COVID-19 and influenza co-infection

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Zaida Obeidat, M.D.[2]

Synonyms and Keywords:

Overview

In December 2019, a novel coronavirus, known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was identified as the cause of an outbreak of acute respiratory illness in Wuhan, China. Since then, there has been a rapid spread of the virus, leading to a global pandemic of coronavirus disease 2019 (COVID-19). Influenza, commonly known as flu, is an infectious disease of birds and mammals caused by RNA viruses of the biological family Orthomyxoviridae (the influenza viruses). Coronavirus disease 2019 (COVID-19) and Influenza share many characteristics, common symptoms of the co-infection are fever, sore throat, dyspnea, myalgia, cough, headache, fatigue and malaise. [1] [2] [3]

Historical Perspective

Classification

  • There is no established system for the classification of COVID-19 and Influenza co-infection.

Pathophysiology

  • The exact pathogenesis of co-infection with SARS-CoV-2 and Influenza viruses is not fully understood.

Causes

  • Coronavirus disease 2019 (COVID-19) and Influenza co-infection are caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and influenza (A or B) virus.

Differentiating COVID-19 and Influenza co-infection from other Diseases

This table compares the Influenza and COVID-19: "Similarities and Differences between Flu and COVID-19 | CDC".
Similarities between Covid-19 and Influenza infection Differences between Covid-19 and Influenza infection
Signs and symptoms
  • Signs and symptoms can vary from asymptotic (subclinical) to severe symptoms.
Incubation Period
  • It takes one or more days for a person to get infected and develop symptoms after the exposure.
Period of Contagiousness
  • A person can spread the virus for 1 day before the appearance of any symptoms.
How does it spread
  • COVID-19 is very contagious among certain populations and age groups than Influenza.
  • The SARS-CoV-2 virus can quickly and easily spread to a lot of people, COVID-19 has been observed to have more super spreading events than Influenza.
High risk groups

- Elderly.

- People with underlying medical conditions.

- Pregnant[ women.

- School-aged children infected with COVID-19 are at higher risk of Multisystem Inflammatory Syndrome in Children (MIS-C) which is rare but sever complication.

- The risk of complications in Influenza for young healthy children are higher compared to COVID-19.

- Infants and children with underlying medical conditions are at the highest risk for both Influenza and COVID-19.

Complications
Treatment - Supportive medical care to relieve symptoms and complications.

- The National Institute of Health (NIH) has developed guidance on treatment, which will be updated regularly as new evidence on safety and efficacy of drugs come out.

- There are no drugs approved by the FDA to prevent or treat COVID-19.

- Remdesivir (antiviral agent) is available under Emergency Use Authorization (EUA), and being explored as a treatment for COVID-19.

- Hospitalized patients with Influenza or high risk group are recommended to be treated with antiviral drugs.

Vaccine - Vaccines for COVID-19 and Influenza must be approved by the FDA. - There are multiple vaccines to protect against 3 or 4 viruses that cause the Influenza produced annually and approved by the FDA.

- There is no Vaccine to COVID-19 yet but researchers and vaccine developers are working on developing a vaccine to prevent COVID-19.



Diseases Past medical history Symptoms Physical Examination Diagnostic tests Other Findings
Headache Chest pain Wheezing Dyspnea Chest Tenderness Cough Hemoptysis Fever Tachypnea Tachycardia CT/MRI Chest X-ray
COVID-19 and Influenza co-infection
  • Possible exposure to infected individuals.
+/- +/- - + +/- + +/- + + +
  • Chest CT findings: bilateral ground glass consolidations.
  • Chest X-ray: consolidation, peripheral ground glass opacity.
Pneumonia +/- + - + - + - + + +
Chronic obstructive pulmonary disease (COPD) - - + + - + - - + +

Emphysema may show alveolar septal destruction and airspace enlargement (Centrilobular- upper lobe, panlobular- lower lobe) Giant bubbles

Hyperpolarized Helium MRI may show progressively poor ventilation and destruction of lung

Tuberculosis + + - + - + + + + +

Epidemiology and Demographics

  • Patients of all age groups may develop COVID-19 and influenza co-infection.
  • The countries that got affected by the pandemic are:
    • China
    • Italy
    • India
    • The United States
    • Brazil

Risk Factors

Screening

Natural History, Complications, and Prognosis

Diagnosis

Diagnostic Study of Choice

Symptoms

Physical Examination

Laboratory Findings

Common laboratory findings associated with covid-19 and influenza coinfection are:

Imaging studies

Treatment

Medical Therapy

Surgery

  • Surgical intervention is not recommended for the management of COVID-19 and Influenza co-infection.

Primary Prevention

Secondary prevention

References

  1. Merck Manual Home Edition. "Influenza: Viral Infections".
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