ABSTRACT
SESSION TITLE: COVID-19 Co-Infections SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/19/2022 12:45 pm - 1:45 pm INTRODUCTION: Over the past 2 years, SARS-CoV-2 has been undergoing research regarding its immunopathology, with its understanding continuously evolving. We present a case of severe respiratory failure from viral co-infection with SARS-CoV-2, parainfluenza virus III, influenza A, and adenovirus. CASE PRESENTATION: A 42-year-old female with no respiratory or immunological comorbidities, was admitted with respiratory failure that progressed within days to severe septic shock and refractory hypoxemia requiring venovenous extracorporeal membrane oxygenation (VV-ECMO). On initial laboratory evaluation, her nasopharyngeal swab sample tested positive for SARS-CoV-2, Parainfluenza virus III, Influenza A, and Adenovirus on our institute's ROCHE PCR detection test. This was then confirmed with an endotracheal sample and a BAL sample, each of which tested positive for the above 4 viruses. The patient had no prior history of lung disease, autoimmune disorder, immunodeficiency, or malignancy. Serum immunoglobulin levels were within normal range, and the patient tested negative for HIV. She was not on any immunomodulators, and had no known contacts with individuals with polyviral infection. Her presentation had been usual, with 6 days of fever, shortness of breath, extreme fatigue, coughing, and diarrhea. She had initially received treatment with remdesivir, tocilizumab, and dexamethasone. But these tests were noted to be positive prior to her receiving any therapies. Her hospital course was complicated by septic shock, refractory hypoxemia, secondary ventilator associated pneumonia, and fungemia, requiring invasive mechanical ventilation, inhaled nitric oxide, vasopressors, broad spectrum antimicrobials, and eventually rescue by VV-ECMO. She slowly recovered over 6 weeks, received a tracheostomy and was discharged to a long-term acute care hospital for continued rehabilitation and weaning from mechanical ventilation. At 1 year follow up, she has made a full recovery with no residual respiratory limitation. DISCUSSION: Co-infection is defined as infection at diagnosis within 7 days of initial primary infection, whereas, secondary infection develops after 7 days. Co-infection of respiratory viruses, though uncommon, has been reported. Their detection has improved with the use of PCR testing. Simultaneous infection of COVID-19 and usual respiratory viruses has also been documented. Effect of co-infection on disease severity is a result of interaction of viruses among themselves and with the host. CONCLUSIONS: COVID-19 research has mainly focused on SARS-CoV-2 effects on the human host, but with it evolving into an endemic, its interaction and co- and superinfection with other pathogens is imperative. Further research into such interactions of SARS-CoV2 are required to help develop preventative and therapeutic measures. Reference #1: Lansbury L, Lim B, Baskaran V, Lim WS. Co-infections in people with covid-19: A systematic review and meta-analysis. SSRN Electronic Journal. 2020. Reference #2: Kim D, Quinn J, Pinsky B, Shah NH, Brown I. Rates of co-infection between SARS-COV-2 and other respiratory pathogens. JAMA. 2020;323(20):2085. Reference #3: DaPalma T, Doonan BP, Trager NM, Kasman LM. A systematic approach to virus–virus interactions. Virus Research. 2010;149(1):1-9. DISCLOSURES: No relevant relationships by Vinita Kusupati No relevant relationships by Jyoti Lenka No relevant relationships by Rachel Tan