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Published on: June 5, 2021
Detection of pneumococcus during hospitalization for SARS-CoV-2
Anne Stahlfeld1, Laura R Glick2, Isabel M Ott1
1Department of Epidemiology of Microbial Diseases, Yale School of Public Health, LEPH823, 60 College St, New Haven, CT 06510, United States.
Background:
Infections with respiratory viruses [e.g. influenza and respiratory syncytial virus (RSV)] can increase the risk of severe pneumococcal infections. Likewise, pneumococcal coinfection is associated with poorer outcomes in viral respiratory infection. However, there are limited data describing the frequency of pneumococcus and SARS-CoV-2 coinfection and the role of coinfection in influencing COVID-19 severity. We, therefore, investigated the detection of pneumococcus in COVID-19 inpatients during the early pandemic period.
Methods:
The study included patients aged 18 years and older, admitted to the Yale-New Haven Hospital who were symptomatic for respiratory infection and tested positive for SARS-CoV-2 during March-August 2020. Patients were tested for pneumococcus through culture-enrichment of saliva followed by RT-qPCR (to identify carriage) and serotype-specific urine antigen detection (UAD) assays (to identify presumed lower respiratory tract pneumococcal disease).
Results:
Among 148 subjects, the median age was 65 years; 54.7% were male; 50.7% had an ICU stay; 64.9% received antibiotics; and 14.9% died while admitted. Pneumococcal carriage was detected in 3/96 (3.1%) individuals tested by saliva RT-qPCR. Additionally, pneumococcus was detected in 14/127 (11.0%) individuals tested by UAD, and more commonly in severe than moderate COVID-19 [OR: 2.20; 95% CI: (0.72, 7.48)]; however, the numbers were small with a high degree of uncertainty. None of the UAD-positive individuals died.
Conclusions:
Pneumococcal lower respiratory tract infection (LRTI), as detected by positive UAD, occurred in patients hospitalized with COVID-19. Moreover, pneumococcal LRTI was more common in those with more serious COVID-19 outcomes. Future studies should assess how pneumococcus and SARS-CoV-2 interact to influence COVID-19 severity in hospitalized patients.
Insights
Pneumococcus coinfection was detected in 11% of hospitalized COVID-19 patients, with higher rates in severe cases. This suggests pneumococcal lower respiratory tract infection may worsen COVID-19 severity.
Area of Science:
- Infectious Diseases
- Pulmonology
- Microbiology
Background:
- Viral respiratory infections increase risk of severe pneumococcal infections.
- Pneumococcal coinfection is linked to worse outcomes in viral respiratory infections.
- Limited data exist on Streptococcus pneumoniae and SARS-CoV-2 coinfection and its impact on COVID-19 severity.
Purpose of the Study:
- Investigate the frequency of pneumococcus detection in hospitalized COVID-19 patients during the early pandemic.
- Determine the association between pneumococcal coinfection and COVID-19 severity.
Main Methods:
- Study included 148 adult COVID-19 inpatients admitted to Yale-New Haven Hospital (March-August 2020).
- Pneumococcus detection via saliva RT-qPCR for carriage and urine antigen detection (UAD) assays for lower respiratory tract infection.
- Patients were tested for SARS-CoV-2 positivity and disease severity.
Main Results:
- Pneumococcal carriage detected in 3.1% of patients.
- Pneumococcus detected by UAD in 11.0% of patients, more common in severe COVID-19 (OR: 2.20).
- No UAD-positive patients died, but numbers were small.
Conclusions:
- Pneumococcal lower respiratory tract infection (LRTI) occurs in hospitalized COVID-19 patients.
- Pneumococcal LRTI is more frequent in patients with severe COVID-19 outcomes.
- Further research is needed on the interaction between pneumococcus and SARS-CoV-2 in COVID-19 severity.
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