por SARS-CoV-2 y rinovirus-enterovirus en una paciente adulta joven críticamente enferma en Colombia

Abstract

La actual pandemia por SARS-CoV-2 ha ocasionado un enorme problema de salud pública mundial. Se reporta el caso de una paciente adulta joven con SARS-CoV-2 confirmado por laboratorio. Se describe la identificación del virus y el curso clínico, el diagnóstico y el tratamiento de la infección. La paciente tuvo un rápido deterioro clínico a partir de síntomas iniciales leves que progresaron a una neumonía multilobar que requirió su hospitalización en la unidad de cuidados intensivos.Se destaca la importancia de establecer un diagnóstico basado en la clínica y los antecedentes del paciente, y considerando los posibles síntomas gastrointestinales además de los respiratorios. Asimismo, debe indagarse sobre la presencia de factores de riesgo, en este caso, la obesidad. También se señalan las limitaciones en las pruebas diagnósticas y la posibilidad de infección concomitante con otros agentes patógenos respiratorios, así como los hallazgos en las imágenes diagnósticas, los exámenes de laboratorio y el tratamiento en el marco de la limitada información con que se cuenta actualmente.

Identification of Coinfections by Viral and Bacterial Pathogens in COVID-19 Hospitalized Patients in Peru: Molecular Diagnosis and Clinical Characteristics

“…In Brazil, it was documented that one patient presented Lautropia , Prevotella, and Haemophilus [ 17 ]. Finally, Orozco-Hernández et al reported a case of coinfection with rhinovirus and enterovirus in Colombia [ 18 ].…”

Are we now observing an increasing number of coinfections between SARS‐CoV‐2 and other respiratory pathogens?

“…Recently, Orozco-Hernández et al 7 reported it in an obese young adult with coinfection by SARS-CoV-2 and rhinovirus/enterovirus, who developed severe multilobar pneumonia requiring support in intensive care unit. 7 Based on these reports, the use of the respiratory panel (RP) for the multiple pathogens identification (RP-FilmArray), as well as the performance of cultures for specific pathogens is recommended especially in severe cases or in scenarios where a positive result would change disease management (eg, for the identification of bacterial resistance or neuraminidase inhibitors for influenza in appropriate patients) to prevent disease progression or death. [2][3][4]6 The identification of clinical and epidemiological risk factors of each patient that could suggest a coinfection by a virus, bacteria, and fungi, even three pathogens as Ou et al, 6 and Cuadrado-Payán et al 10 reported.…”

“…There are in summary at least ten reports of different coinfecting organisms isolated simultaneously with SARS-CoV-2 ( Table 1). [1][2][3][4][5][6][7][8][9][10] Even more, recently, two brief reviews without meta-analysis found additional cases, 11,12 although not necessarily included in the current assessment of coinfections. In one of them, published on 2 May 2020, they found that 8% of patients with COVID-19 experienced a bacterial/fungal coinfection during hospital admission, based on 18 studies included.…”

“…11 Nevertheless, this review only considered one of the included studies of the current article, 2 while the rest not. 1,[3][4][5][6][7][8][9][10] In the second one, published online on 23 May 2020, 12 the authors suggested that coinfections would be a risk factor for fatal outcomes, as its prevalence could be up to 50% among non-survivors, however, they did not perform either a metaanalysis and did not include five of the reports included in our Table 1. 1,6,7,9,10 Then, all of these publications complement with the information on coinfections.…”

“…Jorge A. Sánchez-Duque 1,2,3 Juan Pablo Orozco-Hernández 3 Daniel S. Marín-Medina 3,4 Aleksandar Cvetkovic-Vega 2,5,6 Telmo Raul Aveiro-Róbalo 2,7 Alvaro Mondragon-Cardona 2,8,9,10 Virgilio E. Failoc-Rojas 2,11 Estefanía Gutiérrez-Ocampo 1…”