key: cord-0885600-rs0y48ob
authors: Huang, Allen Chung-Cheng; Huang, Chung-Guei; Yang, Cheng-Ta; Hu, Han-Chung
title: Concomitant Infection with COVID-19 and Mycoplasma Pneumoniae
date: 2020-07-14
journal: Biomed J
DOI: 10.1016/j.bj.2020.07.002
sha: 5d5b8fdd75b505531444650e9b048fdd90017865
doc_id: 885600
cord_uid: rs0y48ob

In late 2019, cases of atypical pneumonia caused by a novel coronavirus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were first reported in Wuhan, China. The disease was officially called coronavirus disease 2019 (COVID-19) and has been declared a pandemic disease by the World Health Organization (WHO). The clinical symptoms may include fever, cough, fatigue, headache, and diarrhea. The radiographic features comprise various presentations, including ground-glass opacities, tiny nodules, and consolidation. However, some atypical pathogens related to community-acquired pneumonia (CAP) may share similar presentations. They may be difficult to distinguish according to the clinical presentation and radiographic findings. Recently, there have been several reports reminding physicians to heed the possibility of co-infection with other pathogens in patients diagnosed with COVID-19. We report a COVID-19 patient co-infected with Mycoplasma pneumoniae who recovered well after combination therapy. We propose that all COVID-19 patients should undergo a meticulous screening routine to ensure that they receive adequate treatments.

In late 2019, several cases of atypical pneumonia were caused by a novel coronavirus 2 called SARS-CoV-2, which was first reported in Wuhan, China. It later spread worldwide in 3 the next few months. COVID-19 was declared a pandemic disease by the World Health 4

Organization (WHO) on March 11, 2020[1]. The clinical presentations of the disease are 5 diverse and may be asymptomatic, mimic the common cold, involve severe pneumonia, or 6 even deteriorate to acute respiratory distress syndrome (ARDS). 7

According to recent reports, the initial presentation includes fever, cough, fatigue, 8 headache, and diarrhea [2, 3] .The radiographic features may also have a wide variety of 9

presentations ranging from ground glass opacities to tiny nodules and consolidation [4] . 10

However, the community-acquired pneumonia (CAP) caused by atypical pathogens may 11 present similarly to COVID-19, and it may be challenging to distinguish them based on Chest radiography at presentation indicated mildly increased infiltrations in both lungs 8 ( Figure 1A ). Routine laboratory and serology tests were performed, including influenza (ICU), and the ICU mortality rate was 29.4% [8] . In terms of image findings, the most common features in chest radiographs of COVID-1 19 pneumonia include ground-glass opacities, bilateral or local patchy shadowing, and 2 interstitial abnormalities [3, 9] . In chest radiographs of mycoplasma pneumonia, the most 3 common patterns are peribronchial and perivascular interstitial infiltrates, airspace 4 consolidation, and nodular opacification [10, 11] . In HRCT, the most common features 5 reported for COVID-19 pneumonia are bilateral and subpleural areas of ground-glass 6 opacification, consolidation affecting the lower lobes, or both[4, 12-14]. 7

One study analyzed the HRCT patterns in 28 patients with mycoplasma pneumonia, and 8 the most common patterns were ground glass attenuation (86%) and airspace consolidation 9 (79%) [10].Thus, based on the current findings and previous reports, it may be difficult to 10 distinguish between the two diseases using chest radiographs and HRCT. Indeed, the HRCT 11 of our patient exhibited features resembling both COVID-19 and mycoplasma pneumonia. number of COVID cases, the presence of mycoplasma coinfection could be easily overlooked. 25 7 We have reported a patient who presented with non-specific symptoms, including general 1 malaise and dry cough, and there was no lymphopenia. Further testing confirmed the co-2 infection with SARS-CoV-2 and M. pneumoniae, and there was good recovery after 3 combination therapy. Therefore, every COVID-19 patient should undergo a meticulous 4 screening routine to ensure that adequate treatment is provided. 

The authors declare that they have no competing interests. 

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