Covid-19 and swine flu can coinfect, make diagnosis difficult: Docs

Hyderabad: With the monsoon having set in, doctors do not rule out the possibility of coinfection of Covid-19 and human influenza A (swine flu).

China has already recorded a case of coinfection in which both Covid-19 and swine flu viruses were present making it difficult for the doctors to diagnose the problem. As influenza A is now endemic to Telugu states and Covid-19 likely to become part of the viruses circulating in these parts, doctors observe that both viruses can stay in the same patient, requiring two tests to diagnose cases of coinfection.

In a recent issue of ‘Journal of Emerging Diseases’, published by the Centers for Disease Control and Prevention (CDC) of the US, Chinese doctors have reported a case of coinfection with novel coronavirus (SARS-CoV-2) and novel influenza A virus in an elderly patient with pneumonia.

“The case highlights possible co-detection of known respiratory viruses. We noted low sensitivity of upper respiratory specimens for coronavirus, which could further complicate recognition of the full extent of disease,” the Chinese doctors said in their research publication.

Though India has not yet officially reported coinfection of Covid-19 and swine flu, city doctors point out such a scenario is possible as there are several cases of coinfection regarding diseases like chikungunya and dengue. They also call for simultaneous tests for Covid-19 and influenza A to rule out possible coinfection. Luckily, as both Covid-19 and influenza A do not have medicines for treatment and patients are treated based on symptoms, coinfection may not change the medicare regimen.

“Coinfection with influenza A may be seen in a significant number of patients,” said Dr Suneetha Narreddy, consultant, infectious diseases, Apollo Hospitals. Initially, all samples for Covid-19 were tested for influenza A, she said, adding that if “coinfection exists, then treatment of influenza A can improve Covid-19 outcomes”.

Dr J Anish Anand, expert in internal medicine, however, makes a cautious observation on the coinfection. “Since there are no major case reports throughout the world of Covid-19 and influenza A coinfection, there is no need to panic,” he points out.

Not ruling out the possibility of coinfection, Dr Anish said technically it can take place. “Superinfection of one bug over the other in any patient with low immunity can occur,” he said.

The CDC publication had documented an elderly person, who was hospitalised in China with persistent fever and breathlessness. The doctors took his samples and tested for influenza A and Covid-19. While the test for influenza was positive, he tested negative four times.

Finally, as there was no respite from fever and severe breathlessness, doctors conducted covid-19 tests using a new lab method – mNGS (metagenomic next generation sequencing) and rRT-PCR (real-time reverse transcription-polymerase chain reaction) to diagnose Covid-19 coinfection.