Coinfections with Respiratory Pathogens among COVID-19 Patients in Korea

Abstract

The detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in upper and lower respiratory specimens and coinfection with other respiratory pathogens in patients with coronavirus disease 2019 (COVID-19) was investigated. Study subjects (N = 342) were retrospectively enrolled after being confirmed as SARS-CoV-2 positive, and their nasopharyngeal swab (NPS), oropharyngeal swab (OPS), and sputum specimens were restored for SARS-CoV-2 retesting and respiratory pathogen detection. The majority of the subjects (96.5%, N = 330) were confirmed as SARS-CoV-2 positive using NPS/OPS specimens. Among the COVID-19 patients (N = 342), 7.9% (N = 27) and 0.9% (N = 3) were coinfected with respiratory viruses and Mycoplasma pneumoniae, respectively, yielding an 8.8% (N = 30) overall respiratory pathogen coinfection rate. Of the respiratory virus coinfection cases (N = 27), 92.6% (N = 25) were coinfected with a single respiratory virus and 7.4% (N = 2) with two viruses (metapneumovirus/adenovirus and rhinovirus/bocavirus). No triple coinfections of other respiratory viruses or bacteria with SARS-CoV-2 were detected. Respiratory viruses coinfected in the patients with COVID-19 were as follows: rhinovirus (N = 7, 2.1%), respiratory syncytial virus A and B (N = 6, 1.8%), non-SARS-CoV-2 coronaviruses (229E, NL63, and OC43, N = 5, 1.5%), metapneumovirus (N = 4, 1.2%), influenza A (N = 3, 0.9%), adenovirus (N = 3, 0.9%), and bocavirus (N = 1, 0.3%). In conclusion, the diagnostic value of utilizing NPS/OPS specimens is excellent, and, as the first report in Korea, coinfection with respiratory pathogens was detected at a rate of 8.8% in patients with COVID-19.

Prevalence and Clinical Impact of Coinfection in Patients with Coronavirus Disease 2019 in Korea

“…HBoV, an enveloped virus, was detected consistently during the COVID-19 pandemic according to the Korea Influenza and Respiratory Viruses Surveillance System [23]. The higher detection of viral pathogens in the 20-39 age group suggests that young patients with COVID-19 are more susceptible to respiratory viral coinfection, consistent with the findings of a previous study [20].…”

“…HRV with a long period of viral shedding and environmental resistance [23] has been associated with higher morbidity rather than mortality, causing an economic burden [24]. HBoV was also observed in a previous study using the same RT-PCR kit in South Korea [20]. HBoV, an enveloped virus, was detected consistently during the COVID-19 pandemic according to the Korea Influenza and Respiratory Viruses Surveillance System [23].…”

“…The values ranged from 1.3% to 3.3%, which is similar to that reported in our study. Moreover, a study including 342 patients with COVID-19 demonstrated a viral coinfection of 7.9% in South Korea [20]. Locoregional situations such as an outbreak in Kyungpook province and sampling timing limited to February 2020 might have caused this difference.…”

Assay System for Simultaneous Detection of SARS-CoV-2 and Other Respiratory Viruses

“…The clinical performance of the SC2FabR assay showed 100% diagnostic accuracy, and the assay results were consistent with those of the reference platforms (2019-nCoV or Standard M assays) (Table 2). In addition, the clinical performance of the SC2FabR kit for the analysis of seasonal RVs showed 98.4-100% diagnostic accuracy (Table 2), and the simultaneous detection of co-infection with SARS-CoV-2 presented 100% reliability for Flu A and RSV (Supplementary Table S2), which is similar to the results of previous studies [28]. Thirteen samples that yielded inconsistent results frequently gave "weakly positive" reactions in the SC2FabR assay, with the target amplification detected in the "gray" region [29], with Ct values of 36 to 40 (Figures 3 and 4).…”

The Role of Pulmonary Surfactants in the Treatment of Acute Respiratory Distress Syndrome in COVID-19

“…Abbas et al (Abbasi et al, 2021) has made a serendipitous observation that non-invasive ventilation improved the survival of mice with bacterial pneumonia and the improved survival is associated with the expression of surfactant protein A. Majority of the COVID-19 patients are also reported to be co-infect with other pathogens (Hughes et al, 2020;Jiang et al, 2020;Kim et al, 2020;Roh et al, 2021) and many research papers (Floros and Phelps, 2020;Tekos et al, 2020;Xu et al, 2020) have highlighted that SP-A variants have shown beneficial effects in the treatment of ARDS in COVID-19 patients under different scenarios. Thus, in an opinion article by Abbs et al (Abbasi et al, 2021), the team has expressed that non-invasive ventilation using high-flow nasal cannula (HFNC) may be beneficial for COVID-19 patients which Oxygen in the alveolus is exchanged with carbon dioxide in the capillaries.…”