key: cord-0849870-4jbo1z7g authors: Kim, Zehwan; Lee, Jong Ho title: Coinfection with severe acute respiratory syndrome coronavirus‐2 and other respiratory viruses at a tertiary hospital in Korea date: 2021-07-17 journal: J Clin Lab Anal DOI: 10.1002/jcla.23868 sha: 306543a608aebb3b03627222137757593b4eb6ac doc_id: 849870 cord_uid: 4jbo1z7g BACKGROUND: Studies have reported coinfection of severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2), the cause of coronavirus disease‐2019 (COVID‐19), with other viruses that cause respiratory tract infections (RTIs). We investigated the coinfection rate of SARS‐CoV‐2 and other RTI‐causing viruses, and whether the cycle threshold (Ct) value of a real‐time reverse transcriptase PCR (RT‐PCR) differed when the coinfection occurred during the first wave of COVID‐19 in Daegu, Republic of Korea, in 2020. METHODS: After performing PCR for SARS‐CoV‐2, we additionally tested for the presence of RTI‐causing viruses to check for coinfection. Subsequently, we identified the specific coexisting respiratory viruses and calculated the coinfection rate. In addition, based on the coinfection status, we compared the Ct values obtained from RT‐PCR for SARS‐CoV‐2 in patients who tested positive for COVID‐19 PCR. RESULTS: Of 13,717 patients, 123 had positive results on COVID‐19 PCR testing and six tested positive for an RTI‐causing virus. Thus, the coinfection rate was 4.9%. There were no statistically significant differences in the mean Ct values of SARS‐CoV‐2 RT‐PCR between coinfected and non‐coinfected patients. CONCLUSION: This study computed the coinfection rate of SARS‐CoV‐2 and RTI‐causing viruses and revealed that the mean Ct values in SARS‐CoV‐2 real‐time RT‐PCR did not differ according to the coinfection status. SARS-CoV-2 test has been associated with disease severity and patient mortality. 5 Furthermore, some studies have explored the pathophysiology of SARS-CoV-2 6, 7 as well as the multidisciplinary approaches for COVID-19 management as it affects most organ systems, including cardiovascular, neurological, and hematological systems. [8] [9] [10] Besides SARS-CoV-2, other viral respiratory tract infections (RTIs) also have a detrimental impact on human mortality and morbidity and are one of the leading causes of death. 11 Although most cases of RTIs do not require additional treatment, Coronaviridae, including SARS-CoV-2, Paramyxoviridae, and Picornaviridae, may result in the development of secondary bacterial infections after RTI. Recently, a study promoting an understanding of RTI viruses, including SARS-CoV-2, was published for clinicians. 12 Coinfection of SARS-CoV-2 and other RTI viruses is gaining attention. Several studies have reported the coinfection rates and changes in symptoms, the rate of hospitalization, and the length of hospital stay after coinfection. [13] [14] [15] [16] [17] [18] [19] [20] [21] [22] The first wave of COVID-19 infections occurred in Daegu, Republic of Korea, between February and May 2020. Here, we investigated specific RTI-causing viruses and their possible interactions with SARS-CoV-2. Further, we calculated the coinfection rate and variations in Ct obtained from real-time RT-PCR SARS-CoV-2 tests during the aforementioned period. The flow diagram for subject allocation is shown in Figure 1 The SARS-CoV-2 must be present for the diagnosis of COVID- 19 The continuous variables were compared using Welch's two-sample t test; they were presented as median and interquartile range (IQR). The categorical variables were compared using Pearson's chi-square test or Fisher's exact test; they were presented as total count and percentage. Statistical significance was set at a p-value of 0.05, and p-values less than 0.05 were deemed statistically significant. All statistical analyses were performed using R statistical software version 4.0.3, and graphs were generated using the ggplot2 package in R. 23 During the study period, 13,717 individuals underwent COVID-19 PCR testing, and 123 tested positive. When the RQ assay was performed on the specimens of these 123 individuals, six (4.9%) tested positive and 117 (95.1%) tested negative ( Figure 1 ). To represent 13,594 individuals who tested negative on the COVID-19 PCR test, 100 specimens were randomly selected and analyzed using RQ assay. On analysis, five (5.0%) individuals tested positive and 95 (95.0%) tested negative ( Table 1 ). The percentage of RQ-positive patients did not significantly differ between COVID-19 PCR-positive and -negative individuals. Similarly, the male-to-female sex ratio also did not significantly differ between the two groups. However, the median age of the male and female individuals differed significantly. The Ct values for the target gene, used to determine positivity/ negativity on the Allplex assay, are shown as box plots (Figure 2 ). An array of colonized viruses exists in the supposedly sterile pulmonary environment 24, 25 ; however, the presence of these viruses may not cause an infection. Nevertheless, it is still necessary to detect these respiratory tract viruses to verify the assumption that they may cause a coinfection with SARS-CoV-2. Therefore, we performed RQ assays on patients who underwent SARS-CoV-2 testing for COVID-19. This work was supported by the 2020 Yeungnam University Research Grant. There are no potential conflicts of interest relevant to this article. The authors confirm that the data supporting the findings of this study are available within the article. https://orcid.org/0000-0002-4185-5270 Jong Ho Lee https://orcid.org/0000-0002-6837-838X COVID-19 Weekly Epidemiological Update. World Health Organization Covid-19: UK approves Pfizer and BioNTech vaccine with rollout due to start next week Challenges in ensuring global access to COVID-19 vaccines: production, affordability, allocation, and deployment What is happening with the vaccine rollout? 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