ABSTRACT
INTRODUCTION: The novel coronavirus SARS-CoV-2 has spread all over the world causing a global pandemic and representing a great medical challenge. Nowadays, there is limited knowledge on the rate of co-infections with other respiratory pathogens, with viral co-infection being the most representative agents. Co-infection with Mycoplasma pneumoniae has been described both in adults and pediatrics whereas only two cases of Chlamydia pneumoniae have been reported in a large US study so far. METHODS: In the present report, we describe a series of seven patients where co-infection with C. pneumoniae (n = 5) or M. pneumoniae (n = 2) and SARS-CoV-2 was detected in a large teaching hospital in Rome. RESULTS AND CONCLUSION: An extensive review of the updated literature regarding the co-infection between SARS-CoV-2 and these atypical pathogens is also performed.
Subject(s)
COVID-19/diagnosis , COVID-19/virology , Chlamydial Pneumonia/diagnosis , Chlamydial Pneumonia/microbiology , Coinfection , Pneumonia, Mycoplasma/diagnosis , Pneumonia, Mycoplasma/microbiology , Adult , Aged , Aged, 80 and over , COVID-19/epidemiology , COVID-19/therapy , Chlamydial Pneumonia/epidemiology , Chlamydial Pneumonia/therapy , Comorbidity , Disease Management , Female , Hospitals, Teaching , Humans , Male , Middle Aged , Pneumonia, Mycoplasma/epidemiology , Pneumonia, Mycoplasma/therapy , Retrospective Studies , Rome/epidemiology , Symptom Assessment , Treatment Outcome , Young AdultABSTRACT
Mycoplasma pneumoniae and Chlamydia pneumoniae are the most common atypical pathogens seen in respiratory infections in children. Currently, the management of atypical pneumonia due to these pathogens is blurry. The clinical features are hardly specific ; it appears that M. pneumoniae respiratory infect ions are associated with chest pain and the absence of wheezing, however, further confirmations are needed. Hoarseness is frequently seen with C. pneumoniae infection. Co-infections with viruses, bacteria or even between M. pneumoniae and C. pneumoniae can be frequent. Infection with either of these bacteria seems to increase the incidence of asthma. PCR appears to be the most sensitive and specific for rapid diagnosis of M. pneumoniae and C. pneumoniae infections, however, it cannot dif ferentiate asymptomatic carriage from infection. Serodiagnosis can be helpful. This requires two serum samples taken with several weeks interval. Macrolides are the classical antibiotics used for treatment of these pathogens. In vivo efficacy of antibiotic treatment of M. pneumoniae remains unclear. Resistance to macrolides in M. pneumoniae treatment has been described. In conclusion, there is still a lack in scientific literature of high level evidences and clear consensus in the management of suspicious infection due to M. pneumoniae and C. pneumoniae.
Les germes atypiques les plus fréquemment rencontrés dans les infections respiratoires chez l'enfant sont Mycoplasma pneumoniae ou Chlamydia pneumoniae. La prise en charge des bronchopneumopathies atypiques à ces deux germes reste actuellement floue. La symptomatologie est pauvre, aucun signe clinique spécifique n'a pu être à ce jour identifié. Il semblerait que les infections respiratoires à M. pneumoniae sont associées à des douleurs thoraciques ou à une absence de wheezing même si cela reste à confirmer. Les infections à C. pneumoniae seraient plus souvent associées à des laryngites. Les co-infections virales, bactériennes ou entre les deux germes atypiques, M. pneumoniae et le C. pneumoniae, ne sont pas rares. Une infection par une de ces deux bactéries augmenterait l'incidence de l'asthme. Le diagnostic par PCR semble être la méthode diagnostique la plus spécifique et la plus sensible, autant pour le M. pneumoniae que pour le C. pneumoniae. Cependant, elle ne permet pas de différencier les infections des portages asymptomatiques. Le diagnostic par sérologie peut être utile mais nécessite deux échantillons à quelques semaines d'intervalle. Les macrolides sont la classe d'antibiotique classiquement utilisées dans le traitement des infections à ces deux germes. L'ef ficacité du traitement antibiotique pour le M. pneumoniae est actuellement remis en doute par certaines études. Des résistances au traitement du M. pneumoniae par macrolide sont décrites. En conclusion, il manque encore de littérature scientifique à hauts niveaux de preuve et de concensus clairs dans la prise en charge des suspicions d'infection à M. pneumoniae et C. pneumoniae.
