SARS‐CoV‐2 and <i>Streptococcus pneumoniae</i> coinfection as a cause of severe pneumonia in an infant

Nieto-Moro, Montserrat; Ecclesia, Francesco Giuseppe; Tomé-Masa, Irene; Caro-Patón, G. de Lama; Leoz-Gordillo, Inés; Cabrero-Hernández, Marta; García-Salido, Alberto

doi:10.1002/ppul.24916

Cited by 15 publications

(14 citation statements)

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“… 21 Most infants in our hospital had uncomplicated disease with the exception of 1 newborn with apnoea of infancy 22 and 1 infant with pneumococcal pneumonia. 23 More than half of admitted children were aged more than 6 years, and the median age of children with shock was 10 years. It is not known whether the risk of developing MIS-C in association with COVID-19 is greater in older children.…”

Section: Discussionmentioning

confidence: 99%

Clinical spectrum and risk factors for complicated disease course in children admitted with SARS-CoV-2 infection

Storch-de-Gracia

Leoz-Gordillo

Andina

et al. 2020

Anales de Pediatría (English Edition)

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Introduction At this time there are still major questions about the characteristics of disease caused by the new coronavirus (COVID-19) in children as well as factors associated with the development of severe forms of the disease. Study design Retrospective study including patients under 18 years of age admitted with SARS-CoV-2 infection from March 1 to April 30, 2020. Infection was confirmed by real-time reverse transcriptase polymerase chain reaction (RT-PCR) or antibody testing. We describe the epidemiological and clinical data, laboratory and imaging findings, as well as treatment and outcome in these patients. In light of these findings, patients were classified into two severity groups and then compared. Results Thirty-nine children were included, with a median age of 9 years (range 12 days–16 years); 23 were boys. Cases with uncomplicated disease course (24) mostly presented to the emergency department (ED) with fever and/or respiratory symptoms without significant alterations in laboratory findings. Of the 15 children with a complicated course, 12 developed shock. In addition to fever, they frequently presented altered appearance, extreme tachycardia, abdominal pain, vomiting, diarrhea, rash, and/or conjunctival hyperemia. They also showed greater lymphopenia ( p = 0.001), elevated neutrophil/lymphocyte ratio ( p = 0.001), C-reactive protein ( p < 0.001), procalcitonin ( p = 0.001), D-dimer ( p < 0.001), and ferritin ( p < 0.001). Conclusions SARS-CoV-2 infection in admitted children presents with great clinical variability. When provided supportive care, patients with predominant respiratory symptoms without altered laboratory-test results generally have an uncomplicated course. Patients with complicated disease present mainly with fever and abdominal and/or mucocutaneous symptoms. Most develop shock. Elevation of inflammatory markers may allow for early detection and the final outcome is good.

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Section: Discussionmentioning

confidence: 99%

Clinical spectrum and risk factors for complicated disease course in children admitted with SARS-CoV-2 infection

Storch-de-Gracia

Leoz-Gordillo

Andina

et al. 2020

Anales de Pediatría (English Edition)

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“… Rhinovirus Respiratory Yes Major disease-causing rhinovirus serotype HRV-A16 infection upregulates ACE2 and TMPRSS2 expression in epithelial cells by inducing by IFNb1. This event facilitates SARS-CoV-2 transmission and further disease severity [ 125 ] One case has been reported in a young patient expressing critical illness as the outcome of co-infection [ 126 ] Adenovirus Respiratory Yes Similar ion channel forming capability of SARS-CovV-2 E and Adenovirus 6 K proteins facilitates co-infection [ 123 ] Unfavorable prognostic outcome including ARDS [ 127 ] Bacterial Streptococcus pneumoniae Respiratory Yes Opportunistic normal flora of human upper respiratory track Severe respiratory distress followed by pleural effusion and necrotizing pneumonia [ 128 ], higher mortality rate [ 129 ] Staphylococcus aureus Respiratory/Digestive/Contact Yes Opportunistic normal flora of human upper respiratory track, gut mucosa and skin Necrotizing pneumonia [ 130 ]. Bacteremia and higher mortality [ 131 ] Pseudomonas aeruginosa Contact Yes Opportunistic pathogen causing HAI mostly related with poor hygiene, mechanical ventilation and urinary catheterization.…”

Section: Molecular Mechanism Of Co-infection In Covid-19mentioning

confidence: 99%

Microbial co-infections in COVID-19: Associated microbiota and underlying mechanisms of pathogenesis

Hoque

Akter

Mishu

et al. 2021

Microbial Pathogenesis

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The novel coronavirus infectious disease-2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has traumatized the whole world with the ongoing devastating pandemic. A plethora of microbial domains including viruses (other than SARS-CoV-2), bacteria, archaea and fungi have evolved together and interact in complex molecular pathogenesis along with SARS-CoV-2. However, the involvement of other microbial co-pathogens and underlying molecular mechanisms leading to extortionate ailment in critically ill COVID-19 patients has yet not been extensively reviewed. Although, the incidence of co-infections could be up to 94.2% in laboratory-confirmed COVID-19 cases, the fate of co-infections among SARS-CoV-2 infected hosts often depends on the balance between the host's protective immunity and immunopathology. Predominantly identified co-pathogens of SARS-CoV-2 are bacteria such as Streptococcus pneumoniae, Staphylococcus aureus, Klebsiella pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae, Acinetobacter baumannii , Legionella pneumophila and Clamydia pneumoniae followed by viruses including influenza, coronavirus, rhinovirus/enterovirus, parainfluenza, metapneumovirus, influenza B virus, and human immunodeficiency virus. The cross-talk between co-pathogens (especially lung microbiomes), SARS-CoV-2 and host is an important factor that ultimately increases the difficulty of diagnosis, treatment, and prognosis of COVID-19. Simultaneously, co-infecting microbiotas may use new strategies to escape host defense mechanisms by altering both innate and adaptive immune responses to further aggravate SARS-CoV-2 pathogenesis. Better understanding of co-infections in COVID-19 is critical for the effective patient management, treatment and containment of SARS-CoV-2. This review therefore necessitates the comprehensive investigation of commonly reported microbial co-pathogens amid COVID-19, their transmission pattern along with the possible mechanism of co-infections and outcomes. Thus, identifying the possible co-pathogens and their underlying molecular mechanisms during SARS-CoV-2 pathogenesis may shed light in developing diagnostics, appropriate curative and preventive interventions for suspected SARS-CoV-2 respiratory infections in the current pandemic.

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“…En nuestra serie, 12 de los 39 pacientes eran menores de un año (32% de los casos), cifra que es similar al 40% comunicado por Cantoni y a la tasa del 30% comunicada por Garazzino 14 en Italia, aunque un porcentaje mucho más alto que en China (18% en la serie Lu 9 y 11% en la de Dong 8 ) y la tasa contenida en un informe de CDC (15%) 21 . La mayoría de los lactantes de nuestro hospital tuvieron una enfermedad no complicada, con la excepción de un recién nacido con apnea 22 y un lactante con neumonía neumocócica 23 . Más de la mitad de los niños ingresados eran mayores de seis años, y la edad media de los niños con shock fue de 10 años.…”

Section: Discussionunclassified

Espectro clínico y factores de riesgo de enfermedad complicada en niños ingresados con infección por SARS-CoV-2

Storch-de-Gracia¹,

Leoz-Gordillo²,

Andina³

et al. 2020

Anales de Pediatría

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Introducción En este momento existen todavía grandes interrogantes acerca de las características de enfermedad causada por el nuevo coronavirus (COVID-19) en los niños, así como acerca de los factores asociados al desarrollo de formas graves de la enfermedad. Métodos Estudio retrospectivo que incluye pacientes menores de 18 años ingresados debido a infección por SARS-CoV-2. La infección fue confirmada por la reacción en cadena de la transcriptasa inversa-polimerasa (RT-PCR) en tiempo real o por serología. Describimos los datos epidemiológicos y clínicos, los hallazgos de laboratorio y de imágenes, así como el tratamiento y la evolución de estos pacientes. Los pacientes se clasificaron en dos grupos de gravedad y luego se compararon. Resultados Se incluyeron 39 niños, con una mediana de edad de nueve años (rango 12 días-16 años); 23 eran varones. Los casos con evolución no complicada (24) se presentaron en su mayoría con fiebre y/o síntomas respiratorios sin alteraciones significativas en los hallazgos de laboratorio. De los 15 niños con enfermedad complicada, 12 desarrollaron shock . Además de la fiebre, frecuentemente presentaban alteraciones de la apariencia, taquicardia extrema, dolor abdominal, vómitos, diarrea, erupción cutánea y/o hiperemia conjuntival. También mostraron mayor linfopenia (p = 0,001), elevación de la proporción neutrófilos/linfocitos (p = 0,001), proteína C reactiva (p < 0,001), procalcitonina (p = 0,001), dímero D (p < 0,001) y ferritina (p < 0,001). Conclusiones La infección por SARS-CoV-2 en niños ingresados se presenta con una gran variabilidad clínica. Cuando se les proporciona tratamiento de soporte, los pacientes con síntomas respiratorios que no tienen alteración de las pruebas de laboratorio, generalmente tienen una enfermedad no complicada. Los pacientes con enfermedad complicada se presentan principalmente con fiebre y síntomas abdominales y/o mucocutáneos, la mayoría desarrollan un shock . La elevación de los marcadores inflamatorios puede permitir una detección temprana y el pronóstico final es bueno.

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SARS‐CoV‐2 and Streptococcus pneumoniae coinfection as a cause of severe pneumonia in an infant

Cited by 15 publications

References 5 publications

Clinical spectrum and risk factors for complicated disease course in children admitted with SARS-CoV-2 infection

Clinical spectrum and risk factors for complicated disease course in children admitted with SARS-CoV-2 infection

Microbial co-infections in COVID-19: Associated microbiota and underlying mechanisms of pathogenesis

Espectro clínico y factores de riesgo de enfermedad complicada en niños ingresados con infección por SARS-CoV-2

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