key: cord-1047820-benansqq
authors: Faqihi, Fahad; Alharthy, Abdulrahman; Pirompanich, Pattarin; Noor, Alfateh; Shahzad, Ahmad; Naseem, Nasir; Balhamar, Abdullah; Memish, Ziad A.; Karakitsos, Dimitrios
title: Co-infection of SARS-CoV-2 and Bordetella bronchiseptica in a young man with idiopathic non-cystic bronchiectasis and vitamin D(3) deficiency
date: 2020-08-28
journal: Respir Med Case Rep
DOI: 10.1016/j.rmcr.2020.101203
sha: 3f568d90b991ae56258279deaf85dabdddddfade
doc_id: 1047820
cord_uid: benansqq

This is the first reported case, to our knowledge, of co-infection of Bordetella bronchiseptica and SARS-CoV-2 in a young patient with underlying idiopathic bronchiectasis and vitamin D(3) deficiency that was treated successfully with a combination therapeutic regime integrating doxycycline, empiric therapies for COVID-19, vitamin D supplementation, and supportive ICU care. Large prospective studies are required to investigate further the role of co-infections in COVID-19 patients with bronchiectasis. Randomized control trials should examine the putative beneficial role of vitamin D supplementation in patients with COVID-19.

The novel SARS-CoV-2 disease has affected almost every national health care system in the world [1] . Bacterial co-infection rates in patients with COVID-19 have been reported to be lower compared to flu pandemics in a recent meta-analysis integrating four thousand COVID-19 patients [2] . However, scarce data exist about co-infection rates in COVID-19 patients with underlying lung pathology. Non-cystic bronchiectasis (bronchiectasis) has been remotely identified, mainly in elderly COVID-19 patients, by chest computed tomography (CT) studies [3] [4] [5] [6] [7] [8] . Idiopathic bronchiectasis is a chronic irreversible airway dilatation of unknown underlying causes, which occurs more frequently in younger patients, and accounts for approximately 50% of all bronchiectasis etiologies [9, 10]. Patients with idiopathic bronchiectasis could accumulate thick mucus within their enlarged bronchi making them susceptible to various infectious pathogens. Notably, it has been speculated that vitamin D 3 supplementation may reduce the infection risk in idiopathic bronchiectasis as well as ameliorate the severity of symptoms in COVID-19 [11, 12] . We are briefly presenting a rare co-infection of Bordetella bronchiseptica and SARS-CoV-2 in a young man with underlying idiopathic bronchiectasis and vitamin D 3 deficiency.

In June 2020, a 30 year old man with a past medical history of idiopathic bronchiectasis was admitted to the emergency department (ED) due to recent onset fever (38.6 o C), productive cough, chest pain, dyspnea, and anosmia. The patient has been living alone with his pet dog; however, he had recent contact with his friend who has just recovered from COVID-19. Hence, nasopharyngeal swabs were derived and sent for SARS-CoV-2 testing as per hospital protocol. Physical examination showed bilateral crackles at the lower lobes. The saturation of peripheral oxygen (SpO 2 ) was 65%, on room air, but the patient had no X-ray showed peripheral infiltrates (Fig. 1 ). Soon after, the patient desaturated (SpO 2 : 55%), and thus he was intubated and connected to mechanical ventilation (MV). Nasopharyngeal which were derived on day-1, revealed ≥ 10 5 colony-forming-units (cfu)/ml of Bordetella bronchiseptica that was sensitive to doxycycline [17, 18] . Hence, the antibiotic regime was adjusted accordingly. The patient received doxycycline for approximately two weeks. Also, his serum 25(OH) D levels revealed severe vitamin D deficiency (25 nmol/L, normal: > 50 nmol/L). Thus, the patient received an initial vitamin D 3 bolus dose of 100,000 IU, and thereafter a weekly vitamin D 3 dose of 25,000 IU was prescribed. On day-15, he was extubated. On day-18, RT-PCR for COVID-19 and microbiology were negative. The patient was finally discharged to home isolation twenty days post-ICU admission. He was asked to monitor his pet dog for any symptoms of "kennel cough", and review his vitamin D supplementation prescription as well as his dietary habits with his family physician.

A minority of COVID-19 patients have critical illness characterized by ARDS, sepsis, thromboembolic disease, and multi-system organ failure [19] . An important risk factor for developing critical illness is age of more than 65 year old [20] . Notably, bronchiectasis is an uncommon comorbid disease found in COVID-19 [19, 20] . Our patient was a young healthy man who presented with happy hypoxemia (very low oxygenation without respiratory distress; or type L COVID-19 pneumonia) and cytokine storm [21, 22] .

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