Fatal Superimposed Bacterial Sepsis in a Healthy Coronavirus (COVID-19) Patient

Abstract

Coronavirus disease 2019 (COVID-19) is a highly infectious disease caused by the newly discovered coronavirus, SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2). The novel coronavirus first emerged in Wuhan, China, in December 2019 and has led to a global pandemic. The virus mainly spreads through respiratory droplets from an infected person, but environmental contamination can also act as a source of infection, making social distancing an important key in containing the spread of infection. Those with underlying health conditions are more susceptible to complications such as acute respiratory distress syndrome, which can be fatal. However, healthy individuals experience a mild flu-like illness or may be asymptomatic, recuperating from the infection even without any particular intervention. We present a case of a healthy COVID positive individual, with no underlying comorbidities, who rapidly deteriorated overnight on readmission to the hospital after initial discharge and succumbed to this disease due to a superimposed bacterial infection with COVID pneumonia. This case report highlights the importance of educating COVID-19 positive patients about the precautions, as well as signs and symptoms of a superimposed bacterial infection, when their plan of care is in a home setting. It also emphasizes the potential role of checking procalcitonin levels as a part of routine laboratory investigation at initial presentation in all suspected as well as confirmed COVID-19 cases to rule out an ongoing bacterial infection that can prove fatal in the course of the disease.

Superinfections in COVID-19 Patients: Role of Antimicrobials

“…Bacterial and fungal superinfections occur more commonly in critically ill hospitalized patients with risk factors such as advanced age, underlying systemic diseases, patients with immunosuppression, corticosteroid use, mechanical ventilation, and prolonged hospital and ICU stays [ 7 ] though relatively uncommon, superinfections can also complicate coronavirus disease in an immunocompetent patient [ 8 , 9 ].…”

“…The definite incidence of bacterial superinfections in COVID-19 is not known so far; it seems to be lower than in severe influenza cases [ 4 , 5 ]. A few reports, mostly from China, have reported secondary infections in the range of 5–27% of severe acute respiratory syndrome (SARS)-CoV-2 infected adults in several hospitals, which included 50–100% of those who died [ 6 , 7 , 8 , 9 , 10 , 11 , 12 ]. These infections are more commonly seen in patients with severe disease who are critically ill and in intensive care receiving mechanical ventilation.…”

“…These infections are more commonly seen in patients with severe disease who are critically ill and in intensive care receiving mechanical ventilation. The reported incidence of super added infection in intensive care unit (ICU) cases ranges between 13.5 and 44% in patients with COVID-19, the most frequent type of infection seen is ventilator-associated pneumonia (VAP) due to bacterial or fungal causes, followed by bacteremia with sepsis and urinary tract infections (UTIs) [ 8 , 12 , 13 ]. An association between COVID-19 and superinfection can be possibly attributed to major lung damage caused by viral replication which results in cytokine storm and complex inflammatory processes.…”

Gastrointestinal Manifestation of Severe SARS-CoV-2 Infection in an Immunocompromised Dog

“…Concurrent bacterial sepsis and COVID-19 have been previously reported in humans, with up to 7% of hospitalized COVID-19 patients having bacterial co-infections. 32,33 Remarkably, the dog did not have evidence of significant respiratory disease. Although the dog's respiratory rate was elevated on presentation, it normalized within a few hours of supportive care, as did her heart rate and blood pressure.…”

Respiratory bacterial pathogen spectrum among COVID-19 infected and non–COVID-19 virus infected pneumonia patients

“…COVID-19 is a respiratory pathogen, and its infection could result in severe pneumonia ( Zhu et al, 2020 ). Coinfection with bacterial pathogens was one of the reasons why COVID-19 is fatal ( Cox et al, 2020 ; Jose and Desai, 2020 ). Identification of coinfection pathogens plays a great important role in treatment of COVID-19 infected patients.…”