A case of severe COVID-19 and influenza co-infection
DOI:
https://doi.org/10.14739/2310-1210.2023.5.277452Keywords:
coronavirus disease COVID-19, influenza, viral infection, co-infection, clinic, complications, diagnosis, comorbidity, risk factors, treatmentAbstract
Aim. To analyze a case of severe COVID-19 and influenza co-infection in a 48-year-old female patient.
Materials and methods. The clinical course, specifics of diagnosis and therapy of the 48-year-old patient S., who was treated for severe co-infection of COVID-19 and influenza at Municipal non-profit Enterprise “Regional Infectious Clinical Hospital” Zaporizhzhіa Regional Council from 29.01.2023 to 17.02.2023, were analyzed. The diagnosis of COVID-19 was confirmed by the detection of SARS-CoV-2 Ag in nasopharyngeal swabs by the immunochromatographic method, and the diagnosis of influenza – by the influenza A viral RNA detection by the polymerase chain reaction method. Current regulatory documents were used when examining and treating the patient.
Results. It has been recognized that the unvaccinated 48-year-old female patient was at a risk group due to comorbid pathology (stage 2 hypertension, type 2 diabetes mellitus, grade 2 obesity) developed a severe course of COVID-19 and influenza type A co-infection. The course of co-infection was complicated by severe acute respiratory distress syndrome already on the 6th day of the disease. The diagnosis of COVID-19 was confirmed by a rapid SARS-CoV-2 antigen test. Treatment for COVID-19 was started immediately with the use of remdesivir, dexamethasone, and anticoagulants. However, despite the patient was given the treatment, his condition worsened due to the rapid progression of acute respiratory failure. The presence of clear clinical and laboratory signs of “cytokine storm” required the use of tocilizumab on the 7th day of the disease. Oseltamivir was commenced after receiving laboratory confirmation of influenza A by the PCR method on the 8th day of the disease. A complete etiologic interpretation of the diagnosis made it possible to prescribe a combination antiviral treatment which coupled with the timely additional initiation of tocilizumab, allowed obtaining certain positive dynamics after only five days of treatment with further improvement of the patient’s condition.
Conclusions. Our clinical observation has demonstrated the severe course of COVID-19 and influenza co-infection in the unvaccinated high-risk 48-year-old female patient due to the presence of comorbid pathology. The complete etiologic interpretation of the co-infection has made it possible to prescribe the combination antiviral treatment, which coupled with the additional correction of the immunotropic treatment has enabled to obtain the positive dynamics after only 5 days with further improvement of the patient’s condition
References
Rubin, R. (2020). What Happens When COVID-19 Collides With Flu Season? JAMA, 324(10), 923. https://doi.org/10.1001/jama.2020.15260
Ma, S., Lai, X., Chen, Z., Tu, S., & Qin, K. (2020). Clinical characteristics of critically ill patients co-infected with SARS-CoV-2 and the influenza virus in Wuhan, China. International Journal of Infectious Diseases, 96, 683-687. https://doi.org/10.1016/j.ijid.2020.05.068
Wu, X., Cai, Y., Huang, X., Yu, X., Zhao, L., Wang, F., Li, Q., Gu, S., Xu, T., Li, Y., Lu, B., & Zhan, Q. (2020). Co-infection with SARS-CoV-2 and Influenza A Virus in Patient with Pneumonia, China. Emerging Infectious Diseases, 26(6), 1324-1326. https://doi.org/10.3201/eid2606.200299
Yue, H., Zhang, M., Xing, L., Wang, K., Rao, X., Liu, H., Tian, J., Zhou, P., Deng, Y., & Shang, J. (2020). The epidemiology and clinical characteristics of co-infection of SARS-CoV-2 and influenza viruses in patients during COVID-19 outbreak. Journal of Medical Virology, 92(11), 2870-2873. https://doi.org/10.1002/jmv.26163
Hashemi, S. A., Safamanesh, S., Ghafouri, M., Taghavi, M. R., Mohajer Zadeh Heydari, M. S., Namdar Ahmadabad, H., Ghasemzadeh-Moghaddam, H., & Azimian, A. (2020). Co-infection with COVID-19 and influenza A virus in two died patients with acute respiratory syndrome, Bojnurd, Iran. Journal of Medical Virology, 92(11), 2319-2321. https://doi.org/10.1002/jmv.26014
Kondo, Y., Miyazaki, S., Yamashita, R., & Ikeda, T. (2020). Coinfection with SARS-CoV-2 and influenza A virus. BMJ Case Reports, 13(7), e236812. https://doi.org/10.1136/bcr-2020-236812
Konala, V. M., Adapa, S., Naramala, S., Chenna, A., Lamichhane, S., Garlapati, P. R., Balla, M., & Gayam, V. (2020). A Case Series of Patients Coinfected With Influenza and COVID-19. Journal of Investigative Medicine High Impact Case Reports, 8, 232470962093467. https://doi.org/10.1177/2324709620934674
Kim, D., Quinn, J., Pinsky, B., Shah, N. H., & Brown, I. (2020). Rates of Co-infection Between SARS-CoV-2 and Other Respiratory Pathogens. JAMA, 323(20), 2085. https://doi.org/10.1001/jama.2020.6266
Riabokon, O. V., Pak, K. A., Riabokon, Yu. Yu., Furyk, O. O., & Cherkaskyi, V. V. (2022). Extrapulmonary manifestations of coronavirus disease (COVID-19): current status (a literature review). Zaporozhye medical journal, 24(5), 607-612. https://doi.org/10.14739/2310-1210.2022.5.259096
Stowe, J., Tessier, E., Zhao, H., Guy, R., Muller-Pebody, B., Zambon, M., Andrews, N., Ramsay, M., & Lopez Bernal, J. (2021). Interactions between SARS-CoV-2 and influenza, and the impact of coinfection on disease severity: a test-negative design. International Journal of Epidemiology, 50(4), 1124-1133. https://doi.org/10.1093/ije/dyab081
Olsen, S. J., Winn, A. K., Budd, A. P., Prill, M. M., Steel, J., Midgley, C. M., Kniss, K., Burns, E., Rowe, T., Foust, A., Jasso, G., Merced-Morales, A., Davis, C. T., Jang, Y., Jones, J., Daly, P., Gubareva, L., Barnes, J., Kondor, R., ... Silk, B. J. (2021). Changes in Influenza and Other Respiratory Virus Activity During the COVID-19 Pandemic – United States, 2020–2021. MMWR. Morbidity and Mortality Weekly Report, 70(29), 1013-1019. https://doi.org/10.15585/mmwr.mm7029a1
Sakamoto, H., Ishikane, M., & Ueda, P. (2020). Seasonal Influenza Activity During the SARS-CoV-2 Outbreak in Japan. JAMA, 323(19), 1969. https://doi.org/10.1001/jama.2020.6173
Pawlowski, C., Silvert, E., O'Horo, J. C., Lenehan, P. J., Challener, D., Gnass, E., Murugadoss, K., Ross, J., Speicher, L., Geyer, H., Venkatakrishnan, A. J., Badley, A. D., & Soundararajan, V. (2022). SARS-CoV-2 and influenza co-infection throughout the COVID-19 pandemic: An assessment of co-infection rates, cohort characteristics, and clinical outcomes. PNAS Nexus. https://doi.org/10.1093/pnasnexus/pgac071
He, Z., & Tao, H. (2018). Epidemiology and ARIMA model of positive-rate of influenza viruses among children in Wuhan, China: A nine-year retrospective study. International Journal of Infectious Diseases, 74, 61-70. https://doi.org/10.1016/j.ijid.2018.07.003
Tang, C. Y., Boftsi, M., Staudt, L., McElroy, J. A., Li, T., Duong, S., Ohler, A., Ritter, D., Hammer, R., Hang, J., & Wan, X.-F. (2022). SARS-CoV-2 and influenza co-infection: A cross-sectional study in central Missouri during the 2021-2022 influenza season. Virology. https://doi.org/10.1016/j.virol.2022.09.009
Rezaee, D., Bakhtiari, S., Jalilian, F. A., Doosti-Irani, A., Asadi, F. T., & Ansari, N. (2023). Coinfection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and influenza virus during the COVID-19 pandemic. Archives of Virology, 168(2). https://doi.org/10.1007/s00705-022-05628-y
Lv, Z., Cheng, S., Le, J., Huang, J., Feng, L., Zhang, B., & Li, Y. (2020). Clinical characteristics and co-infections of 354 hospitalized patients with COVID-19 in Wuhan, China: a retrospective cohort study. Microbes and Infection, 22(4-5), 195-199. https://doi.org/10.1016/j.micinf.2020.05.007
Aghbash, P. S., Eslami, N., Shirvaliloo, M., & Baghi, H. B. (2021). Viral coinfections in COVID-19. Journal of Medical Virology, 93(9), 5310-5322. https://doi.org/10.1002/jmv.27102
Chen, N., Zhou, M., Dong, X., Qu, J., Gong, F., Han, Y., Qiu, Y., Wang, J., Liu, Y., Wei, Y., Xia, J., Yu, T., Zhang, X., & Zhang, L. (2020). Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. The Lancet, 395(10223), 507-513. https://doi.org/10.1016/s0140-6736(20)30211-7
Huang, C., Wang, Y., Li, X., Ren, L., Zhao, J., Hu, Y., Zhang, L., Fan, G., Xu, J., Gu, X., Cheng, Z., Yu, T., Xia, J., Wei, Y., Wu, W., Xie, X., Yin, W., Li, H., Liu, M., ... Cao, B. (2020). Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet, 395(10223), 497-506. https://doi.org/10.1016/s0140-6736(20)30183-5
Sullivan, S. J., Jacobson, R. M., Dowdle, W. R., & Poland, G. A. (2010). 2009 H1N1 Influenza. Mayo Clinic Proceedings, 85(1), 64-76. https://doi.org/10.4065/mcp.2009.0588
Antony, S. J., Almaghlouth, N. K., & Heydemann, E. L. (2020). Are coinfections with COVID-19 and influenza low or underreported? An observational study examining current published literature including three new unpublished cases. Journal of Medical Virology, 92(11), 2489-2497. https://doi.org/10.1002/jmv.26167
Downloads
Published
How to Cite
Issue
Section
License
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access)
