IDCases: Co-infection With SARS-CoV-2

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Right now, with our winter respiratory season pretty much over, anyone presenting to a hospital with severe ILI (Influenza-Like Illness) would be met with a high degree of suspicion of COVID-19 infection.

Next fall and winter, when Influenza and other respiratory viruses are on the rise, differentiating between COVID-19 and other - more common - viral infections will become a bigger challenge.

Complicating matters, it is possible to be co-infected with two (or more) respiratory viruses.

As a practical matter, co-infection with two different influenza A viruses has always been of greatest concern, due to the potential (low as it might be) of seeing a reassortment event in a human host. A few recent blogs on that possibility include:

MMWR: Seasonal H3N2 & H1N1pdm09 Reassortant Infection — Idaho, 2019

Eurosurveillance: Reassortant Seasonal Influenza A(H1N2) Virus, Denmark, April 2019

Eurosurveillance: Novel influenza A(H1N2) Seasonal Reassortant - Sweden, January 2019

We've also seen reports of influenza A & B, and Influenza and other respiratory virus co-infection (see Co-infections With Influenza and Other Respiratory Viruses).  While only rarely reported, these types of viral double-whammies probably occur more often than we know.

Last month, the EID Journal reported on a  SARS-CoV-2 (the virus that causes COVID-19) &  Influenza A coinfection in China.

Volume 26, Number 6—June 2020
Research Letter

Co-infection with SARS-CoV-2 and Influenza A Virus in Patient with Pneumonia, China

Xiaojing Wu, Ying Cai, Xu Huang, Xin Yu, Li Zhao, Fan Wang, Quanguo Li, Sichao Gu, Teng Xu, Yongjun Li, Binghuai Lu , and Qingyuan Zhan

Abstract

We report co-infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and influenza A virus in a patient with pneumonia in China. The case highlights possible co-detection of known respiratory viruses. We noted low sensitivity of upper respiratory specimens for SARS-CoV-2, which could further complicate recognition of the full extent of disease.

(SNIP)

In summary, our case suggests that COVID-19 might be underdiagnosed because of false-negative tests for upper respiratory specimens or co-infection with other respiratory viruses. Broader viral testing might be needed when an apparent etiology is identified, particularly if it would affect clinical management decisions.

Dr. Wu is a pulmonary and critical care physician specializing in respiratory infection at China-Japan Friendship Hospital, Beijing, China. Her research interests include severe lower respiratory infection and new respiratory infectious diseases.

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While similar reports have been scarce, this week the open-access journal IDCase adds two more for our consideration; one involving Influenza A and the other Parainfluenza.

Case report

Co-infection with SARS-CoV-2 and influenza A virus

ShuheiAzekawaa HoNamkoongbc KeikoMitamurad YoshihiroKawaokae FumitakeSaitoad

https://doi.org/10.1016/j.idcr.2020.e00775

Highlights

• COVID-19, caused by the novel SARS-CoV-2, is a pandemic without a known treatment
• COVID-19 cannot be distinguished from other viral infections based on symptoms
• COVID-19 and influenza-A coinfection presents with clinically important features
• Treatment of influenza-A coinfection could improve COVID-19 coinfection outcome
• Systematic analysis of CT and CXR images is important to follow disease resolution

Abstract

Coronavirus Disease 2019 (COVID-19) infection, caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), is spreading globally and poses a major public health threat. We reported a case of influenza A virus and SARS-CoV-2 co-infection.

As the number of COVID-19 cases increase, it will be necessary to comprehensively evaluate imaging and other clinical findings as well as consider co-infection with other respiratory viruses.

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Co-Infection with SARS-COV-2 and Parainfluenza in a young adult patient with pneumonia: Case 

Jose A.Rodrigueza HeysuRubio-Gomezab Alejandra A.Roab N.Millerc Paula A.Eckardtb 

https://doi.org/10.1016/j.idcr.2020.e00762

Abstract

Coronavirus 2 (SARS-CoV-2) is now considered a pandemic causing Coronavirus disease (COVID-19), multiple fatalities and morbidities which have been associated with it worldwide. We report a severe pneumonia causing acute respiratory distress syndrome due to a coinfection with SARS-COV-2 and Parainfluenza 4 virus in a Hispanic 21 year old male in Florida, USA.

The case represents the importance of prompt diagnosis and awareness of the potential co-infection with other respiratory viruses and this novel deadly virus.

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All three reports are cautionary tales reminding us that just because a rapid influenza test, or RVP (Respiratory Virus Panel) comes back positive for something relatively mundane, it doesn't negate the possibility of a SARS-CoV-2 co-infection.

It is also worth noting that no rapid or laboratory test is 100% foolproof, sensitivities and specificities can vary between tests, and the timing and technique of specimen collection can impact the results.

Test results - both positive and negative - must be weighed along with a patient's presentation, other test results (blood workups, chest CT, etc.) and the the known (or suspected) community prevalence of suspected viruses (for more, see ASM.ORG  Making Sense of Respiratory Viral Panel Results).

Hopefully, by next winter, we'll not only know a great deal more about the incidence of COVID-19 co-infection in the community, we'll also have the testing capacity needed to identify those cases.