Seasonal influenza exhibits similar symptoms to COVID and bacterial infections often appear as superinfections in healthcare settings. It is therefore crucial to determine the difference so as to plan the right line of treatment. This article is the third part of our new series- COVID-19 co-infections where the main focus is the diagnosis and management of bacterial infection, seasonal influenza occurring in tandem with COVID.

For our comprehensive coverage and latest updates on COVID-19 click here.

Co-infection with seasonal influenza and COVID

Management

Numerous investigations have documented co-infection with SARS-CoV-2 and other respiratory viruses. The Respiratory Syncytial Virus (RSV), enteroviruses, and influenza A virus are the most prevalent of these. The impending season may result in an increase in seasonal influenza infections, and there may be cases of coinfection with COVID-19.

Pathogenesis

COVID-19 and influenza share a number of pathogenic characteristics. Both disorders affect the respiratory system and appear in a variety of ways, ranging from ILI to SARI. Pneumonitis is a complication of both illnesses. Both COVID and influenza exhibit the histological manifestations of interstitial inflammation, diffuse alveolar injury, and intra-alveolar oedema, followed by fibrin deposition, hyaline membrane deposition, and leukocyte infiltration of the alveolar septa. Radiographical appearance is also inconclusive, since both illnesses may present with opacities or consolidations.

Both viruses are RNA viruses and share key pathogenic characteristics that finally result in cytokine release and acute respiratory distress syndrome.

Diagnosis

Samples should also be submitted and examined for SARS-CoV-2 and Influenza whenever they are suspected, particularly in locations reporting seasonal influenza infections.

Clinical characteristics

Both infections manifest as a brief febrile illness with fever, cough, and shortness of breath. Similarly, laboratory examinations are ineffective in separating the two, since both demonstrate leucopenia or a normal leucocyte count. When co-infection is suspected, it should be ruled out promptly using an appropriate diagnostic tool in order to commence appropriate specialised care and therefore decrease morbidity and death.

Considerations for certain treatment interventions

Precise therapeutic alternatives and their use in situations of co-infection:

1. The specific treatment regimen prescribed in the COVID clinical management protocol must be followed, depending on the severity of the disease.
2. Along with COVID management, oseltamivir must be taken in the authorised dose for the treatment of influenza.
3. In the event of a seasonal influenza outbreak, blanket treatment with oseltamivir should be considered for all COVID-19 patients.
4. Other forms of supportive treatment should be maintained in accordance with current standards.

Bacterial co-infections and COVID management

There is evidence that a small fraction of COVID-19 patients may have a bacterial coinfection. Patients with co-infections obtained in the community and superinfections acquired in the hospital had poorer outcomes. According to a recent systematic study of co-infections in persons with COVID-19, the most frequently associated pathogens are Mycoplasma pnuemoniae, Psuedomonas aeroginosa, Hemophilus influenzae, and Klebsiella pneumoniae.

It is necessary to examine the prevalence of healthcare-associated infections such as hospital-acquired pneumonia (especially in ICU settings), urinary tract infection, skin/soft tissue infection, and stomach infections.

Antibiotics should not be regularly provided until a clinical suspicion of bacterial illness exists. Consider empiric antibiotic treatment in accordance with the results of the local antibiogram. Collect blood cultures from COVID-19 patients with severe illness as well, ideally prior to initiating antimicrobial medication.

This article is part of our new series on managing COVID-19 coinfections. Stay tuned for a new update every week. To read the first and second parts, click COVID-19 & seasonal illness- Protocol for determining co-infection & Managing dengue with COVID-19: Clinical considerations

Disclaimer- The views and opinions expressed in this article are those of the author's and do not necessarily reflect the official policy or position of M3 India.

The author is a practising super specialist from New Delhi