Influenza co-infection associated with severity and mortality in COVID-19 patients.

BACKGROUND: In COVID-19 patients, undetected co-infections may have severe clinical implications associated with increased hospitalization, varied treatment approaches and mortality. Therefore, we investigated the implications of viral and bacterial co-infection in COVID-19 clinical outcomes. METHODS: Nasopharyngeal samples were obtained from 48 COVID-19 patients (29% ICU and 71% non-ICU) and screened for the presence of 24 respiratory pathogens using six multiplex PCR panels. RESULTS: We found evidence of co-infection in 34 COVID-19 patients (71%). Influenza A H1N1 (n = 17), Chlamydia pneumoniae (n = 13) and human adenovirus (n = 10) were the most commonly detected pathogens. Viral co-infection was associated with increased ICU admission (r = 0.1) and higher mortality (OR 1.78, CI = 0.38-8.28) compared to bacterial co-infections (OR 0.44, CI = 0.08-2.45). Two thirds of COVID-19 critically ill patients who died, had a co-infection; and Influenza A H1N1 was the only pathogen for which a direct relationship with mortality was seen (r = 0.2). CONCLUSIONS: Our study highlights the importance of screening for co-infecting viruses in COVID-19 patients, that could be the leading cause of disease severity and death. Given the high prevalence of Influenza co-infection in our study, increased coverage of flu vaccination is encouraged to mitigate the transmission of influenza virus during the on-going COVID-19 pandemic and reduce the risk of severe outcome and mortality.

COVID-19 in a Three-Year-Old Girl With Total Anomalous Pulmonary Venous Return: A Case Report.

Total anomalous pulmonary venous return (TAPVR) is a rare congenital heart disease (CHD) with an incidence of less than 1%. It is known that coronavirus disease 2019 (COVID-19) has a worse prognosis in those with underlying disorders. Children with congenital heart defects can contract COVID-19 irrespective of their surgical correction status. We report a case of a three-year-old girl with unoperated TAPVR, who presented with respiratory distress, lethargy, and reduced feeding. Reverse transcription polymerase chain reaction (RT-PCR) of nasopharyngeal aspirate came back positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). There was no growth of any other viral or bacterial pathogens. Throughout her admission, she had an overall mild course of the disease and did not need mechanical ventilation. Oxygen was given via nasal cannula to maintain SpO2 in the target range. Chest X-ray (CXR) showed bilateral patchy consolidation while a chest CT with contrast showed significant venous congestion. Her length of hospital stay was 25 days. Infection with SARS-CoV-2 did not cause a critical disease and was not different clinically to any other bacterial or viral infection. The potential risk of further cardiac deterioration in COVID-19 in any CHD should be handled with caution as these children can decompensate rapidly.