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mBio ; 12(1)2021 01 08.
Article in English | MEDLINE | ID: covidwho-1066816


In December 2019 a new coronavirus (CoV) emerged as a human pathogen, SARS-CoV-2. There are few data on human coronavirus infections among individuals living with HIV. In this study we probed the role of pneumococcal coinfections with seasonal CoVs among children living with and without HIV hospitalized for pneumonia. We also described the prevalence and clinical manifestations of these infections. A total of 39,836 children who participated in a randomized, double-blind, placebo-controlled clinical trial on the efficacy of a 9-valent pneumococcal conjugate vaccine (PCV9) were followed for lower respiratory tract infection hospitalizations until 2 years of age. Nasopharyngeal aspirates were collected at the time of hospitalization and were screened by PCR for four seasonal CoVs. The frequency of CoV-associated pneumonia was higher in children living with HIV (19.9%) than in those without HIV (7.6%, P < 0.001). Serial CoV infections were detected in children living with HIV. The case fatality risk among children with CoV-associated pneumonia was higher in those living with HIV (30.4%) than without HIV (2.9%, P = 0.001). C-reactive protein and procalcitonin levels were elevated in 36.8% (≥40 mg/liter) and 64.7% (≥0.5 ng/ml), respectively, of the fatal cases living with HIV. Among children without HIV, there was a 64.0% (95% CI: 22.9% to 83.2%) lower incidence of CoV-associated pneumonia hospitalizations among PCV9 recipients compared to placebo recipients. These data suggest that Streptococcus pneumoniae infections might have a role in the development of pneumonia associated with endemic CoVs, that PCV may prevent pediatric CoV-associated hospitalization, and that children living with HIV with CoV infections develop more severe outcomes.IMPORTANCE SARS-CoV-2 may cause severe hospitalization, but little is known about the role of secondary bacterial infection in these severe cases, beyond the observation of high levels of reported inflammatory markers, associated with bacterial infection, such as procalcitonin. We did a secondary analysis of a double-blind randomized trial of PCV to examine its impact on human CoV infections before the pandemic. We found that both children living with and without HIV randomized to receive PCV had evidence of less hospitalization due to seasonal CoV, suggesting that pneumococcal coinfection may play a role in severe hospitalized CoV infections.

AIDS-Related Opportunistic Infections/prevention & control , Coronavirus Infections/prevention & control , Pneumococcal Vaccines/administration & dosage , Pneumonia, Viral/prevention & control , Streptococcus pneumoniae/immunology , AIDS-Related Opportunistic Infections/epidemiology , AIDS-Related Opportunistic Infections/pathology , Coinfection/epidemiology , Coinfection/microbiology , Coinfection/prevention & control , Coinfection/virology , Coronavirus/classification , Coronavirus/isolation & purification , Coronavirus Infections/epidemiology , Coronavirus Infections/pathology , Follow-Up Studies , Hospitalization/statistics & numerical data , Humans , Incidence , Infant , Pneumonia, Pneumococcal/epidemiology , Pneumonia, Pneumococcal/prevention & control , Pneumonia, Viral/epidemiology , Prevalence , Randomized Controlled Trials as Topic
Clin Med (Lond) ; 20(6): 590-592, 2020 11.
Article in English | MEDLINE | ID: covidwho-927855


While clinical environments are highly focused on COVID-19, reports of missed or delayed treatment for conditions that imitate COVID-19, such as pneumonia caused by the fungus Pneumocystis jirovecii, are emerging. Given the uncertain spectrum of COVID-19 presentations and variable sensitivity of laboratory tests for SARS-CoV-2, there is a risk that, without a high index of suspicion, alternative aetiologies may be overlooked while pursuing a diagnosis of COVID-19. The British HIV Association has been calling for the inclusion of HIV testing in all patients admitted to hospital with suspected COVID-19. In this article we reflect on the importance of including HIV testing to prevent avoidable morbidity and mortality in our patients.

AIDS-Related Opportunistic Infections , Pneumonia, Pneumocystis , AIDS-Related Opportunistic Infections/diagnosis , AIDS-Related Opportunistic Infections/pathology , AIDS-Related Opportunistic Infections/physiopathology , AIDS-Related Opportunistic Infections/therapy , COVID-19 , Coronavirus Infections , Diagnosis, Differential , Fatal Outcome , Humans , Lung/diagnostic imaging , Lung/pathology , Male , Middle Aged , Pandemics , Pneumocystis carinii , Pneumonia, Pneumocystis/diagnosis , Pneumonia, Pneumocystis/pathology , Pneumonia, Pneumocystis/physiopathology , Pneumonia, Pneumocystis/therapy , Pneumonia, Viral