Clinical significance and role of coinfections with respiratory pathogens among individuals with confirmed severe acute respiratory syndrome coronavirus-2 infection

Abstract

IntroductionThis study aimed to determine the prevalence, viral profile, and clinical features of coinfections with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and other respiratory viruses.MethodsNasopharyngeal samples and clinical data of 221 hospitalized patients and 21 outpatients were collected and analyzed. Real-time reverse transcription-polymerase chain reaction was used to detect SARS-CoV-2, influenza virus, respiratory syncytial virus (RSV), human metapneumovirus (HMPV), parainfluenza virus (PIV) 1,2,3, rhinovirus (RV), adenovirus (AdV), bocaviruses (BoV), and seasonal coronaviruses (OC43, 229E, NL63, and HKU1). Viral load was determined by capillary electrophoresis.ResultsFrom November 2020 to mid-March 2022, 242 SARS-CoV-2 positive patients were tested for seasonal respiratory viruses, and 24 (9.9%) cases of coinfections were detected. The distribution of viruses involved in cases of coinfections were as follows: HMPV (n = 6; 25%), RSV (n = 4;16.7%), AdV (n = 4; 16.7%), BoV (n = 4; 16.7%), PIV3 (n = 2; 8.3%), influenza A (H3N2; n = 2; 8.3%), RV (n = 1; 4.62%), and RV+BoV (n = 1; 4.62%). The proportion of detected coinfections with SARS-CoV-2 was highest in children aged 0–5 years (59%), followed by those >65 years (33%). In specimens with detected coinfection, the viral load of influenza was higher than that of SARS-CoV-2, and the mean viral load of SARS-CoV-2 was higher than that of the other respiratory viruses. C-reactive protein (CRP) and lymphocytes count in co-infected patients >65 years of age were on average higher than in children <16 years of age (mean CRP of 161.8 ± 133.1 mg/L; 19.7 ± 3.09% vs. mean 6.9 ± 8.9 mg/L, 0.9 ± 3.1%; p < 0.01). Patients >65 years of age co-infected with SARS-CoV-2 and other respiratory viruses had longer hospital stays than those <16 years of age (mean 9 ± 3.96 days vs. 5.44 ± 1.89 days; p = 0.025). The combination of AdV and SARS-CoV-2 is fatal for patients aged >65 years.ConclusionIn patients aged >65 years, coinfection with SARS CoV-2 and other respiratory viruses, together with concomitant diseases, causes worsening of the clinical picture and complications, and can be fatal. Screening of patients with SARS CoV-2 for other respiratory viruses is needed to select appropriate treatments and prevent a fatal outcome of the disease.

Single-Center Experience in Detecting Influenza Virus, RSV and SARS-CoV-2 at the Emergency Department

“…This corresponds to rates of co-infections of 0.7% for SARS-CoV-2, of 2.4% for influenza A and of 3.7% for RSV with either of the two other viruses. Therefore, the rate of co-infections of individuals with detectable SARS-CoV-2 was lower at our center than the rates of co-infections of 7.2% reported in patients <18 years of age in a pediatric ED in Lithuania [ 55 ] and of 9.9% observed in two tertiary centers in Bulgaria [ 56 ]. We assume that the low rate of co-infections detected in our ED is related to the fact that our study cohort only included patients ≥18 years of age, and that in Austria, some containment measures were still in place at the end of 2022 ( Figure 5 ).…”

Prevalence and clinical impact of mono- and co-infections with endemic coronaviruses 229E, OC43, NL63, and HKU-1 during the COVID-19 pandemic

“…We observed a longer duration of hospital treatment in patients co-infected with HCoV compared with those mono-infected with SARS-CoV-2. Another study of ours reported a longer hospital stay in the remaining mixed infections of SARS-CoV-2 with other respiratory viruses, as along with a greater percentage of intensive treatments [ 23 ]. A similar trend has been reported in other studies [ 24 ].…”

“…The weak circulation of these viruses during the COVID-19 pandemic resulted in a reduced number of co-infections, including that of SARS-CoV-2 [ 21 , 22 ]. In a previous study conducted by us, it was reported that individuals who were infected with both SARS-CoV-2 and another respiratory virus had a more severe clinical course and required more frequent hospitalisation or invasive treatment [ 23 ]. Other studies have also reported a more severe clinical picture in patients with COVID-19 who were co-infected [ [24] , [25] , [26] ].…”

Association between the overall burden of comorbidity and Ct values among the older patients with Omicron infection: Mediated by inflammation

“…Finally, we confirmed that white blood cells and C-reactive protein significantly mediated the relationship between the burden of comorbidity and Ct values by 29.56% and 18.13% of the total effect size, respectively. These results were unsurprising as agerelated diseases share inflammatory pathogenesis and age-related decline and dysregulation of immune function (34)(35)(36). Also, the degree of immune dysfunction correlates with disease severity (37,38).…”