Co-infection of chlamydia pneumoniae and mycoplasma pneumoniae with SARS-CoV-2 is associated with more severe features

Francesco, Maria Antonia De; Poiesi, Claudio; Gargiulo, Franco; Bonfanti, Carlo; Pollara, P.; Fiorentini, Simona; Caccuri, Francesca; Carta, Valentina; Mangeri, Lucia; Pellizzeri, Simone; Rizzoni, Damiano; Malerba, Paolo; Salvetti, Massimo; Muiesan, María Lorenza; Alberici, Federico; Scolari, Francesco; Padovani, Alessandro; Padovani, Alessandro; Bezzi, Michela; Chiappini, R; Ricci, Chiara; Castellano, Maurizio; Berlendis, Marialma; Savio, G; Montani, Giovanni; Ronconi, Maurizio; Bove, Sergio; Focà, Emanuele; Tomasoni, Lina Rachele; Castelli, Francesco; Rossini, Angelo; Inciardi, Riccardo M.; Caruso, Arnaldo

doi:10.1016/j.jinf.2021.01.009

Cited by 29 publications

(34 citation statements)

References 9 publications

(8 reference statements)

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“…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.…”

Section: Discussionmentioning

confidence: 99%

“…receiving antibiotic agents was reported in 34 studies [2,6,7,14,[16][17][18][19][20][21]23,24,31,[34][35][36][37]39,40,42,43,45,46,48,49,51,52,56,57,60,64,70,80,82]. The most commonly used antimicrobials were macrolides (n = 355), 2nd/3rd/5th generation cephalosporins (n = 157), fluoroquinolones, (n = 150), antifungals (n = 62), beta-lactams/beta-lactam inhibitors (n = 26), beta-lactams (n = 21), tetracyclines (n = 17), linezolid (n = 13), carbapenems (n = 4), and glycopeptides (n = 2).…”

Section: Characteristics and Quality Of Included Studiesmentioning

confidence: 99%

“…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).…”

Section: Characteristics and Quality Of Included Studiesmentioning

confidence: 99%

“…The majority of the studies were single center and only 24 studies were multi-center. Laboratory techniques for co-pathogen detection within studies included 19 that used respiratory samples and RT-PCR tests [4,5,8,[11][12][13]29,33,37,38,53,55,58,59,62,63,66,70,80], 17 that used serologic tests (antibodies) [6,10,14,19,24,31,32,35,36,[43][44][45]50,52,60,64,68], 15 that used RT-PCR tests with respiratory and/or blood cultures [7,9,17,18,23,26,28,34,39,42,51,56,57,…”

Section: Characteristics and Quality Of Included Studiesmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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Background: Coinfection with bacteria, fungi, and respiratory viruses in SARS-CoV-2 is of particular importance due to the possibility of increased morbidity and mortality. In this meta-analysis, we calculated the prevalence of such coinfections. Methods: Electronic databases were searched from 1 December 2019 to 31 March 2021. Effect sizes of prevalence were pooled with 95% confidence intervals (CIs). To minimize heterogeneity, we performed sub-group analyses. Results: Of the 6189 papers that were identified, 72 articles were included in the systematic review (40 case series and 32 cohort studies) and 68 articles (38 case series and 30 cohort studies) were included in the meta-analysis. Of the 31,953 SARS-CoV-2 patients included in the meta-analysis, the overall pooled proportion who had a laboratory-confirmed bacterial infection was 15.9% (95% CI 13.6–18.2, n = 1940, 49 studies, I2 = 99%, p < 0.00001), while 3.7% (95% CI 2.6–4.8, n = 177, 16 studies, I2 = 93%, p < 0.00001) had fungal infections and 6.6% (95% CI 5.5–7.6, n = 737, 44 studies, I2 = 96%, p < 0.00001) had other respiratory viruses. SARS-CoV-2 patients in the ICU had higher co-infections compared to ICU and non-ICU patients as follows: bacterial (22.2%, 95% CI 16.1–28.4, I2 = 88% versus 14.8%, 95% CI 12.4–17.3, I2 = 99%), and fungal (9.6%, 95% CI 6.8–12.4, I2 = 74% versus 2.7%, 95% CI 0.0–3.8, I2 = 95%); however, there was an identical other respiratory viral co-infection proportion between all SARS-CoV-2 patients [(ICU and non-ICU) and the ICU only] (6.6%, 95% CI 0.0–11.3, I2 = 58% versus 6.6%, 95% CI 5.5–7.7, I2 = 96%). Funnel plots for possible publication bias for the pooled effect sizes of the prevalence of coinfections was asymmetrical on visual inspection, and Egger’s tests confirmed asymmetry (p values < 0.05). Conclusion: Bacterial co-infection is relatively high in hospitalized patients with SARS-CoV-2, with little evidence of S. aureus playing a major role. Knowledge of the prevalence and type of co-infections in SARS-CoV-2 patients may have diagnostic and management implications.

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Section: Discussionmentioning

confidence: 99%

Section: Characteristics and Quality Of Included Studiesmentioning

confidence: 99%

Section: Characteristics and Quality Of Included Studiesmentioning

confidence: 99%

Section: Characteristics and Quality Of Included Studiesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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Atypical bacterial co‐infections among patients with COVID‐19: A study from India

Chaudhry

Sreenath

Batra

et al. 2021

Journal of Medical Virology

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Emerging evidence shows co-infection with atypical bacteria in coronavirus disease 2019 patients. Respiratory illness caused by atypical bacteria such as Mycoplasma pneumoniae, Chlamydia pneumoniae, and Legionella pneumophila may show overlapping manifestations and imaging features with COVID-19 causing clinical and laboratory diagnostic issues. We conducted a prospective study to identify co-infections with SARS-CoV-2 and atypical bacteria in an Indian tertiary hospital. From June 2020 to January 2021, a total of 194 patients with laboratoryconfirmed COVID-19 were also tested for atypical bacterial pathogens. For diagnosing M. pneumoniae, a real-time polymerase chain reaction (PCR) assay and serology (IgM ELISA) were performed. C. pneumoniae diagnosis was made based on IgM serology. L. pneumophila diagnosis was based on PCR or urinary antigen testing. Clinical and epidemiological features of SARS-CoV-2 and atypical bacteria-positive and -negative patient groups were compared. Of the 194 patients admitted with COVID-19, 17 (8.8%) were also diagnosed with M. pneumoniae (n = 10) or C. pneumoniae infection (n = 7). Confusion, headache, and bilateral infiltrate were found more frequently in the SARS CoV-2 and atypical bacteria co-infection group. Patients in the M. pneumoniae or C. pneumoniae co-infection group were more likely to develop ARDS, required ventilatory support, had a longer hospital length of stay, and higher fatality rate compared to patients with only SARS-CoV-2. Our report highlights co-infection with bacteria causing atypical pneumonia should be considered in patients with SARS-CoV-2 depending on the clinical context. Timely identification of co-existing pathogens can provide pathogen-targeted treatment and prevent fatal outcomes of patients infected with SARS-CoV-2 during the current pandemic.

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Bordetella pertussis, Chlamydia pneumoniae, and Mycoplasma pneumoniae Findings in Children During COVID-19 Pandemic in Finland

Kuitunen

2022

SN Compr. Clin. Med.

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Social restrictions effectively interrupted the typical respiratory virus circulation. The aim of this report is to describe how atypical pneumonia bacteria detections have changed during the COVID-19 pandemic in Finnish children. Bordetella pertussis, Chlamydia pneumoniae, and Mycoplasma pneumoniae findings were gathered from the National Infectious Diseases Register from 2015 to 2021 and stratified into three age groups (0–4, 5–9, and 10–14 years). Incidences per 100,000 children were calculated and 2020 and 2021 was compared to the mean incidence of reference years (2015–2019) by incidence rate ratios. B. pertussis incidence was 32% lower in 2020 and 88% lower in 2021 compared to reference years. C. pneumoniae detections decreased rapidly in 2020 and not a single detection of C. pneumoniae was reported to the register in 2021. M. pneumoniae incidence was 72% lower in 2020 and 89% lower in 2021 than in the reference years. All these findings were seen in all age groups. As the incidences of B. pertussis, C. pneumoniae, and M. pneumoniae detections have been low throughout the pandemic, it seems that the social restrictions have been effective in preventing the spreading of these respiratory bacteria in children.

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Co-infection of chlamydia pneumoniae and mycoplasma pneumoniae with SARS-CoV-2 is associated with more severe features

Cited by 29 publications

References 9 publications

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

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

Atypical bacterial co‐infections among patients with COVID‐19: A study from India

Bordetella pertussis, Chlamydia pneumoniae, and Mycoplasma pneumoniae Findings in Children During COVID-19 Pandemic in Finland

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