key: cord-1000412-mt4dftwj
authors: Gayam, Vijay; Konala, Venu M.; Naramala, Srikanth; Garlapati, Pavani Reddy; Merghani, Mohamed A.; Regmi, Nirajan; Balla, Mamtha; Adapa, Sreedhar
title: Presenting characteristics, comorbidities, and outcomes of patients coinfected with COVID‐19 and Mycoplasma pneumoniae in the USA
date: 2020-05-25
journal: J Med Virol
DOI: 10.1002/jmv.26026
sha: 123f11ab642f91be4fa7d4fc18e850badc2ab20d
doc_id: 1000412
cord_uid: mt4dftwj

Coronavirus disease 2019 (COVID‐19) caused by severe acute respiratory syndrome‐coronavirus 2 (SARS‐CoV‐2) is spreading at a rapid pace, and the World Health Organization declared it as pandemic on 11 March 2020. Mycoplasma pneumoniae is an "atypical" bacterial pathogen commonly known to cause respiratory illness in humans. The coinfection from SARS‐CoV‐2 and mycoplasma pneumonia is rarely reported in the literature to the best of our knowledge. We present a study in which 6 of 350 patients confirmed with COVID‐19 were also diagnosed with M. pneumoniae infection. In this study, we described the clinical characteristics of patients with coinfection. Common symptoms at the onset of illness included fever (six [100%] patients); five (83.3%) patients had a cough, shortness of breath, and fatigue. The other symptoms were myalgia (66.6%), gastrointestinal symptoms (33.3%‐50%), and altered mental status (16.7%). The laboratory parameters include lymphopenia, elevated erythrocyte sedimentation rate, C‐reactive protein, lactate dehydrogenase, interleukin‐6, serum ferritin, and D‐dimer in all six (100%) patients. The chest X‐ray at presentation showed bilateral infiltrates in all the patients (100%). We also described electrocardiogram findings, complications, and treatment during hospitalization in detail. One patient died during the hospital course.

Our study found that 6 patients were coinfected with COVID-19 and mycoplasma among 350 patients infected with COVID-19, with an incidence rate of 1.7%. Among the 350 patients, 30 patients (8.5%) were Hispanics, 10 (2.8%) were Caucasians, 5 (1.5%) were Asians (1.5%), and 305 (87.1%) were African-Americans. The clinical characteristics of the coinfected patients were listed in Table 1 . The age range of these patients was from 39 to 68 years (mean age ± SD = 57 ± 10.6 years). Among the six patients, four were females and two were males. All the patients were African-Americans except for one Hispanic female. Among the comorbidities, hypertension was present in the majority (five patients-83.3%) and congestive heart failure in half (three patients-50%) of the patients. One-third (two patients-33.3%) of the patients had diabetes, hyperlipidemia, and bronchial asthma. Only one patient (16.7%) had a history of malignancy and one patient with end-stage renal disease (ESRD). The body mass index ranged from 22.6 to 40.7 (mean ± SD = 28 ± 6.5). One-third of the patients (two patients-33.3%) are active smokers, and one patient (16.7%) has a history of alcohol intake. Only one patient was taking Angiotensin-converting enzyme inhibitors on admission. The majority of the patients had hypertension, five of them were African-Americans and one of them was morbidly obese.

All the patients had a fever (100%). Cough, shortness of breath, and fatigue were present in the majority (five patients-83.3%).

Two-thirds (four patients-66.6%) had myalgias, half of them (three patients-50%) had nausea, and one-third (two patients-33.3%) had diarrhea and vomiting. Only one patient (16.7%) had altered mental status. The length of the stay ranged from 5 to 11 days, and one patient expired on the fifth day of admission.

The vital signs, EKG, and chest X-ray at presentation were summarized in Table 2 . The temperature ranged from 99.8°F to 103.1°F. The respiratory rate ranged from 18 to 22 breaths per minute. 83.3% of the patients were hypoxic, with one patient needing mechanical ventilation, one patient needing nonrebreather, and three patients needing oxygen delivery by nasal cannula, and two among them needed high flow.

Bilateral infiltrates were present in all the patients on a chest X-ray at presentation (100%), as shown in 

The laboratory parameters for all the patients were summarized in Table 3 .

White cell count was elevated in two patients (33.3%), while all the patients had lymphopenia, and neutrophils were elevated in the majority of the patients (five patients-83.3%). All the patients had a normal platelet count. Out of six patients, only one patient had anemia of chronic disease due to a history of ESRD at admission (16.6%). As there was no drop in hemoglobin/hematocrit for all the T A B L E 2 Vital signs, electrocardiogram (EKG), and chest X-ray at presentation 

The complications that occurred during the hospital course were summarized in Table 4 The medications used for the treatment of patients were listed in Table 5 . All the patients received ceftriaxone for pneumonia, zinc, and vitamin C. About half of them (three patients-50%) received azithromycin or doxycycline with no overlap. Hydroxychloroquine was given to two patients (33.3%), and steroids were given to two patients (33.3%). The patient who died was treated with ceftriaxone, azithromycin, and steroids, but did not receive hydroxychloroquine.

The novel coronavirus SARS-Cov-2 causes fever, cough, and shortness of breath and is spreading at an unrelenting pace daily. The

United States has the highest number of patients infected, and mortality than any other country in the world. 1 SARS-CoV-2 has spike (S) protein that utilizes membrane-bound angiotensinconverting enzyme 2 aided by serine proteases to gain entry into the human cell and cause infection. 8 Abbreviations: Ab, antibody; Ag, antigen; ALT, alanine aminotransferase; AST, aspartate aminotransferase; BNP, brain natriuretic peptide; BUN, blood urea nitrogen; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; IgG, immunoglobulin G; IgM, immunoglobulin M; IL-6, interleukin-6, LDH, lactate dehydrogenase; NA, not applicable; PCR, polymerase chain reaction; PCT, procalcitonin; SARS-COV-2, severe acute respiratory syndrome-coronavirus 2. There is no effective proven therapy for COVID-19 as of now, and supportive care is a vital aspect of care. Many treatment strategies have been utilized like hydroxychloroquine, remdesivir, azithromycin, lopinavir/ritonavir, and tocilizumab. 13, 20 The first-line therapies for M. pneumoniae are macrolides, tetracyclines, and fluoroquinolones. [21] [22] [23] Fortunately, the majority of the patients responded well to the treatment and were discharged from the hospital.

The COVID-19 pneumonia is a serious condition and can be associated with the common respiratory pathogens. This can be dangerous and can result in protracted respiratory symptoms, prolonged ICU stay, morbidity, and mortality if not detected and treated appropriately. The physicians should screen for the common respiratory pathogens with appropriate diagnostic tests.

The authors declare that there are no conflict of interests.

VG, PRG, MAM, and NR were involved in data collection, review, and preparation of the manuscript. VMK, MB, SN, and SA were involved in the analysis of data and final review of the manuscript, the 

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