Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and Middle East Respiratory Syndrome Coronavirus (MERS-CoV) coinfection: A unique case series

Abstract

Introduction The emergence of the Severe Acute Respiratory Syndrome Coroanvirus 2 (SARS-CoV-2) had raised possibilities of coinfection with the Middle East Respiratory Syndrome Coronavirus (MERS-CoV) in countries were these two viruses were reported. In this study, we describe the clinical presentation and demographics of eight patients who were coinfected with SARS-CoV-2 and MERS-CoV. Materials and Methods This is a case series of hospitalized patients admitted to Saudi intensive care units (ICUs). We collected demographics, underlying conditions, presenting symptoms and clinical outcome from the patients’ medical records. Results During the study period from March 14, 2020 to October 19, 2020, there was a total of 67 SARS-CoV-2 ICU admitted patients who underwent simultaneous SARS-CoV-2 and MERS-CoV testing. Of those patients, 8 (12%) tested positive for both SARS-CoV-2 and MERS-CoV. There were 6 (75%) males, the mean age + SD was 44.4 + 11.8 years, and 7 (87.5%) were obese. Of the patients, 7 (87.5%) were non-smokers, 1 (12.5%) had diabetes mellitus, 1 (12.5%) had heart failure, and 1 (12.5%) had been on anti-platelet therapy. The mean hospital length of stay (LOS) was 21.1 + 11.6 days and the average ICU LOS was 10.9 + 6.03 days. All patients received supportive therapy and all were treated with corticosteroid. Of all the patients, 4 (50%) were discharged home and 3 (37.5%) died. Conclusion This case series is an important addition to the medical knowledge as it showed the interaction of the coinfection of SARS-CoV-2 and MERS-CoV.

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

“…The current meta-analysis is more comprehensive and included a total of 71 studies [2,80] and one abstract [3], including a total of 31,953 patients. The inclusion of 18 recently published studies [2,3,[5][6][7][8][9][10][12][13][14]22,24,27,41,62,64,65] contributed to the refinement of the estimate of the pooled prevalence of pathogens contributing to coinfections in SARS-CoV-2 patients.…”

“…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 [80][81][82], while 68 articles were included in the meta-analysis [2][3][4][5][6][7][8][9][10][11][39][40][41][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][59][60][61][62][63][64][65][66][67][68][69][70][80][81][82] (Figure 1).…”

“…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,, cohort studies [3,4,6,7,9,10,12,13,17,18,21,22,[51][52][53][54][55][56][57][58][59][60][61][62][63][64][65][66][67][68][69][70], and meta-analyses [71][72][73], have shown variable results. In light of recent studies evaluating coinfections in SARS-CoV-2 patients, we aimed to re-evaluate the prevalence of bacterial, fungal, and respiratory viral coinfections in a comprehensive meta-analysis.…”

The Complexity of Co-Infections in the Era of COVID-19

“…Viral co-infection does not seem to be correlated with age [54]. The citation of SARS-CoV-2 and MERS-CoV co-infections must be carefully considered for diagnostic thresholds and confirmatory testing [79].…”

“…Most of these studies are observational and vary in the spectrum of other viruses that could be detected. Apart from SARS-CoV-2, other coronaviruses have been co-detected, but not any one has a predilection for such association [44,47,52,54,56,62,[71][72][73]79]. Some co-infections have included more than one other virus [18,56,57,62,71].…”