COVID-19 and influenza co-infection: Difference between revisions
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* [[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 [[coronavirus]]2 ([[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. | * [[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 [[coronavirus]]2 ([[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. | ||
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* [[COVID-19]] and [[Influenza]] co-[[infection]] should be differentiated from other [[diseases]] presenting with [[cough]], [[fever]], [[shortness of breath]], and [[tachypnea]]. | |||
* To read more about COVID-19 differential diagnosis, [[COVID-19 differential diagnosis|Click here]] | |||
==Epidemiology and Demographics== | ==Epidemiology and Demographics== | ||
Revision as of 02:52, 20 July 2020
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COVID-19 Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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COVID-19 and influenza co-infection On the Web |
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American Roentgen Ray Society Images of COVID-19 and influenza co-infection |
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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 virus, it causes an acute 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
Pathophysiology
- The pathogenesis of [disease name] is characterized by [feature1], [feature2], and [feature3].
- The [gene name] gene/Mutation in [gene name] has been associated with the development of [disease name], involving the [molecular pathway] pathway.
- On gross pathology, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
- On microscopic histopathological analysis, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
Causes
Disease name] may be caused by [cause1], [cause2], or [cause3].
OR
Common causes of [disease] include [cause1], [cause2], and [cause3].
OR
The most common cause of [disease name] is [cause 1]. Less common causes of [disease name] include [cause 2], [cause 3], and [cause 4].
OR
The cause of [disease name] has not been identified. To review risk factors for the development of [disease name], click here.
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.
- 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 does it spread | - 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 |
- 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 |
- Pneumonia. - 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. |
- Blood clots in heart, lungs or brain blood vessels. |
| 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. |
- COVID-19 and Influenza co-infection should be differentiated from other diseases presenting with cough, fever, shortness of breath, and tachypnea.
- To read more about COVID-19 differential diagnosis, Click here
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 infections 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
- According to a study conducted in Wuhan, China, common symptoms at onset of illness included: [2] [7] [8]
Physical Examination
Laboratory Findings
- Lymphocytopenia (80% of patients)
- Thrombocytopenia
- Elevated liver functions AST, ALT (40%)
- Elevated CRP (80%)
- Elevated ESR (30%)
- Elevated BUN (30%)
- Elevated Creatinine (70%)
- Elevated ferritin (70%)
- Elevated fibrinogen
- Elevated D-dimer
- Elevated interleukin-6
- Elevated lactic acid
- Elevated LDH
- Elevated creatine kinase [2] [9] [3] [7]
Imaging studies
- Chest Tomography images showing peripheral and bilateral ground-glass consolidation peripherally. [7] [8]
Treatment
Medical Therapy
Surgery
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
- ↑ 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.
- ↑ 2.0 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). - ↑ 3.0 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). - ↑ 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). - ↑ 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). - ↑ 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). - ↑ 7.0 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). - ↑ 8.0 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). - ↑ 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).