doi: 10.1016/j.virusres.2020.198005

Abstract

Accumulating evidence shows that microbial co-infection increases the risk of disease severity in humans. There have been few studies about SARS-CoV-2 co-infection with other pathogens. In this retrospective study, 257 laboratory-confirmed COVID-19 patients in Jiangsu Province were enrolled from January 22 to February 2, 2020. They were re-confirmed by real-time RT-PCR and tested for 39 respiratory pathogens. In total, 24 respiratory pathogens were found among the patients, and 242 (94.2 %) patients were co-infected with one or more pathogens. Bacterial co-infections were dominant in all COVID-19 patients, Streptococcus pneumoniae was the most common, followed by Klebsiella pneumoniae and Haemophilus influenzae. The highest and lowest rates of co-infections were found in patients aged 15–44 and below 15, respectively. Most co-infections occurred within 1–4 days of onset of COVID-19 disease. In addition, the proportion of viral co-infections, fungal co-infections and bacterial-fungal co-infections were the highest severe COVID-19 cases. These results will provide a helpful reference for diagnosis and clinical treatment of COVID-19 patients.

Keywords: SARS-CoV-2, COVID-19, RT-PCR, Co-infection

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1. Introduction

Respiratory illness caused by a novel coronavirus was first noted in December of 2019 in Wuhan, Hubei Province, China (Zhu, et al. 2020). The novel coronavirus is now referred to as severe and critical acute respiratory syndrome coronavirus-2 (SARS-CoV-2) by the International Committee on Taxonomy of Viruses (ICTV). The SARS-CoV-2 was transmitted through respiratory tract and could induce pneumonia (Chen, et al. 2020; Chu, et al. 2020). By 6 April, WHO has reported of 1, 210, 956 laboratory-confirmed cases of SARS-CoV-2 infection and 67,594 deaths worldwide (WHO, 2020). The current outbreaks of coronavirus infection remind us that CoVs are still a severe and critical threats to global public health.

There are no proven antiviral therapies or vaccines till now. Thus, the best way to deal with severe and critical infections of SARS-CoV-2 is to control the source of infection, early diagnosis, quarantine and supportive treatments. It is difficult for physicians to distinguish causative agents without a laboratory diagnosis due to the similar clinical presentations of different pathogens. Therefore, the fast and accurate diagnosis of SARS-CoV-2 are particularly important for patients. However, most studies only focused on SARS-CoV-2, while the co-infection with SARS-CoV-2 has been somewhat neglected. Co-infection with certain pathogens may also hinder accurate disease diagnosis. Wang et al. presented the latest status of the SARS-CoV-2 co-infection in China and added details on combined bacterial and fungal infections (Wang, et al. 2020). However, the types of co-infected pathogens and the proportion of co-infection in SARS-CoV-2-positive patients are unclear. In this study, the clinical features of COVID-19 patients were analyzed, then 39 respiratory pathogens in their throat swab were detected by specific real-time RT-PCR. This study will provide a reference for epidemic prevention and clinical treatment in Wuhan and other areas combating this epidemic.