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Co-infections among patients with COVID-19: The need for combination therapy with non-anti-SARS-CoV-2 agents?
J Microbiol Immunol Infect. 2020 Aug; 53(4):505-512.JM

Abstract

Co-infection has been reported in patients with severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome, but there is limited knowledge on co-infection among patients with coronavirus disease 2019 (COVID-19). The prevalence of co-infection was variable among COVID-19 patients in different studies, however, it could be up to 50% among non-survivors. Co-pathogens included bacteria, such as Streptococcus pneumoniae, Staphylococcus aureus, Klebsiella pneumoniae, Mycoplasma pneumoniae, Chlamydia pneumonia, Legionella pneumophila and Acinetobacter baumannii; Candida species and Aspergillus flavus; and viruses such as influenza, coronavirus, rhinovirus/enterovirus, parainfluenza, metapneumovirus, influenza B virus, and human immunodeficiency virus. Influenza A was one of the most common co-infective viruses, which may have caused initial false-negative results of real-time reverse-transcriptase polymerase chain reaction for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Laboratory and imaging findings alone cannot help distinguish co-infection from SARS-CoV-2 infection. Newly developed syndromic multiplex panels that incorporate SARS-CoV-2 may facilitate the early detection of co-infection among COVID-19 patients. By contrast, clinicians cannot rule out SARS-CoV-2 infection by ruling in other respiratory pathogens through old syndromic multiplex panels at this stage of the COVID-19 pandemic. Therefore, clinicians must have a high index of suspicion for coinfection among COVID-19 patients. Clinicians can neither rule out other co-infections caused by respiratory pathogens by diagnosing SARS-CoV-2 infection nor rule out COVID-19 by detection of non-SARS-CoV-2 respiratory pathogens. After recognizing the possible pathogens causing co-infection among COVID-19 patients, appropriate antimicrobial agents can be recommended.

Authors+Show Affiliations

Department of Internal Medicine, Kaohsiung Veterans General Hospital, Tainan Branch, Tainan.Department of Internal Medicine, Cardinal Tien Hospital and School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.Departments of Laboratory Medicine and Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan. Electronic address: hsporen@ntu.edu.tw.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

32482366

Citation

Lai, Chih-Cheng, et al. "Co-infections Among Patients With COVID-19: the Need for Combination Therapy With non-anti-SARS-CoV-2 Agents?" Journal of Microbiology, Immunology, and Infection = Wei Mian Yu Gan Ran Za Zhi, vol. 53, no. 4, 2020, pp. 505-512.
Lai CC, Wang CY, Hsueh PR. Co-infections among patients with COVID-19: The need for combination therapy with non-anti-SARS-CoV-2 agents? J Microbiol Immunol Infect. 2020;53(4):505-512.
Lai, C. C., Wang, C. Y., & Hsueh, P. R. (2020). Co-infections among patients with COVID-19: The need for combination therapy with non-anti-SARS-CoV-2 agents? Journal of Microbiology, Immunology, and Infection = Wei Mian Yu Gan Ran Za Zhi, 53(4), 505-512. https://doi.org/10.1016/j.jmii.2020.05.013
Lai CC, Wang CY, Hsueh PR. Co-infections Among Patients With COVID-19: the Need for Combination Therapy With non-anti-SARS-CoV-2 Agents. J Microbiol Immunol Infect. 2020;53(4):505-512. PubMed PMID: 32482366.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Co-infections among patients with COVID-19: The need for combination therapy with non-anti-SARS-CoV-2 agents? AU - Lai,Chih-Cheng, AU - Wang,Cheng-Yi, AU - Hsueh,Po-Ren, Y1 - 2020/05/23/ PY - 2020/05/15/received PY - 2020/05/18/accepted PY - 2020/6/3/pubmed PY - 2020/8/28/medline PY - 2020/6/3/entrez KW - COVID-19 KW - Co-infection KW - Influenza viruses KW - SARS-CoV-2 SP - 505 EP - 512 JF - Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi JO - J Microbiol Immunol Infect VL - 53 IS - 4 N2 - Co-infection has been reported in patients with severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome, but there is limited knowledge on co-infection among patients with coronavirus disease 2019 (COVID-19). The prevalence of co-infection was variable among COVID-19 patients in different studies, however, it could be up to 50% among non-survivors. Co-pathogens included bacteria, such as Streptococcus pneumoniae, Staphylococcus aureus, Klebsiella pneumoniae, Mycoplasma pneumoniae, Chlamydia pneumonia, Legionella pneumophila and Acinetobacter baumannii; Candida species and Aspergillus flavus; and viruses such as influenza, coronavirus, rhinovirus/enterovirus, parainfluenza, metapneumovirus, influenza B virus, and human immunodeficiency virus. Influenza A was one of the most common co-infective viruses, which may have caused initial false-negative results of real-time reverse-transcriptase polymerase chain reaction for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Laboratory and imaging findings alone cannot help distinguish co-infection from SARS-CoV-2 infection. Newly developed syndromic multiplex panels that incorporate SARS-CoV-2 may facilitate the early detection of co-infection among COVID-19 patients. By contrast, clinicians cannot rule out SARS-CoV-2 infection by ruling in other respiratory pathogens through old syndromic multiplex panels at this stage of the COVID-19 pandemic. Therefore, clinicians must have a high index of suspicion for coinfection among COVID-19 patients. Clinicians can neither rule out other co-infections caused by respiratory pathogens by diagnosing SARS-CoV-2 infection nor rule out COVID-19 by detection of non-SARS-CoV-2 respiratory pathogens. After recognizing the possible pathogens causing co-infection among COVID-19 patients, appropriate antimicrobial agents can be recommended. SN - 1995-9133 UR - https://www.unboundmedicine.com/medline/citation/32482366/Co_infections_among_patients_with_COVID_19:_The_need_for_combination_therapy_with_non_anti_SARS_CoV_2_agents L2 - https://linkinghub.elsevier.com/retrieve/pii/S1684-1182(20)30127-4 DB - PRIME DP - Unbound Medicine ER -