Journal of Current Biomedical Reports jcbior.com
Volume 2, Number 1, 2021 eISSN: 2717-1906
1
Editorial Letter
COVID-19 and respiratory tract viral co-infections: Choosing the
screening method
Amin Mohsenzadeh1, Hoda Sabati2,*
1Faculty of Science, Islamic Azad University of Ardabil, Iran
2Biotechnology and Biological Science Research Center, Faculty of Science, Shahid Chamran University of Ahvaz, Iran
Keywords: COVID-19, SARS-CoV-2, Diagnostic, Co-infection, Secondary infection
The new pandemic pathogen, severe acute
respiratory syndrome coronavirus 2 (SARS-CoV-2) or
Coronavirus disease 2019 (COVID-19), causes a wide
range of symptoms that differ from mild cold‐like
symptoms to pneumonia and death. This virus has
been an international public health emergency since
December, 2019 due to its high infectious rate. Beyond
the pathogenesis of COVID-19, viral co-infections play
a vital role in the occurrence and development of this
pandemic by increasing the difficulties of diagnosis,
treatment and even the disease symptoms and
mortality. Regarding clinical presentation,
transmission and coincidence this disease is very
similar to Middle East respiratory syndrome (MERS),
severe acute respiratory syndrome (SARS) and
seasonal influenza which makes it difficult to
accurately detect [1-3].
The COVID-19 detection and diagnostic methods
are mainly divided into two groups, a laboratory-based
(such as serological tests, and real-time reverse-
transcriptase polymerase chain reaction (RT-PCR))
and lung computed tomography (CT) scan or chest
radiography. Accuracy of these methods related to
their sensitivity and specificity. Previous studies
showed that only some of them had both sensitivity
and specificity over 50% in detecting SARS-CoV-2
infection. Therefore, the use of appropriate diagnostic
* Corresponding author:
Hoda Sabati, MSc
Biotechnology and Biological Science Research Center,
Faculty of Science, Shahid Chamran University of Ahvaz, Iran
Tel/Fax:+98 922 6092051
Email: h.sabati@yahoo.com
https://orcid.org/0000-0002-4473-7245
Received: January, 03, 2021
Accepted: January, 05, 2021
methods with sufficient accuracy is of particular
importance in screening COVID-19 [4-6].
Several reports indicate that viral interactions
have some effect on the course of infectious diseases.
Therefore, high co-infection rate might be due to the
overlap between the emergence of COVID-19 and
other respiratory viruses. This overlap emphasizes the
importance of the COVID-19 screening methods,
regardless of other positive results for other viruses in
the initial trials [7].
Although co-infection with dual respiratory
viruses is uncommon in adults, but there were cases
have been reported. Previous study showed that
influenza A virus was one of the common viral
pathogens causing co-infection among patients with
COVID-19 which may have caused initial false-
negative results of RT-PCR for SARS-CoV-2 [8]. In a
case report, co-infection of metapneumovirus and
SARS-CoV-2 has been investigated [9]. Huang et al.
reported a unique case of influenza B virus co-infection
with SARS-CoV-2 in Taiwan [10]. Other viruses that
can cause co-infection include: coronavirus,
rhinovirus/enterovirus, respiratory syncytial virus
(RSV), parainfluenza [11-13]. Therefore, it is necessary
to limit the risk of secondary infections by other viruses
that can cause false-negative results for SARS-CoV-2
on screening methods and increase the risk of
https://jcbior.com/
Mohsenzadeh et al.
2
mortality rate in COVID-19 patients. Recognition of
possible viruses causing co-infection among COVID-
19 patients helps clinicians to choose appropriate
screening method, proper management and
therapeutic [7, 14].
Author Contributions
All authors contributed equally to this manuscript,
and approved the final version of manuscripts.
Conflict of Interests
The authors declare that they have no conflicts of
interest.
Ethical declarations
Not applicable.
Financial Support
None to be declared.
References
1. Sharma A, Tiwari S, Deb MK, Marty JL. Severe acute respiratory
syndrome coronavirus-2 (SARS-CoV-2): a global pandemic and
treatment strategies. Int J Antimicrob Agents. 2020;
56(2):106054.
2. Gerges Harb J, Noureldine HA, Chedid G, Eldine MN, Abdallah
DA, Chedid NF, et al. SARS, MERS and COVID-19: clinical
manifestations and organ-system complications: a mini review.
Pathog Dis. 2020; 78(4).
3. Chen X, Liao B, Cheng L, Peng X, Xu X, Li Y, et al. The microbial
coinfection in COVID-19. Appl Microbiol Biotechnol. 2020;
104(18):7777-85.
4. Harahwa TA, Lai Yau TH, Lim-Cooke MS, Al-Haddi S, Zeinah
M, Harky A. The optimal diagnostic methods for COVID-19.
Diagnosis (Berl). 2020; 7(4):349-56.
5. Floriano I, Silvinato A, Bernardo WM, Reis JC, Soledade G.
Accuracy of the Polymerase Chain Reaction (PCR) test in the
diagnosis of acute respiratory syndrome due to coronavirus: a
systematic review and meta-analysis. Rev Assoc Med Bras. 2020;
66(7):880-8.
6. Lisboa Bastos M, Tavaziva G, Abidi SK, Campbell JR, Haraoui
L-P, Johnston JC, et al. Diagnostic accuracy of serological tests for
covid-19: systematic review and meta-analysis. BMJ. 2020;
370:m2516.
7. Khodamoradi Z, Moghadami M, Lotfi M. Co-infection of
Coronavirus Disease 2019 and Influenza A: A Report from Iran.
Arch Iran Med. 2020; 23(4):239-43.
8. Lai CC, Wang CY, Hsueh PR. Co-infections among patients with
COVID-19: The need for combination therapy with non-anti-
SARS-CoV-2 agents? J Microbiol Immunol Infect. 2020;
53(4):505-12.
9. Touzard-Romo F, Tapé C, Lonks JR. Co-infection with SARS-
CoV-2 and Human Metapneumovirus. R I Med J (2013). 2020;
103(2):75-6.
10. Huang BR, Lin YL, Wan CK, Wu JT, Hsu CY, Chiu MH, et al.
Co-infection of influenza B virus and SARS-CoV-2: A case report
from Taiwan. J Microbiol Immunol Infect. 2020. [In press]. doi:
10.1016/j.jmii.2020.06.011.
11. Su IC, Lee KL, Liu HY, Chuang HC, Chen LY, Lee YJ. Severe
community-acquired pneumonia due to Pseudomonas aeruginosa
coinfection in an influenza A(H1N1)pdm09 patient. J Microbiol
Immunol Infect. 2019; 52(2):365-6.
12. Hung HM, Yang SL, Chen CJ, Chiu CH, Kuo CY, Huang KA, et
al. Molecular epidemiology and clinical features of rhinovirus
infections among hospitalized patients in a medical center in
Taiwan. J Microbiol Immunol Infect. 2019; 52(2):233-41.
13. Huang SH, Su MC, Tien N, Huang CJ, Lan YC, Lin CS, et al.
Epidemiology of human coronavirus NL63 infection among
hospitalized patients with pneumonia in Taiwan. J Microbiol
Immunol Infect. 2017; 50(6):763-70.
14. Si Y, Zhao Z, Chen R, Zhong H, Liu T, Wang M, et al.
Epidemiological surveillance of common respiratory viruses in
patients with suspected COVID-19 in Southwest China. BMC
Infect Dis. 2020; 20(1):688.
https://pubmed.ncbi.nlm.nih.gov/32534188/
https://pubmed.ncbi.nlm.nih.gov/32534188/
https://pubmed.ncbi.nlm.nih.gov/32534188/
https://pubmed.ncbi.nlm.nih.gov/32534188/
https://pubmed.ncbi.nlm.nih.gov/32633327/
https://pubmed.ncbi.nlm.nih.gov/32633327/
https://pubmed.ncbi.nlm.nih.gov/32633327/
https://pubmed.ncbi.nlm.nih.gov/32633327/
https://pubmed.ncbi.nlm.nih.gov/32780290/
https://pubmed.ncbi.nlm.nih.gov/32780290/
https://pubmed.ncbi.nlm.nih.gov/32780290/
https://pubmed.ncbi.nlm.nih.gov/32621728/
https://pubmed.ncbi.nlm.nih.gov/32621728/
https://pubmed.ncbi.nlm.nih.gov/32621728/
https://doi.org/10.1590/1806-9282.66.7.880
https://doi.org/10.1590/1806-9282.66.7.880
https://doi.org/10.1590/1806-9282.66.7.880
https://doi.org/10.1590/1806-9282.66.7.880
https://doi.org/10.1590/1806-9282.66.7.880
https://doi.org/10.1136/bmj.m2516
https://doi.org/10.1136/bmj.m2516
https://doi.org/10.1136/bmj.m2516
https://doi.org/10.1136/bmj.m2516
https://pubmed.ncbi.nlm.nih.gov/32271596/
https://pubmed.ncbi.nlm.nih.gov/32271596/
https://pubmed.ncbi.nlm.nih.gov/32271596/
https://pubmed.ncbi.nlm.nih.gov/32482366/
https://pubmed.ncbi.nlm.nih.gov/32482366/
https://pubmed.ncbi.nlm.nih.gov/32482366/
https://pubmed.ncbi.nlm.nih.gov/32482366/
https://pubmed.ncbi.nlm.nih.gov/32192233/
https://pubmed.ncbi.nlm.nih.gov/32192233/
https://pubmed.ncbi.nlm.nih.gov/32192233/
https://pubmed.ncbi.nlm.nih.gov/32646801/
https://pubmed.ncbi.nlm.nih.gov/32646801/
https://pubmed.ncbi.nlm.nih.gov/32646801/
https://pubmed.ncbi.nlm.nih.gov/32646801/
https://pubmed.ncbi.nlm.nih.gov/29958866/
https://pubmed.ncbi.nlm.nih.gov/29958866/
https://pubmed.ncbi.nlm.nih.gov/29958866/
https://pubmed.ncbi.nlm.nih.gov/29958866/
https://pubmed.ncbi.nlm.nih.gov/30201131/
https://pubmed.ncbi.nlm.nih.gov/30201131/
https://pubmed.ncbi.nlm.nih.gov/30201131/
https://pubmed.ncbi.nlm.nih.gov/30201131/
https://pubmed.ncbi.nlm.nih.gov/26746130/
https://pubmed.ncbi.nlm.nih.gov/26746130/
https://pubmed.ncbi.nlm.nih.gov/26746130/
https://pubmed.ncbi.nlm.nih.gov/26746130/
https://pubmed.ncbi.nlm.nih.gov/32957928/
https://pubmed.ncbi.nlm.nih.gov/32957928/
https://pubmed.ncbi.nlm.nih.gov/32957928/
https://pubmed.ncbi.nlm.nih.gov/32957928/