COVID-19 Co-infection Research Articles

Case of Covid-19 co-infection with Crimean Congo haemorrhagic fever (CCHF) in a CCHF endemic country: a case report

Covid-19 pandemic affected the health care systems globally. In many countries, healthcare services were overwhelmed by the huge number of Covid cases; hence, shifting the focus from locally endemic infectious diseases. Such a case presented to us that was initially managed along the lines of critical Covid pneumonia with steroids, Remdesivir, and supplemental oxygen for hypoxic respiratory failure. The patient also received Baricitinib, to which he was non-responsive and thus offered invasive mechanical ventilation. Post intubation, the patient was managed for Covid-associated ARDS with lung protective ventilation. He later also developed liver dysfunction, renal failure, coagulation derangements, and shock. Workup for malaria and dengue were negative. Later, Crimean Congo PCR was sent which came positive; a possible cause of progressive deterioration. In CCHF endemic areas, it is crucial to rule out the CCHF infection among patients presenting with critical Covid pneumonia due to similar clinical presentation in both the infections.

Impact of the COVID-19 Pandemic on the Epidemiological Situation of Pulmonary Tuberculosis-Using Natural Language Processing.

We aimed to analyze the impact of the COVID-19 pandemic on pulmonary tuberculosis (TB) using artificial intelligence. To do so, we compared the real-life situation during the pandemic with the pre-2020 situation. This non-interventional, retrospective, observational study applied natural language processing to the electronic health records of the Castilla-La Mancha region of Spain. The analysis was conducted from January 2015 to December 2020. A total of 2592 patients were diagnosed with pulmonary tuberculosis; 64.6% were males, and the mean age was 53.5 years (95%CI 53.0-54.0). In 2020, pulmonary tuberculosis diagnoses dropped by 28% compared to 2019. In total, 62 (14.2%) patients were diagnosed with COVID-19 and pulmonary tuberculosis coinfection in 2020, with a mean age of 52.3 years (95%CI 48.3-56.2). The main symptoms in these patients were dyspnea (27.4%) and cough (35.5%), although their comorbidities were no greater than patients with isolated TB. The female sex was more frequently affected, representing 53.4% of this patient subgroup. During the first year of the COVID-19 pandemic, a decrease was observed in the incidence of pulmonary tuberculosis. Women presented a significantly higher risk for pulmonary tuberculosis and COVID-19 coinfection, although the symptoms were not more severe than patients diagnosed with pulmonary tuberculosis alone.

The Impact of Antimicrobial Stewardship in Treating Patients with Escherichia coli Bacteremia in a Small Single Center Community Hospital.

Purpose: There are many challenges that pharmacist led antimicrobial stewardship programs can encounter including lack of resources, costs, and inaccurate antimicrobial susceptibility testing (AST) results. The COVID-19 pandemic has led to increased resistance especially with gram negative infections. At a small single center community hospital, gram negative infections, particularly Escherichia coli infections, predominately occur. Therefore, this study aims to address gram negative bacteremia burden and its impact on antimicrobial stewardship efforts for combatting Escherichia coli and ESBL organisms with such barriers during the pandemic. Methods: In a retrospective cohort study, patients ≥ 18 years of age from a small community hospital were reviewed. Patients were excluded if their blood cultures were not positive for Escherichia coli and if antibiotics were not initiated during hospital stay. The primary endpoint was to determine the length of hospital stay. Critical secondary endpoints include antibiotic de-escalations, duration of antibiotics, time to definitive antibiotic therapy, serum procalcitonin levels, blood culture availabilities, MIC breakpoints, co-infection of COVID-19, and Clostridioides difficile occurrences. Results: Out of 74 patients with gram negative bacteremia, 41 patients specifically had Escherichia coli bacteremia. The primary endpoint results showed that patients with Escherichia coli bacteremia that stayed in the ICU had a length of stay of 13.6 days. Patients with Escherichia coli bacteremia in the Non-ICU setting has a length of stay of 7.3 days, and patients with ESBL bacteremia in the Non-ICU setting had a length of stay of 6.8 days. Conclusions: Despite the various challenges that antimicrobial stewardship programs (ASP) face in a single center small community hospital, the ASP at this small community hospital utilizes various policies and tools to increase appropriate antibiotic use and decrease hospital length of stay in patients with Escherichia coli bacteremia.

Lung Inflammation Signature in Post-COVID-19 TB Patients.

Tuberculosis (TB) remains a leading cause of infectious disease mortality worldwide, despite the COVID-19 pandemic. The mechanisms by which SARS-CoV-2 affects tuberculosis progression have not yet been established. Here, we compared the level of inflammation in the wall of the tuberculoma and in the parenchymal lung tissue of 30 patients diagnosed with tuberculoma without a history of COVID-19 and 30 patients diagnosed with tuberculoma 3 months after COVID-19. We also characterized TB activity in these patients using a panel of TB-associated miRNAs. Histopathological changes were examined in the resection material, and the expression level of cytokine/chemokine genes was determined by qRT-PCR. In patients with a history of COVID-19, the histological data obtained suggested activation of tuberculosis. In the same group of patients, as opposed to those without a history of COVID-19, equally high levels of pro-inflammatory cytokines/chemokines were expressed both in the tuberculoma wall and in the periphery of the resected specimen. A full set of miRNAs (miR-191, miR-193a, miR-222, miR-223, miR-155, miR-26a, and miR-150) were downregulated in the sera of patients with TB and active COVID-19 co-infection compared to controls. Our observations indicate signs of tuberculosis activation resulting from COVID-19 infection.

Clinical characteristics of a case of severe pneumonia caused by coinfection of COVID-19 and Chlamydia Psittaci

A 69-year-old female patient was admitted to the Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Xuzhou Medical University due to a "cough and fever for eight days". On admission, a coronavirus disease (COVID-19) nucleic acid test was positive, and a chest CT scan showed progressive patchy shadows and consolidation shadows in both lungs. Arterial blood gas analysis showed type Ⅰ respiratory failure. The primary diagnosis was severe community-acquired pneumonia in an older adult without underlying disease. However, oxygen inhalation, steroid, anti-inflammatory, and antibacterial empirical treatment with piperacillin/tazobactam was ineffective. Metagenomic next-generation sequencing of bronchoscopy alveolar lavage fluid showed Chlamydia psittaci(C. psittaci). Severe pneumonia was confirmed, caused by coinfection with severe acute respiratory syndrome coronavirus 2 and C. psittaci. A combination of doxycycline and moxifloxacin significantly improved the targeted and symptomatic treatment of the underlying cause. After discharge, the patient recovered within four weeks of follow-up. Therefore, clinicians should be alert to the possibility of coinfection of C. psittaci in patients already diagnosed with COVID-19.

Two Swords in the Storm: Parvovirus B19 and COVID-19 Clash in a Myocardial Mayhem of Arrhythmias

Myocarditis can be caused by a variety of infectious and non-infectious illnesses [1]. Although viral infection remains the most commonly identified cause of myocarditis, the role of parvovirus B19 (B19V) from the Erythrovirus genus in the pathogenesis of myocarditis has been identified as a potentially important contributor to myocarditis because of the high prevalence of Parvovirus B 19 (B19V) DNA in hearts of patients with myocarditis [2]. Co-infections of cardiotropic viruses are rarely reported and the mechanisms of viral interactions remain unknown [3]. In this report, we present a case of acute myocarditis in a young male, precipitated by a co-infection of Parvovirus B19 and COVID-19, characterized by fulminant progression and the development of multiple arrhythmias.

On the fractal-fractional Mittag-Leffler model of a COVID-19 and Zika Co-infection

The World Health Organization declared COVID-19 a global pandemic in March 2020, which had a significant impact on global health and economies. There have been several Zika outbreaks in different regions such as Africa, Southeast Asia, and the Americas. Therefore, it is essential to study the dynamics of these two diseases, taking into account their memory and recurrence effects. A new fractal-fractional hybrid Mittag-Leffler model of COVID-19 and Zika co-dynamics is designed and studied to evaluate the effects of COVID-19 on Zika and vice-versa. The stability analysis of the local asymptotic type at disease-free equilibrium is conducted for the hybrid model. The existence of unique solutions to the model is established via some fixed point results. The fractal-fractional model is proved to be Hyers–Ulam stable. With the help of Newton polynomials, we obtain some numerical algorithms to approximate the solutions of the fractal-fractional hybrid Mittag-Leffler model graphically. The impact of fractional and fractal orders on the dynamics of each of the epidemiological classes is also assessed. In addition, empirical evidence from numerical simulations suggests that implementing measures to contain the transmission of the SARS-CoV-2 virus can significantly contribute to the reduction of co-infections involving the Zika virus. Therefore, it is imperative for healthcare systems to maintain a state of constant vigilance in order to detect any atypical patterns or probable occurrences of co-infections, particularly in areas where both diseases are widespread. Additionally, it is vital to consult the most recent directives provided by health authorities, as our comprehension of diseases may undergo advancements over the course of time.

Sub-therapeutic trimethoprim and sulfamethoxazole plasma concentrations during continuous venovenous hemofiltration in a patient with COVID-19 and pulmonary Pneumocystis jirovecii co-infection: Acase report.

To investigate drug concentration of trimethoprim-sulfamethoxazole (TMP-SMX) using therapeutic drug monitoring (TDM) for severe Pneumocystis jirovecii (PJP) infection in a critically ill patient with COVID-19 receiving continuous venovenous hemofiltration treatment and regional citrate anticoagulation (RCA-CCVH). A 72-year-old man with hypoxemic respiratory failure due to COVID-19 infection was admitted to the intensive care unit for invasive mechanical ventilation. The patient developed acute renal failure that required RCA-CVVH. Pulmonary co-infection with PJP was diagnosed, and a high TMP-SMX dose was initiated according to (inter)national guidelines with dose reduction after 3 days because of renal failure. Population pharmacokinetics were assessed for TMP and SMX as well as clearance by RCA-CVVH, volume of distribution, and time above threshold levels for measured plasma concentrations. During renal failure requiring RCA-CVVH, a corresponding dose reduction of TMP-SMX to 320/1,600 mg twice a day, according to current Dutch SWAB and Dutch Association of Hospital Pharmacists guidelines, resulted in unintended under-dosing with sub-therapeutic TMP-SMX concentrations. Pharmacokinetic modeling and dose adjustment of TMP-SMX to 640/3,200 mg 3 times daily resulted in steady-state TMP-SMX peak concentrations associated with efficacy against PJP. Hence, the patient was successfully weaned from the ventilator and discharged. We hypothesize that our new dose recommendation of 640/3,200 mg TMP-SMX 3 times daily is associated with an increased probability of critical patients being successfully liberated from mechanical weaning following PJP pneumonia and COVID-19 infection.

Pre-existing neurological conditions and COVID-19 co-infection: Data from systematic reviews, meta-analyses, and scoping reviews

BackgroundPre-existing neurological diseases have been identified as risk factors for severe COVID-19 infection and death. There is a lack of comprehensive literature review assessing the relationship between pre-existing neurological conditions and COVID-19 outcomes. Identification of high risk groups is critical for optimal treatment and care. MethodsA literature review was conducted for systematic reviews, meta-analyses, and scoping reviews published between January 1, 2020 and January 1, 2023. Literature assessing individuals with pre-existing neurological diseases and COVID-19 infection was included. Information regarding infection severity was extracted, and potential limitations were identified. ResultsThirty-nine articles met inclusion criteria, with data assessing >3 million patients from 51 countries. 26/51 (50.9%) of countries analyzed were classified as high income, while the remaining represented middle-low income countries (25/51; 49.0%). A majority of evidence focused on the impact of cerebrovascular disease (17/39; 43.5%) and dementia (5/39; 12.8%) on COVID-19 severity and mortality. 92.3% of the articles (36/39) suggested a significant association between neurological conditions and increased risk of severe COVID-19 and mortality. Cerebrovascular disease, dementia, Parkinson's disease, and epilepsy were associated with increased COVID severity and mortality. ConclusionPre-existing neurological diseases including cerebrovascular disease, Alzheimer's disease and other dementias, epilepsy, and Parkinson's disease are significant risk factors for severity of COVID-19 infection and mortality in the acute infectious period. Given that 61.5% (24/39) of the current evidence only includes data from 2020, further updated literature is crucial to identify the relationship between chronic neurological conditions and clinical characteristics of COVID-19 variants.

INVASIVE TRICHOSPORON INFECTION IN A SARS-COV-2 AND INFLUENZA COINFECTED PATIENT: A CASE REPORT

Trichosporon species can cause systemic or mucosal-associated or superficial infections, including white piedra, as well as invasive fungal infections. They can be an opportunistic cause of invasive infection, especially in patients with hematological malignancies and solid organ tumors or immunosuppressed transplant recipients. There has been an increase in invasive infections due to Trichosporon species in recent years. Treatment of patients with trichosporonosis poses a problem due to limited data regarding the antifungal agents used. In this article, we present a case that resulted in death as a result of invasive trichosporonosis infection that developed after a long stay in intensive care due to co-infection of COVID-19 and influenza.

Case study of tuberculosis and COVID-19 coinfection in a tertiary hospital in Benue state, Nigeria: Rationale for integration of surveillance activities

Several intervention strategies have been implemented to eliminate tuberculosis (TB) over the past three decades. The emergence of COVID-19 has disrupted most of these strategies, thereby reversing the gains made in the management of TB over time. This study highlighted the literature on TB and COVID-19, the challenges in making the diagnosis of TB and COVID-19 coinfection, and the rationale for the integration of surveillance activities using a case report of a 69-year-old pulmonary TB and COVID-19 coinfected patient who was first managed with COVID-19 in a tertiary health facility in Benue State, Nigeria, without much improvement. She was later re-assessed, diagnosed with drug-sensitive TB, and cured after a 6-month course of anti-TB regimen. This case indicates that the initially missed diagnosis of TB and the catastrophic effects could have been avoided if the TB and COVID-19 services were integrated.

The Role of COVID-19 Pandemic on Malaria Incidence; Meta-Analysis and Systematic Review Study

Background: Today, COVID-19 and malaria are the leading causes of death in the worldwide. Malaria and COVID-19 have common aspects and may be was a high potential for mutual influence. Hence, consequences and outcomes of COVID-19 become very dangerous and problematic. The aim of this study, investigate of the influence of COVID-19 mortality and malaria prevalence by systematic review and meta-analysis study. Method: We searched authentic research databases by using the following keywords in English language. In additional, for statistical analysis, meta-analysis and random effect model and I2 index were used. Statistical analysis was performed with STAT (version 11.2). Result: In the present study, nine articles were selected from 1,014 articles that examined co-infection in COVID-19 and malaria. This study revealed that co-infection between malaria and COVID-19 has very interesting and surprising results. OR (odds ratio) =-1.2 (95% CI: -1.8 to -0.6). We encounter high values of I2 in the study (l2=98.549). Conclusion: People with malaria who show symptoms such as fever should be evaluated by COVID-19 to prevent serious complications. The present study provided information on malaria and COVID-19 co-infection. Nevertheless, further prospective studies are needed to investigate the burden and consequences of COVID-19 in malaria endemic areas.

COVID-19 and cholera co-infection and comorbidity in Africa and Asia: a systematic review and meta-analysis

COVID-19 and cholera co-infection and comorbidity in Africa and Asia: a systematic review and meta-analysis

Characteristics of and Deaths among 333 Persons with Tuberculosis and COVID-19 in Cross-Sectional Sample from 25 Jurisdictions, United States.

Little is known about co-occurring tuberculosis (TB) and COVID-19 in low TB incidence settings. We obtained a cross-section of 333 persons in the United States co-diagnosed with TB and COVID-19 within 180 days and compared them to 4,433 persons with TB only in 2020 and 18,898 persons with TB during 2017‒2019. Across both comparison groups, a higher proportion of persons with TB-COVID-19 were Hispanic, were long-term care facility residents, and had diabetes. When adjusted for age, underlying conditions, and TB severity, COVID-19 co-infection was not statistically associated with death compared with TB infection only in 2020 (adjusted prevalence ratio 1.0 [95% CI 0.8‒1.4]). Among TB-COVID-19 patients, death was associated with a shorter interval between TB and COVID-19 diagnoses, older age, and being immunocompromised (non-HIV). TB-COVID-19 deaths in the United States appear to be concentrated in subgroups sharing characteristics known to increase risk for death from either disease alone.

A case of severe COVID-19 and influenza co-infection

Aim. To analyze a case of severe COVID-19 and influenza co-infection in a 48-year-old female patient. Materials and methods. The clinical course, specifics of diagnosis and therapy of the 48-year-old patient S., who was treated for severe co-infection of COVID-19 and influenza at Municipal non-profit Enterprise “Regional Infectious Clinical Hospital” Zaporizhzhіa Regional Council from 29.01.2023 to 17.02.2023, were analyzed. The diagnosis of COVID-19 was confirmed by the detection of SARS-CoV-2 Ag in nasopharyngeal swabs by the immunochromatographic method, and the diagnosis of influenza – by the influenza A viral RNA detection by the polymerase chain reaction method. Current regulatory documents were used when examining and treating the patient. Results. It has been recognized that the unvaccinated 48-year-old female patient was at a risk group due to comorbid pathology (stage 2 hypertension, type 2 diabetes mellitus, grade 2 obesity) developed a severe course of COVID-19 and influenza type A co-infection. The course of co-infection was complicated by severe acute respiratory distress syndrome already on the 6th day of the disease. The diagnosis of COVID-19 was confirmed by a rapid SARS-CoV-2 antigen test. Treatment for COVID-19 was started immediately with the use of remdesivir, dexamethasone, and anticoagulants. However, despite the patient was given the treatment, his condition worsened due to the rapid progression of acute respiratory failure. The presence of clear clinical and laboratory signs of “cytokine storm” required the use of tocilizumab on the 7th day of the disease. Oseltamivir was commenced after receiving laboratory confirmation of influenza A by the PCR method on the 8th day of the disease. A complete etiologic interpretation of the diagnosis made it possible to prescribe a combination antiviral treatment which coupled with the timely additional initiation of tocilizumab, allowed obtaining certain positive dynamics after only five days of treatment with further improvement of the patient’s condition. Conclusions. Our clinical observation has demonstrated the severe course of COVID-19 and influenza co-infection in the unvaccinated high-risk 48-year-old female patient due to the presence of comorbid pathology. The complete etiologic interpretation of the co-infection has made it possible to prescribe the combination antiviral treatment, which coupled with the additional correction of the immunotropic treatment has enabled to obtain the positive dynamics after only 5 days with further improvement of the patient’s condition

Co-Circulation of SARS-CoV-2 and Other Respiratory Pathogens in Upper and Lower Respiratory Tracts during Influenza Season 2022-2023 in Lazio Region.

Lower respiratory tract infections (LRTIs) occur when there is a lower airway tract infection. They are well-known for increasing the susceptibility of patients to bacterial/fungal co-infections and super-infections. In this study, we present the results of our investigation, which involved 381 consecutive patients admitted to our hospital during the Influenza season from October 2022 to April 2023. Among the 381 specimens, 75 were bronchoalveolar (BAL), and 306 were nasopharyngeal swabs (NPSs). Notably, 34.4% of the examined samples tested positive for SARS-CoV-2. Of these, we observed that 7.96% of NPSs showed positivity only for other respiratory viruses, while a substantial percentage (77%) of BAL specimens exhibited positive results only for bacterial co-infections. The results of our study not only confirm the importance of co-infections in COVID-19 but also emphasize the significance of utilizing rapid diagnostic tests (RDTs) for the timely diagnosis of LRTIs. In fact, RDTs allow for the identification of multiple pathogens, providing clinicians with useful and timely information to establish effective therapy.

Coinfection of Monkeypox, COVID-19 and Syphilis in a PrEP using MSM: A case report from Barcelona

Monkeypox virus (MPXV) is a zoonotic disease, with endemic circulation and it’s not considered a sexually transmitted infection. Recently, it has been reported a particularly high incidence among men who have sex with men (MSM). We report the first case of a male HIV-negative patient with HIV Pre-Exposition Prophylaxis (PrEP), and a simultaneous coinfection of Monkeypox Virus, COVID-19 and Syphilis.

The Impact of Viral and Bacterial Co-Infections and Home Antibiotic Treatment in SARS-CoV-2 Hospitalized Patients at the Policlinico Tor Vergata Hospital, Rome, Italy.

Co-infections during COVID-19 may worsen patients' outcomes. This study reports the results of a screening assessing the presence of co-infections among patients hospitalized for SARS-CoV-2 infection in the Infectious Diseases-Ward of the Policlinico Tor Vergata Hospital, Rome, Italy, from 1 January to 31 December 2021. Data on hepatitis B and C virus, urinary antigens for legionella pneumophila and streptococcus pneumoniae, pharyngeal swab for respiratory viruses, QuantiFERON®-TB Gold Plus assay (QFT-P), blood cultures and pre-hospitalization antibiotic prescription were recorded. A total of 482 patients were included, 61% males, median age of 65 years (IQR 52-77), median Charlson comorbidity index of 4 (IQR 2-5). The mortality rate was 12.4%; 366 patients needed oxygen supply. In total, 151 patients (31.3%) received home antibiotics without any association with the outcome. No significant association between mortality and the positivity of viral hepatitis markers was found. Out of 442 patients, 125 had an indeterminate QFT-P, associated with increased mortality. SARS-CoV-2 was the only respiratory virus detected among 389 pharyngeal swabs; 15/428 patients were positive for S. pneumoniae; none for L. pneumophila. In total, 237 blood cultures were drawn within 48 h from hospital admission: 28 were positive and associated with increased mortality. In our cohort, bacterial and viral co-infections in COVID-19 hospitalized patients were rare and not associated with higher mortality.

Clinical, Epidemiological and Laboratory Features of Invasive Candida parapsilosis Complex Infections in a Brazilian Pediatric Reference Hospital during the COVID-19 Pandemic.

The present study aimed to describe the clinical, epidemiological and laboratory characteristics of invasive candidiasis by C. parapsilosis complex (CPC) in a Brazilian tertiary pediatric hospital during the COVID-19 pandemic. Clinical samples were processed in the BACT/ALERT® 3D system or on agar plates. Definitive identification was achieved by MALDI-TOF MS. Antifungal susceptibility was initially analyzed by the VITEK 2 system (AST-YS08 card) and confirmed by the CLSI protocol. Patient data were collected from the medical records using a structured questionnaire. CPC was recovered from 124 patients over an 18-month period, as follows: C. parapsilosis (83.87%), C. orthopsilosis (13.71%) and C. metapsilosis (2.42%). Antifungal resistance was not detected. The age of the patients with invasive CPC infections ranged from <1 to 18 years, and most of them came from oncology-related sectors, as these patients were more affected by C. parapsilosis. C. orthopsilosis infections were significantly more prevalent in patients from critical care units. Invasive infections caused by different pathogens occurred in 75 patients up to 30 days after the recovery of CPC isolates. Overall, 23 (18.55%) patients died within 30 days of CPC diagnosis. Catheter removal and antifungal therapy were important measures to prevent mortality. COVID-19 coinfection was only detected in one patient.

A non-linear differential equation model of COVID-19 and seasonal influenza co-infection dynamics under vaccination strategy and immunity waning

This study presents a mathematical model of the transmission dynamics of COVID-19 and influenza co-infection. The potential impacts of the influenza vaccine only on the co-infection dynamics and the potential impacts of both vaccines on the co-infection dynamics are thoroughly studied. The basic reproduction number for the two diseases using the next-generation matrix approach and the stability of the sub-model is examined. The model assessed the scenario whereby both diseases’ waning immunity occurs concurrently to check the epidemic peaks. The numerical simulation results show that the diseases would continue to be endemic in the population if the immunity waning rates increase. The epidemic peak can be reduced by increasing vaccination and vaccine efficacy rates. The results show that the COVID-19 contact rate significantly increases the epidemic level more than the co-infection contact rate. A similar result was obtained when it was observed that the COVID-19 post-recovery waning rate has more significant effects on the epidemic peak than the co-infection post-recovery waning rate. A possible reason for this counter-intuitive occurrence is that two infections cannot have the same viral load nor the same within-host competitiveness. This means an infectious co-infected person will transmit the infection with the highest within-host competitiveness. Here, it is suspected that COVID-19 has a within-host competitive advantage over influenza in the co-dynamics.