tetano
Editor, Senior Moderator
PLoS Negl Trop Dis
. 2021 Nov 29;15(11):e0009997.
doi: 10.1371/journal.pntd.0009997. Online ahead of print.
Clinical and virological impact of single and dual infections with influenza A (H1N1) and SARS-CoV-2 in adult inpatients
Jiazhen Zheng[SUP] 1 2 [/SUP], Fengjuan Chen[SUP] 3 [/SUP], Keyi Wu[SUP] 1 [/SUP], Jiancheng Wang[SUP] 4 [/SUP], Furong Li[SUP] 5 [/SUP], Shan Huang[SUP] 6 [/SUP], Jianyun Lu[SUP] 7 [/SUP], Jinghan Huang[SUP] 8 [/SUP], Huamin Liu[SUP] 1 [/SUP], Rui Zhou[SUP] 1 [/SUP], Zhiwei Huang[SUP] 1 [/SUP], Bingyao Meng[SUP] 9 [/SUP], Zelin Yuan[SUP] 1 [/SUP], Xianbo Wu[SUP] 1 [/SUP]
Affiliations
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mimics the influenza A (H1N1) virus in terms of clinical presentation, transmission mechanism, and seasonal coincidence. Comprehensive data for the clinical severity of adult patients co-infected by both H1N1 and SARS-CoV-2, and, particularly, the relationship with PCR cycle threshold (Ct) values are not yet available. All participants in this study were tested for H1N1 and SARS-CoV-2 simultaneously at admission. Demographic, clinical, treatment, and laboratory data were extracted from electronic medical records and compared among adults hospitalized for H1N1 infection, SARS-CoV-2 infection and co-infection with both viruses. Ct values for viral RNA detection were further compared within SARS-CoV-2 and co-infection groups. Score on seven-category ordinal scale of clinical status at day 7 and day 14 were assessed. Among patients with monoinfection, H1N1 infection had higher frequency of onset symptoms but lower incidence of adverse events during hospitalization than SAR-CoV-2 infection (P < 0.05). Co-infection had an increased odds of acute kidney injury, acute heart failure, secondary bacterial infections, multilobar infiltrates and admittance to ICU than monoinfection. Score on seven-category scale at day 7 and day 14 was higher in patients with coinfection than patients with SAR-CoV-2 monoinfection (P<0.05). Co-infected patients had lower initial Ct values (referring to higher viral load) (median 32) than patients with SAR-CoV-2 monoinfection (median 36). Among co-infected patients, low Ct values were significantly and positively correlated with acute kidney injury and ARDS (P = 0.03 and 0.02, respectively). Co-infection by SARS-CoV-2 and H1N1 caused more severe disease than monoinfection by either virus in adult inpatients. Early Ct value could provide clues for the later trajectory of the co-infection. Multiplex molecular diagnostics for both viruses and early assessment of SAR-CoV-2 Ct values are recommended to achieve optimal treatment for improved clinical outcome.
. 2021 Nov 29;15(11):e0009997.
doi: 10.1371/journal.pntd.0009997. Online ahead of print.
Clinical and virological impact of single and dual infections with influenza A (H1N1) and SARS-CoV-2 in adult inpatients
Jiazhen Zheng[SUP] 1 2 [/SUP], Fengjuan Chen[SUP] 3 [/SUP], Keyi Wu[SUP] 1 [/SUP], Jiancheng Wang[SUP] 4 [/SUP], Furong Li[SUP] 5 [/SUP], Shan Huang[SUP] 6 [/SUP], Jianyun Lu[SUP] 7 [/SUP], Jinghan Huang[SUP] 8 [/SUP], Huamin Liu[SUP] 1 [/SUP], Rui Zhou[SUP] 1 [/SUP], Zhiwei Huang[SUP] 1 [/SUP], Bingyao Meng[SUP] 9 [/SUP], Zelin Yuan[SUP] 1 [/SUP], Xianbo Wu[SUP] 1 [/SUP]
Affiliations
- PMID: 34843492
- DOI: 10.1371/journal.pntd.0009997
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mimics the influenza A (H1N1) virus in terms of clinical presentation, transmission mechanism, and seasonal coincidence. Comprehensive data for the clinical severity of adult patients co-infected by both H1N1 and SARS-CoV-2, and, particularly, the relationship with PCR cycle threshold (Ct) values are not yet available. All participants in this study were tested for H1N1 and SARS-CoV-2 simultaneously at admission. Demographic, clinical, treatment, and laboratory data were extracted from electronic medical records and compared among adults hospitalized for H1N1 infection, SARS-CoV-2 infection and co-infection with both viruses. Ct values for viral RNA detection were further compared within SARS-CoV-2 and co-infection groups. Score on seven-category ordinal scale of clinical status at day 7 and day 14 were assessed. Among patients with monoinfection, H1N1 infection had higher frequency of onset symptoms but lower incidence of adverse events during hospitalization than SAR-CoV-2 infection (P < 0.05). Co-infection had an increased odds of acute kidney injury, acute heart failure, secondary bacterial infections, multilobar infiltrates and admittance to ICU than monoinfection. Score on seven-category scale at day 7 and day 14 was higher in patients with coinfection than patients with SAR-CoV-2 monoinfection (P<0.05). Co-infected patients had lower initial Ct values (referring to higher viral load) (median 32) than patients with SAR-CoV-2 monoinfection (median 36). Among co-infected patients, low Ct values were significantly and positively correlated with acute kidney injury and ARDS (P = 0.03 and 0.02, respectively). Co-infection by SARS-CoV-2 and H1N1 caused more severe disease than monoinfection by either virus in adult inpatients. Early Ct value could provide clues for the later trajectory of the co-infection. Multiplex molecular diagnostics for both viruses and early assessment of SAR-CoV-2 Ct values are recommended to achieve optimal treatment for improved clinical outcome.