COVID-19 and influenza co-infection: Difference between revisions

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Revision as of 13:18, 17 July 2020

COVID-19 Microchapters

Home

Long COVID

Frequently Asked Outpatient Questions

Frequently Asked Inpatient Questions

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating COVID-19 from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography and Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Interventions

Surgery

Primary Prevention

Vaccines

Secondary Prevention

Future or Investigational Therapies

Ongoing Clinical Trials

Case Studies

Case #1

COVID-19 and influenza co-infection On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of COVID-19 and influenza co-infection

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on COVID-19 and influenza co-infection

CDC on COVID-19 and influenza co-infection

COVID-19 and influenza co-infection in the news

Blogs on COVID-19 and influenza co-infection

Directions to Hospitals Treating Psoriasis

Risk calculators and risk factors for COVID-19 and influenza co-infection

For COVID-19 frequently asked inpatient questions, click here

For COVID-19 frequently asked outpatient questions, click here

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

Historical Perspective

  • COVID-19, also called Sever Acute Respiratory Distress Syndrome Coronavirus 2 (SARS-CoV-2) originated in Wuhan, China in late December 2019.
  • It has been declared a global pandemic by the WHO after being caused a significant morbidity and mortality worldwide.
  • Influenza is a highly contagious respiratory acute virus respiratory infection, occurs mainly during the winter, it causes significant morbidity and mortality worldwide.
  • It can be mild or sever, which may result in hospitalization or death.
  • People at high risk of serious complications are young children, elderly, and people with underlying medical conditions.
  • The total number of morbidity and mortality has been declining significantly after the seasonal Influenza vaccine.

Classification

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

Pathophysiology

Causes

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

  • Influenza and COVID-19 are both contagious respiratory illnesses, but they are caused by different viruses. Influenza is caused by infection with influenza viruses and COVID-19 is caused by infection with the coronavirus2 (SARS-CoV-2). Testing may be needed to help confirm a diagnosis because some of the symptoms of flu and COVID-19 are similar. Influenza and COVID-19 share many characteristics, but there are some key differences between the two.


  • This table compares the Influenza and COVID-19: "Similarities and Differences between Flu and COVID-19 | CDC".
Similarities Differences
Signs and symptoms - It can be vary from asymptotic disease to sever symptoms.
  • Common symptoms include:

- Fever/chills, cough, shortness of breath, fatigue, sore throat, runny nose, muscle aches, headache, and gastrointestinal symptoms (vomiting and diarrhea).

- Change in or loss of taste or smell can be a sign of COVID-19.
Incubation period - It takes one or more days for a person to get infected and develop symptoms after the exposure. - It takes longer to develop symptoms in COVID-19 than Influenza.

- The time range can be vary in COVID-19, symptoms can appear early in 2 days or late in 14 days.

- In Influenza, symptoms may develop 2 to 4 days after infection.

Period of Contagiousness - A person can spread the virus for 1 day before the appearance of any symptoms. - The period of contagiousness is longer in COVID-19, a person can spread the virus for about 2 days before having any symptoms and remain contagious for at least 10 days after experience any signs or symptoms.

- Asymptotic or after the symptoms disappeared, It can be contagious for 10 days after testing positive for COVID-19.

- In Influenza, it can be contagious for about 1 day before appear any symptoms.

- Older children and adults can be most contagious during the first 3-4 days, but many remain contagious for 7 days of their illness.

- Infants and immunocompromised patients can be contagious for longer.

How it spreads - Both can spread from person-to-person, people in close contact (within 6 feet) with one another.

- Mainly by droplets from sick people when cough, sneeze, or talk.

- Physical contact or touching their own face, mouth, nose or eye after touching contaminated surfaces or objects.

- Asymptotic or people with very mild symptoms.

- COVID-19 is very contagious among certain populations and age groups than Influenza.

- SARS-CoV-2 virus can cause quickly and easily spread to a lot of people, COVID-19 has been observed to have more superspreading events than Influenza.

High risk groups
  • Highest risk groups to develop severe illness and complications in both COVID-19 and Influenza includes:

- 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
  • Complications in both can include:

- Pneumonia.

- Respiratory failure.

- Acute respiratory distress syndrome (ARDS).

- Sepsis.

- Heart attacks or myocardial infarction (MI).

- Multiple organ failure (renal failure, respiratory failure, shock).

- Worsening of chronic medical conditions.

- Heart, muscle, or brain tissues inflammations.

  • COVID-19 can associate with:

- Blood clots in heart, lungs or brain blood vessels.

- Multisystem Inflammatory Syndrome in Children (MIS-C).

Treatment - Supportive medical care to relieve symptoms and complications.
  • COVID-19:

- 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.

  • Influenza:

- 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.

Epidemiology and Demographics

  • All age groups can get affected.
  • It is a pandemic, the countries that got affected most are:
    • China
    • Italy
    • India
    • The United States
    • Brazil

Risk Factors

  • The risk factors are:
    • Immunocompromised ( e.g. chronic infection or cancer patients).
    • It's more common among the workers who works in close contact.
    • It's common among the population who doesn't maintain proper social distancing.
  • To view the COVID-19 risk factors, click here.

Screening

  • There is insufficient evidence to recommend routine screening for COVID-19 and Influenza co-infection.
  • For the prevention and control of infection, on January 24th 2020 Taiwan Centers for Disease Control started testing of SARS-CoV-2 for people suspected with COVID-19. Until February 28th, 2015 cases were screened and 34 of them were diagnosed of COVID-19. During this time, 43 flu-like symptomatic patients were screened in China Medical University Hospital and 2 of them were confirmed to be positive for SARS-CoV-2. [1]
  • To establish the diagnostic protocol for the co-infection of COVID-19 and other respiratory infections like Influenza A and B, they comparatively analyzed the clinical presentations, laboratory data, radiologic findings, and travel and exposure contact histories, of COVID-19 patients who suspected to have other respiratory infections.
  • SARS-CoV-2 detection by real-time reverse transcription polymerase chain reaction (rRT-PCR) and Respiratory pathogens detection by FilmArray™ Respiratory Panel were used for screening.

Natural History, Complications, and Prognosis

  • SARS-CoV-2 and Influenza co-infection has a wide range of clinical presentation, most of the symptoms are similar, the symptoms can be vary from asymptomatic to severe disease (ARDS) which require the ICU admission.
  • The main complications for the patients according to a study conducted in Wuhan, China, were acute respiratory distress syndrome, acute liver injury, and diarrhea. [2]
  • SARS-CoV-2 and Influenza co-infection did not significantly worsen the symptoms and outcomes. [3]

Diagnosis

Diagnostic Study of Choice

  • The diagnosis of COVID-19 and Influenza Co-infection can be established by the following investigations: [3]
    • SARS-CoV-2 detection by real-time reverse transcription polymerase chain reaction (rRT-PCR) from nasopharyngeal swab sample or bronchoalveolar lavage fluid.
    • Respiratory pathogens detection by FilmArray™ Respiratory Panel. [4]
    • Rapid nucleic acid amplification test for influenza A and B.[5]
    • Chest Tomography images showing peripheral and bilateral multiple plaques or nodular ground-glass opacities.[6]

Symptoms

Physical Examination

Laboratory Findings

Imaging studies

  • Chest Tomography images showing peripheral and bilateral ground-glass consolidation peripherally. [7] [8]

Treatment

Medical Therapy

Surgery

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

Primary Prevention

  • The CDC recommends getting the Influenza vaccine, there are multiple FDA-licensed influenza vaccines produced annually to protect against the 3 or 4 influenza viruses.
  • There is currently no vaccine to prevent COVID-19. The best way to prevent infection is to avoid being exposed to the virus by:
    • Washing hands regularly with soap and water for at least 20 seconds or using a hand sanitizer with 60% alcohol.
    • Wearing a cloth face mask and avoid touching eyes, nose, and mouth with unwashed hands.
    • Covering mouth and nose when cough or sneeze.
    • Maintaining 6 feet distance from other people and avoiding close contact.
    • Refraining smoking and other activities that weaken the lungs.
    • Clean and disinfect frequently touched surfaces and objects.

Secondary prevention

  • There are no secondary prevention measures of COVID-19 and Influenza co-infection.
  • The secondary prevention measures of COVID-19 include measures to make sure that an infected individual does not transfer the disease to others.
  • WHO recommends for patients with suspected or confirmed COVID-19 with mild symptoms to stay home and self isolation from other family members at home.
  • To read more about COVID-19 secondary prevention, Click here.

References

  1. Sevilla DC, Wagner NB, Anderson WD, Ideker RE, Reimer KA, Mikat EM; et al. (1990). "Sensitivity of a set of myocardial infarction screening criteria in patients with anatomically documented single and multiple infarcts". Am J Cardiol. 66 (10): 792–5. doi:10.1016/0002-9149(90)90353-3. PMID 2220574.
  2. 2.0 2.1 2.2 Ding Q, Lu P, Fan Y, Xia Y, Liu M (2020). "The clinical characteristics of pneumonia patients coinfected with 2019 novel coronavirus and influenza virus in Wuhan, China". J Med Virol. doi:10.1002/jmv.25781. PMC 7228290 Check |pmc= value (help). PMID 32196707 Check |pmid= value (help).
  3. 3.0 3.1 3.2 Konala VM, Adapa S, Naramala S, Chenna A, Lamichhane S, Garlapati PR; et al. (2020). "A Case Series of Patients Coinfected With Influenza and COVID-19". J Investig Med High Impact Case Rep. 8: 2324709620934674. doi:10.1177/2324709620934674. PMC 7290261 Check |pmc= value (help). PMID 32522037 Check |pmid= value (help).
  4. Hsih WH, Cheng MY, Ho MW, Chou CH, Lin PC, Chi CY; et al. (2020). "Featuring COVID-19 cases via screening symptomatic patients with epidemiologic link during flu season in a medical center of central Taiwan". J Microbiol Immunol Infect. 53 (3): 459–466. doi:10.1016/j.jmii.2020.03.008. PMC 7102665 Check |pmc= value (help). PMID 32220574 : 32220574 Check |pmid= value (help).
  5. Cuadrado-Payán E, Montagud-Marrahi E, Torres-Elorza M, Bodro M, Blasco M, Poch E; et al. (2020). "SARS-CoV-2 and influenza virus co-infection". Lancet. 395 (10236): e84. doi:10.1016/S0140-6736(20)31052-7. PMC 7200126 Check |pmc= value (help). PMID 32423586 Check |pmid= value (help).
  6. Yin S, Peng Y, Ren Y, Hu M, Tang L, Xiang Z; et al. (2020). "The implications of preliminary screening and diagnosis: Clinical characteristics of 33 mild patients with SARS-CoV-2 infection in Hunan, China". J Clin Virol. 128: 104397. doi:10.1016/j.jcv.2020.104397. PMC 7192082 Check |pmc= value (help). PMID 32388472 Check |pmid= value (help).
  7. 7.0 7.1 7.2 D'Abramo A, Lepore L, Palazzolo C, Barreca F, Liuzzi G, Lalle E; et al. (2020). "Acute respiratory distress syndrome due to SARS-CoV-2 and Influenza A co-infection in an Italian patient: Mini-review of the literature". Int J Infect Dis. 97: 236–239. doi:10.1016/j.ijid.2020.06.056. PMC 7301795 Check |pmc= value (help). PMID 32565366 Check |pmid= value (help).
  8. 8.0 8.1 Awadasseid A, Wu Y, Tanaka Y, Zhang W (2020). "Initial success in the identification and management of the coronavirus disease 2019 (COVID-19) indicates human-to-human transmission in Wuhan, China". Int J Biol Sci. 16 (11): 1846–1860. doi:10.7150/ijbs.45018. PMC 7211182 Check |pmc= value (help). PMID 32398954 Check |pmid= value (help).
  9. Konala VM, Adapa S, Gayam V, Naramala S, Daggubati SR, Kammari CB; et al. (2020). "Co-infection with Influenza A and COVID-19". Eur J Case Rep Intern Med. 7 (5): 001656. doi:10.12890/2020_001656. PMC 7213830 Check |pmc= value (help). PMID 32399452 Check |pmid= value (help).