COVID-19 complicated by multiple germs infection -case report and short literature review

Abstract

Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is characterised by a varied clinical picture. In some cases the evolution may be unfavourable, progressing to pneumonia and acute respiratory distress syndrome. Clinical case: A 70-years-old woman, with multiple comorbidities, was admitted for low-grade fever, dry cough and loss of appetite, symptoms that started 4 days prior to hospitalisation. She was initially diagnosed with mild coronavirus disease 2019 (COVID-19). On the 18th day of illness, there was an increase in inflammatory markers, progression of radiological lesions and SpO2 dropped to 88% room air. Treatment with tocilizumab, remdesivir and high-flow oxygen therapy was initiated. Chest Computed tomography with pulmonary artery angiography ruled out suspected pulmonary embolism, but revealed a new pneumonic process and right pleural effusion, therefore antibiotic therapy was started. Imaging reassessment revealed excavation of the pneumonic process and persistence of pleural effusion. Reverse transcription polymerase chain reaction (RT-PCR) retesting for SARSCOV2 was negative and the patient was transferred to another hospital to undergo bronchoscopy and continue the treatment. Bacteriological examination of the induced sputum revealed the presence of Stenotrophomonas maltophilia, and in the bronchial aspirate was isolated Legionella pneumophilla; whereas the pharyngeal exudate highlighed the presence of Candida glabrata. Finally, the evolution was favorable. The patient was discharged with the recommendation to continue antibiotic therapy at home. Conclusions: The evolution of SARS-CoV-2 infection may be unpredictable, the superinfection with other pathogens may influence the prognosis and progression of the disease.