key: cord-289088-7uoia564 authors: Ding, Qiang; Lu, Panpan; Fan, Yuhui; Xia, Yujia; Liu, Mei title: The clinical characteristics of pneumonia patients coinfected with 2019 novel coronavirus and influenza virus in Wuhan, China date: 2020-03-30 journal: J Med Virol DOI: 10.1002/jmv.25781 sha: doc_id: 289088 cord_uid: 7uoia564 The outbreak of 2019 novel coronavirus (COVID‐19) infection emerged in Wuhan, China, in December 2019. Since then the novel coronavirus pneumonia disease has been spreading quickly and many countries and territories have been affected, with major outbreaks in China, South Korea, Italy, and Iran. Influenza virus has been known as a common pathogen in winter and it can cause pneumonia. It was found clinically that very few patients were diagnosed with both COVID‐19 and influenza virus. A total of 5 of the 115 patients confirmed with COVID‐19 were also diagnosed with influenza virus infection, with three cases being influenza A and two cases being influenza B. In this study, we describe the clinical characteristics of those patients who got infected with COVID‐19 as well as influenza virus. Common symptoms at onset of illness included fever (five [100%] patients), cough (five [100%] patients), shortness of breath (five [100%] patients), nasal tampon (three [60%] patients), pharyngalgia (three [60%] patients), myalgia (two [40%] patients), fatigue (two [40%] patients), headache (two [40%] patients), and expectoration (two [40%] patients). The laboratory results showed that compared to the normal values, the patients' lymphocytes were reduced (four [80%] patients), and liver functions alanine aminotransferase and aspartate aminotransferase (two [40%] patients and two [40%] patients) and C‐reactive protein (four [80%] patients) were increased when admitted to hospital. They stayed in the hospital for 14, 30, 17, 12, and 19 days (28.4 ± 7.02), respectively. The main complications for the patients were acute respiratory distress syndrome (one [20%] patients), acute liver injury (three [60%] patients), and diarrhea (two [40%] patients). All patients were given antiviral therapy (including oseltamivir), oxygen inhalation, and antibiotics. Three patients were treated with glucocorticoids including two treated with oral glucocorticoids. One of the five patients had transient hemostatic medication for hemoptysis. Fortunately, all patients did not need intensive care unit and were discharged from the hospital without death. In conclusion, those patients with both COVID‐19 and influenza virus infection did not appear to show a more severe condition because based on the laboratory findings, imaging studies, and patient prognosis, they showed similar clinical characteristics as those patients with COVID‐19 infection only. However, it is worth noting that the symptoms of nasal tampon and pharyngalgia may be more prone to appear for those coinfection patients. clinically that very few patients were diagnosed with both COVID-19 and influenza virus. A total of 5 of the 115 patients confirmed with COVID-19 were also diagnosed with influenza virus infection, with three cases being influenza A and two cases being influenza B. In this study, we describe the clinical characteristics of those patients who got infected with COVID-19 as well as influenza virus. [1] [2] [3] [4] [5] Common symptoms at the onset of illness included fever, cough, and fatigue or myalgia. Organ dysfunction included acute respiratory distress syndrome (ARDS), acute cardiac injury, acute liver injury, acute kidney injury, and death could occur in severe cases. [1] [2] [3] [4] Computed tomography (CT) images demonstrated typical radiographic features including ground-glass opacities (GGOs), multifocal patchy consolidation, and/or interstitial changes with a peripheral distribution. 6, 7 Influenza virus, a common virus often occurring in winter as well, appears to be similar to COVID-19 in terms of transmission characteristics. 8, 9 The common clinical manifestations of patients with influenza virus included fever, cough, rhinitis, sore throat, headache, dyspnea, myalgia, and radiographic evidence of pneumonia, which are similar to those of COVID-19 patients. 9,10 The typical chest CT presentations for influenza virus pneumonia are also similar to those for COVID-19, including GGO, consolidation, and pleural effusion. 11, 12 In the clinic, we found that a few patients diagnosed with COVID-19 were also infected with the influenza virus. However, to the best of our knowledge, the clinical characteristics of patients who were coinfected with COVID-19 and influenza virus have not been discussed, and that is the focus of this study. The patients who were both infected with the influenza virus and COVID-19 were enrolled from Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology. These case series were approved by the Ethics Commission of Tongji Hospital. Oral consent was obtained from each patient. We always followed the most up-to-date version of the guidelines of diagnosis and treatment of pneumonitis caused by the novel coronavirus, which were promulgated by the National Health Commission of China. Therefore, multiple versions including the fourth, the fifth, and the sixth have been used for these 115 patients. 13 The influenza virus diagnosis in this study was built on the serology. Medical history, clinical symptoms, laboratory findings, chest CT scans, and treatment and outcomes data were obtained with standardized data collection forms. The collected data were also independently reviewed and checked by two reviewers. To minimize the recall and sampling deviations is to communicate with the patients effectively and double-check with them. The data were analyzed using the IBM SPSS, version 19 (SPSS Inc, Chicago, IL) and GraphPad Prism version 5.00 (GraphPad Software, La Jolla). All statistical data were presented as meaning ± SEM. In this study, we found that 5 patients also got infected with the influenza virus among 115 inpatients confirmed with COVID-19 infection, an incidence rate of about 4.35%. Three cases infected with influenza A virus (60%), and the other two cases infected with influenza B virus (40%) among the five patients. The clinical characteristics of patients at admission are given in Table 1 . The age of these five patients (two males and three females) ranged from 39 to 66 years (50.20 ± 9.83). The past medical history of each patient is also shown in Table 1 . Table 3 . We found that only one of five patients had T A B L E 1 Clinical characteristics of patients infected with COVID-19 and influenza virus when admitted to hospital Signs and symptoms patients) had diarrhea during the treatment period. All patients were treated using antiviral therapy (including oseltamivir), oxygen inhalation, and antibiotics ( infection. 3 the therapy methods, the patients did not receive invasive ventilator, extracorporeal membrane oxygenation treatment, and ICU care. All patients were given oxygen inhalation, plus oseltamivir and other antiviral drugs. All the patients in this study received antibacterial agents. All patients recovered and were discharged without death. On one hand, this study showed that the clinical characteristics of patients with both COVID-19 and influenza virus infection were similar to those of COVID-19 infection, but the symptoms of nasal tampon and pharyngalgia may be more prone to appear, which would be more convinced when more cases included. According to the laboratory findings, imaging studies, and patient prognosis, those coinfection patients did not appear to experience a more severe situation. To the best of our knowledge, this is the first time that a comparison of the clinical manifestation between the coinfection patients and the patients infected with COVID-19 only. It is noted that additional cases and more clinical information will enable making more comprehensive and solid conclusions. On the other hand, the report reminded us that it is critical to pay attention to the potential coinfection with other respiratory viruses for the COVID-19 infection patients, which effectively helps us to prevent the aggravation of disease progression and even death for patients. We cannot ignore COVID-19 infection patients might combine with other respiratory viruses, not just the influenza virus, to make sure that we could provide the best and the most comprehensive treatment to the patients. This study is supported by the National Natural Science Foundation of China (No. 81572422, 81700515). A novel coronavirus from patients with pneumonia in China Clinical features of patients infected with 2019 novel coronavirus in Wuhan Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China Clinical characteristics of coronavirus disease 2019 in China Correlation of chest CT and RT-PCR testing in coronavirus disease 2019 (COVID-19) in China: a report of 1014 cases CT imaging features of 2019 novel coronavirus (2019-nCoV) Pattern of early human-to-human transmission of Wuhan Recent advances in the detection of respiratory virus infection in humans Clinical characteristics and severity of influenza infections by virus type, subtype, and lineage: a systematic literature review. Influenza Other Respir Viruses Spectrum of clinical and radiographic findings in patients with diagnosis of H1N1 and correlation with clinical severity Human metapneumovirus infection: diagnostic impact of radiologic imaging Notice on the issuance of a program for the diagnosis and treatment of novel coronavirus (2019-nCoV) infected pneumonia (fourth trial version to sixth trial version The digestive system is a potential route of 2019-nCov infection: a bioinformatics analysis based on single-cell transcriptomes SARS and MERS: recent insights into emerging coronaviruses Treatment The authors declare that there are no conflict of interests. Mei Liu http://orcid.org/0000-0002-7073-6174