Influenza and coronavirus disease 2019 (COVID-19) are both contagious respiratory illnesses, but they are caused by different viruses. COVID-19 pandemic is caused by a novel virus - severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Influenza is an infectious respiratory disease, caused by influenza A and influenza B viruses. We describe the three cases of influenza and COVID-19 co-infection.
Coronavirus disease 2019 (COVID-19) originated in the Huanan South China Seafood Market in Wuhan. It has posed a global health threat. COVID-19 can present with a spectrum of clinical manifestations including fever, myalgia, cough, dyspnea, and less frequently headache, diarrhea, nausea, and vomiting. Although respiratory symptoms predominate, multiple organ dysfunction may also occur with COVID-19. Coagulopathy has been found as a prominent feature of COVID-19 and severe coagulation dysfunction may be associated with poor prognosis [1-3]. Neurological and cardiovascular complications are also common in COVID-19 patients. No effective treatment has yet been established.
The mean age was 59.6 years (range 47-71 years) and 2/3 were female. Two were Hispanic and one was Pilipino. Comorbidities included hypertension and diabetes mellitus. COVID-19 was diagnosed by nasopharyngeal swab reverse-transcription polymerase chain reaction (RT-PCR) and influenza by rapid antigen assay. Two patients had influenza type B and one had influenza type A. The presenting sign and symptoms were cough, fever, shortness of breath and myalgia. Chest X-ray (CXR) and computed tomography (CT) of the case 1 and case 2 are shown in Figure 1A-1D.
CXR of the case 3 is shown in Figure 2.
One patient (case 2) had positive blood culture for Enterococcus faecium. Two patients required intubation during their hospital course. Inflammatory markers (ESR, CRP, IL-6) were elevated in the patients. All three patients were treated with hydroxychloroquine, azithromycin, ceftriaxone for COVID-19 and Oseltamivir for influenza. All were discharged in stable condition. Table 1 summarizes the clinical characteristics of the three patients.
In a metanalysis study, 3% of patients hospitalized with COVID-19 were also co-infected with another respiratory virus; respiratory syncytial virus (RSV) and influenza A being the most common viral pathogens identified . Table 2 summarizes salient differences between the two viruses [4-7].
In conclusion, we report three cases of co-infection of influenza and COVID-19. Health care providers should be aware of this unique situation as both can present with similar symptoms but vary in treatment. Clinicians should have a high index of suspicion in the appropriate clinical scenario. Further studies are needed to determine whether patients who have a concurrent viral infection have a worse prognosis than those in whom SARS-CoV-2 is the only detected pathogen.
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COVID-19 and Influenza Co-Infection: Report of Three Cases
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Human subjects: Consent was obtained by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.
Cite this article as:
Singh B, Kaur P, Reid R, et al. (August 18, 2020) COVID-19 and Influenza Co-Infection: Report of Three Cases. Cureus 12(8): e9852. doi:10.7759/cureus.9852
Received by Cureus: August 03, 2020
Peer review began: August 04, 2020
Peer review concluded: August 07, 2020
Published: August 18, 2020
© Copyright 2020
Singh et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.