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Clinical significance and role of coinfections with respiratory pathogens among individuals with confirmed severe acute respiratory syndrome coronavirus-2 infection.
Front Public Health. 2022; 10:959319.FP

Abstract

Introduction

This 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.

Methods

Nasopharyngeal 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.

Results

From 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.

Conclusion

In 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.

Links

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Authors+Show Affiliations

Trifonova I
National Laboratory "Influenza and ARD", Department of Virology, National Centre of Infectious and Parasitic Diseases, Sofia, Bulgaria.
Christova I
National Laboratory "Influenza and ARD", Department of Virology, National Centre of Infectious and Parasitic Diseases, Sofia, Bulgaria.
Madzharova I
National Laboratory "Influenza and ARD", Department of Virology, National Centre of Infectious and Parasitic Diseases, Sofia, Bulgaria.
Angelova S
Clinical Virology Laboratory, University Hospital "Prof. Dr. Stoyan Kirkovich", Stara Zagora, Bulgaria.
Voleva S
Clinic for Neuro Infections, Airborne, Roof, and Transmissible Infections, Infectious Hospital "Prof. Ivan Kirov", Department of Infectious Diseases, Parasitology and Tropical Medicine, Medical University of Sofia, Sofia, Bulgaria.
Yordanova R
Clinic for Neuro Infections, Airborne, Roof, and Transmissible Infections, Infectious Hospital "Prof. Ivan Kirov", Department of Infectious Diseases, Parasitology and Tropical Medicine, Medical University of Sofia, Sofia, Bulgaria.
Tcherveniakova T
Clinic for Neuro Infections, Airborne, Roof, and Transmissible Infections, Infectious Hospital "Prof. Ivan Kirov", Department of Infectious Diseases, Parasitology and Tropical Medicine, Medical University of Sofia, Sofia, Bulgaria.
Krumova S
National Laboratory "Influenza and ARD", Department of Virology, National Centre of Infectious and Parasitic Diseases, Sofia, Bulgaria.
Korsun N
National Laboratory "Influenza and ARD", Department of Virology, National Centre of Infectious and Parasitic Diseases, Sofia, Bulgaria.

MeSH

AdolescentAgedC-Reactive ProteinCOVID-19ChildCoinfectionHumansInfluenza A Virus, H3N2 SubtypeInfluenza, HumanSARS-CoV-2

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

36117597

Citation

Trifonova, Ivelina, et al. "Clinical Significance and Role of Coinfections With Respiratory Pathogens Among Individuals With Confirmed Severe Acute Respiratory Syndrome Coronavirus-2 Infection." Frontiers in Public Health, vol. 10, 2022, p. 959319.
Trifonova I, Christova I, Madzharova I, et al. Clinical significance and role of coinfections with respiratory pathogens among individuals with confirmed severe acute respiratory syndrome coronavirus-2 infection. Front Public Health. 2022;10:959319.
Trifonova, I., Christova, I., Madzharova, I., Angelova, S., Voleva, S., Yordanova, R., Tcherveniakova, T., Krumova, S., & Korsun, N. (2022). Clinical significance and role of coinfections with respiratory pathogens among individuals with confirmed severe acute respiratory syndrome coronavirus-2 infection. Frontiers in Public Health, 10, 959319. https://doi.org/10.3389/fpubh.2022.959319
Trifonova I, et al. Clinical Significance and Role of Coinfections With Respiratory Pathogens Among Individuals With Confirmed Severe Acute Respiratory Syndrome Coronavirus-2 Infection. Front Public Health. 2022;10:959319. PubMed PMID: 36117597.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical significance and role of coinfections with respiratory pathogens among individuals with confirmed severe acute respiratory syndrome coronavirus-2 infection. AU - Trifonova,Ivelina, AU - Christova,Iva, AU - Madzharova,Iveta, AU - Angelova,Svetla, AU - Voleva,Silvya, AU - Yordanova,Ralitsa, AU - Tcherveniakova,Tatiana, AU - Krumova,Stefka, AU - Korsun,Neli, Y1 - 2022/09/02/ PY - 2022/06/01/received PY - 2022/08/04/accepted PY - 2022/9/19/entrez PY - 2022/9/20/pubmed PY - 2022/9/21/medline KW - COVID-19 KW - SARS-CoV-2 KW - clinical significance KW - coinfection KW - respiratory virus KW - viral load SP - 959319 EP - 959319 JF - Frontiers in public health JO - Front Public Health VL - 10 N2 - Introduction: This 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. Methods: Nasopharyngeal 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. Results: From 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. Conclusion: In 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. SN - 2296-2565 UR - https://www.unboundmedicine.com/medline/citation/36117597/Clinical_significance_and_role_of_coinfections_with_respiratory_pathogens_among_individuals_with_confirmed_severe_acute_respiratory_syndrome_coronavirus_2_infection_ DB - PRIME DP - Unbound Medicine ER -