Case Report: First Confirmed Case of Coinfection of SARS-CoV-2 With Choclo orthohantavirus

Abstract

The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a major international public health concern. The World Health Organization (WHO) declared the pandemic of coronavirus disease 2019 (COVID-19) on March 11, 2020. In Panama, the first SARS-CoV-2 infection was confirmed on March 9, 2020, and the first fatal case associated to COVID-19 was reported on March 10. This report presents the case of a 44-year-old female who arrived at the hospital with a respiratory failure, five days after the first fatal COVID-19 case, and who was living in a region where hantavirus pulmonary syndrome cases caused by Choclo orthohantavirus (CHOV), are prevalent. Thus, the clinical personnel set a differential diagnosis to determine a respiratory disease caused by the endemic CHOV or the new pandemic SARS-CoV-2. This case investigation describes the first coinfection by SARS-CoV-2 and CHOV worldwide. PCR detected both viruses during early stages of the disease and the genomic sequences were obtained. The presence of antibodies was determined during the patient’s hospitalization. After 23 days at the intensive care unit, the patient survived with no sequelae, and antibodies against CHOV and SARS-CoV-2 were still detectable 12 months after the disease. The detection of the coinfection in this patient highlights the importance, during a pandemic, of complementing the testing and diagnosis of the emergent agent, SARS-CoV-2, with other common endemic respiratory pathogens and other zoonotic pathogens, like CHOV, in regions where they are of public health concern.

Hantavirus in Panama: Twenty Years of Epidemiological Surveillance Experience

“…Although another Orthohantavirus ( Calabazo virus [ 14 ]) has been described from Panama and also occurs in a grassland-associated sigmodontine rodent ( Zygodontomys brevicauda ), to date only CHOV has been associated with HPS. In previous studies, phylogenetic analyses have shown that the nucleotide sequences of the S segment obtained in HPS cases in Panama correspond to CHOV [ 21 , 24 , 25 ].…”

“…The management guide and regulations for epidemiological surveillance of hantavirus disease [ 19 ] were released in 2014. This strengthened the notification capacity of health personnel at the national level, with particular emphasis on the endemic regions where suspicion should be maintained in cases that present signs and similar symptoms as other pathologies such as leptospirosis, dengue, rickettsiosis and, more recently, COVID-19 ( Supplementary Figure S1 ) [ 25 , 36 , 44 , 45 , 46 ]. This translated into increased epidemiological notification and documentation of cases observed in the time series.…”

“…Based on that observation, we expected that the HD diagnoses would be higher; however, this was not observed in three of the four provinces of the endemic area. It is possible that adequate differential diagnoses were not made [ 25 , 44 ]. Despite the intense health promotion campaign for prevention and associated research studies carried out in the endemic area, the systematic efforts to search for patients and conduct surveys may have been inadequate [ 26 ] by the health services.…”

Experiences in the use of multiple doses of convalescent plasma in critically ill patients with COVID‐19: An early phase 1 descriptive study

“…in Vero cells (ATCC‐C1008), with a 1/2 serial dilution of the plasma, starting with 1/10 dilution. This was performed in a BSL‐3 laboratory as previously described 22 . PRNT 80 titer was calculated as “the highest dilution of each sample capable of neutralizing the virus by inhibiting the formation of 80% of viral plaque units.”…”