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      Co-infections among patients with COVID-19: the need for combination therapy with non-anti-SARS-CoV-2 agents?

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          Abstract

          Co-infection has been reported in patients with severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome, but there is limited knowledge on co-infection among patients with coronavirus disease 2019 (COVID-19). The prevalence of co-infection was variable among COVID-19 patients in different studies, however, it could be up to 50% among non-survivors. Co-pathogens included bacteria, such as Streptococcus pneumoniae, Staphylococcus aureus, Klebsiella pneumoniae, Mycoplasma pneumoniae, Chlamydia pneumonia , Legionella pneumophila and Acinetobacter baumannii; Candida species and Aspergillus flavus; and viruses such as influenza, coronavirus, rhinovirus/enterovirus, parainfluenza, metapneumovirus, influenza B virus, and human immunodeficiency virus. Influenza A was one of the most common co-infective viruses, which may have caused initial false-negative results of real-time reverse-transcriptase polymerase chain reaction for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Laboratory and imaging findings alone cannot help distinguish co-infection from SARS-CoV-2 infection. Newly developed syndromic multiplex panels that incorporate SARS-CoV-2 may facilitate the early detection of co-infection among COVID-19 patients. By contrast, clinicians cannot rule out SARS-CoV-2 infection by ruling in other respiratory pathogens through old syndromic multiplex panels at this stage of the COVID-19 pandemic. Therefore, clinicians must have a high index of suspicion for coinfection among COVID-19 patients. Clinicians can neither rule out other co-infections caused by respiratory pathogens by diagnosing SARS-CoV-2 infection nor rule out COVID-19 by detection of non-SARS-CoV-2 respiratory pathogens. After recognizing the possible pathogens causing co-infection among COVID-19 patients, appropriate antimicrobial agents can be recommended.

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          Author and article information

          Contributors
          Journal
          J Microbiol Immunol Infect
          J Microbiol Immunol Infect
          Journal of Microbiology, Immunology, and Infection
          Taiwan Society of Microbiology. Published by Elsevier Taiwan LLC.
          1684-1182
          1995-9133
          23 May 2020
          23 May 2020
          Affiliations
          [a ]Department of Internal Medicine, Kaohsiung Veterans General Hospital, Tainan Branch, Tainan
          [b ]Department of Internal Medicine, Cardinal Tien Hospital and School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
          [c ]Departments of Laboratory Medicine and Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
          Author notes
          []Corresponding author. Departments of Laboratory Medicine and Internal Medicine, National Taiwan University Hospital, Number 7, Chung-Shan South Road, Taipei, 100, Taiwan.. hsporen@ 123456ntu.edu.tw
          Article
          S1684-1182(20)30127-4
          10.1016/j.jmii.2020.05.013
          7245213
          32482366
          0d9d58b8-78af-415a-b9ef-bd0a5d54aeb4
          © 2020 Taiwan Society of Microbiology. Published by Elsevier Taiwan LLC.

          Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

          History
          : 15 May 2020
          : 18 May 2020
          Categories
          Article

          co-infection,covid-19,sars-cov-2,influenza viruses
          co-infection, covid-19, sars-cov-2, influenza viruses

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