key: cord-0897751-gnphco0f
authors: Ozaras, Resat; Arslan, Ozgur; Cirpin, Rasim; Duman, Habibe
title: Coinfections among COVID-19 patients: A Need for Combination Therapy?
date: 2020-08-18
journal: J Microbiol Immunol Infect
DOI: 10.1016/j.jmii.2020.08.007
sha: f3ed6a8c0d59a4627d0607d8d5d5b198d7c31bc9
doc_id: 897751
cord_uid: gnphco0f

nan

Dear Editor,

We have read the review of Lai et al. 1 about coinfections among COVID-19 patients with great interest. They emphasized that the prevalence of coinfections varies among the studies, while it could be up to 50% among non-survivors. Viral coinfections, especially with influenza are challenging since COVID-19 pandemic coincided with the local circulation of influenza in many countries. Although the measures taken for COVID-19 pandemic, decreased the influenza cases as well (Figure 1 ), influenza is still a health care problem especially for certain risk groups. We have recently reported 6 COVID-19 patients coinfected with influenza and reviewed 28 previously reported cases 2 . A review of 14 studies reporting viral coinfecting respiratory pathogens estimated that 3% of hospitalized COVID-19 patients were also coinfected with another respiratory virus; respiratory syncytial virus (16.9% of detections) being the most prevalent one, followed by influenza A (15.5%) 3 . This analysis also showed that coinfected COVID-19 patients were more likely to die than patients who were not coinfected.

Coinfection of influenza with COVID-19 may change the epidemiologic, clinical and radiologic features (Table 1) . [2] [3] [4] A study from Wuhan, China reported 93 COVID-19 patients, 44 (47.3%) of whom were coinfected with influenza 2 . Although fatality rates between COVID-19 monoinfected (47%) and coinfected (48%) patients were comparable, the critically ill COVID-19 patients with influenza exhibited more severe inflammation and organ injury, and were more prone to cardiac injury. patients confirmed with influenza and confirmed the predilection of peripheral distribution, GGO with consolidation, and bronchiolar wall thickening in COVID-19. Additionally, the study showed that, compared with the influenza group, the COVID-19 group was more likely to have interlobular septal thickening but less likely to have nodules, tree-in-bud sign, and pleural effusion. Thus, thoracic CT may help to distinguish findings of COVID-19 and those of influenza (Table 1) .

Among COVID-19 guidelines, only Canadian and Turkish guidelines recommend adding oseltamivir, a neuraminidase inhibitor. Neuraminidase inhibitors are used in the prophylaxis and treatment of influenza A and B infections. They are ineffective against COVID-19. They reduce the mortality of patients with influenza, especially those admitted to the intensive care unit. The effectiveness of oseltamivir in reducing the mortality of patients with influenza is J o u r n a l P r e -p r o o f related to the timing: the drug was found effective before the onset of respiratory failure. The patients in critical condition who took the drug showed no benefit in improving the disease. Therefore, neuraminidase inhibitors, oseltamivir or zanamivir, should be initiated rapidly when influenza co-infection is considered among COVID-19 patients.

Accumulating data suggest that influenza coinfection is undiagnosed and underestimated and is likely to associate with a higher mortality. Although influenza is decreasing during this pandemic because of the measures, clinicians should keep alert COVID-19 patients with influenza coinfection. Combination therapy (adding oseltamivir) should be considered in COVID-19 patients with CT findings suggesting influenza coinfection and/or when there is local circulation of influenza. 

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

Influenza and COVID-19 Co-infection: Report of 6 cases and review of the Literature

Co-infections in people with COVID-19: a systematic review and meta-analysis

J o u r n a l P r e -p r o o f 

The effectiveness depends on several host factors and on antigenic matches between the vaccine and circulating viruses. It reduces the risk of illness by between 40% and 60% among the overall populationHigher influenza vaccine uptake in the elderly was found to be associated with less COVID-19 deaths.Influenza vaccine may prevent influenza coinfection among COVID-19 patients.