Precautions are Needed for COVID-19 Patients with Coinfection of Common Respiratory Pathogens

  1. Quan-sheng Xing
  2. Guo-ju Li
  3. Yu-han Xing
  4. Ting Chen
  5. Wen-jie Li
  6. Wei Ni
  7. Kai Deng
  8. Ru-qin Gao
  9. Chang-zheng Chen
  10. Yang Gao
  11. Qiang Li
  12. Gui-ling Yu
  13. Jian-ning Tong
  14. Wei Li
  15. Gui-liang Hao
  16. Yue Sun
  17. Ai Zhang
  18. Qin Wu
  19. Zi-pu Li
  20. Si-lin Pan

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Abstract

Background

With the ongoing outbreak of Coronavirus Disease 2019 (COVID-19), infected patients within and beyond the epidemic area, Wuhan, China, showed different epidemiological and clinical characteristics. There is a paucity of data concerning coinfection with other common respiratory pathogens in COVID-19 patients outside of Wuhan.

Methods

We conducted a double-centre study recruiting 68 patients with severe acute respiratory coronavirus 2 (SARS-CoV-2) infection confirmed by nucleic acid testing in Qingdao and Wuhan from January 17 to February 16, 2020. Indirect immunofluorescence was performed to detect the specific IgM antibody against common respiratory pathogens in collected acute phase serum.

Results

Of the 68 patients with SARS-CoV-2 infection, 30 (44.12%) were from Qingdao. The median age of Qingdao and Wuhan patients were 50 (IQR: 37-59) and 31 (IQR: 28-38) years, respectively, and the majority of patients were female in Qingdao (60.00%) and Wuhan (55.26%). Among COVID-19 patients in Qingdao, 24 (80.00%) of them had IgM antibodies against at least one respiratory pathogen, whereas only one (2.63%) of the patients in Wuhan had positive results for serum IgM antibody detection ( P <0.0001). The most common respiratory pathogens detected in Qingdao COVID-19 patients were influenza virus A (60.00%) and influenza virus B (53.33%), followed by mycoplasma pneumoniae (23.33%) and legionella pneumophila (20.00%). While the pattern for coinfection in patients with community-acquired pneumonia in Qingdao was quite different, with a positive rate of only 20.90%.

Interpretation

We reported a large proportion of COVID-19 patients with coinfection of seasonal respiratory pathogens in Qingdao, northeast China, which differed greatly from the patients in Wuhan, central China. Precautions are needed when dealing with COVID-19 patients beyond the epidemic centre who have coinfection with other respiratory pathogens. We highly recommend adding SARS-CoV-2 to routine diagnostic testing in capable hospitals to prevent misdetection of the virus.

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    SciScore for 10.1101/2020.02.29.20027698: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: 10 This study was approved by the Ethics Commission of each participating hospital (QFFLL-KY-2020-11) and written informed consent was obtained from involved patients prior to enrolment.
    Consent: 10 This study was approved by the Ethics Commission of each participating hospital (QFFLL-KY-2020-11) and written informed consent was obtained from involved patients prior to enrolment.
    RandomizationTo test the reliability of pathogen detection method, we randomly selected 16 healthy blood donors and 14 asymptomatic individuals who came to the hospitals in Qingdao for health counselling as the group for quality control (healthy control group).
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.
    Cell Line AuthenticationContamination: 12 IIFA can detect 9 of the common respiratory pathogens including respiratory syncytial virus (RSV), adenovirus (ADV), influenza virus A (IFV-A), influenza virus B (IFV-B), parainfluenza virus (PIV), mycoplasma pneumoniae (MP), chlamydia pneumoniae (CP), legionella pneumophila (LP) and Coxiella burnetii (COX) in a single assay.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    It is notable that there are several limitations of this study. Two critically ill patients and one patient who died in the end were excluded due to lack of aetiological data other than SARS-CoV-2. As of February 16, 2020, there were 60 cases of confirmed SARS-CoV-2 infection in Qingdao, however, we only analysed 30 non-severe cases whose complete aetiological and clinical information was available. The age of patients in Qingdao ranged from 1.5 years to 80 years; whereas patients in Wuhan were all adults as they were medical professional infected through work. Such age difference between the two groups might bring in bias to this study. We performed nucleic acid testing for the confirmation of SARS-CoV-2 infection, while coinfection with other pathogens was detected by serological testing of antibodies. In spite of superior accuracy, PCR-based molecular testing using throat swabs requires more complicated techniques of laboratory personnel with prolonged reporting time, which may not be suitable for emerging cases of SARS-CoV-2.28,29 Thus, we applied rapid testing of aetiological agents by IIF in collected acute phase serum to guide clinical decision making. Since both the hospitals in Qingdao and Wuhan adopted the same protocol for the diagnosis of coinfection, we believe this will not affect the determination of final outcomes. To test the reliability of serum specific IgM detection, we recruited a control group of normal people without clinical symptoms. The low infection...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  2. Version published to 10.1101/2020.02.29.20027698 on medRxiv