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Case Reports
. 2020 Dec 11;155(11):502-505.
doi: 10.1016/j.medcli.2020.05.022. Epub 2020 Jun 5.

Pneumococcal superinfection in COVID-19 patients: A series of 5 cases

[Article in English, Spanish]
David Cucchiari  1 , Juan M Pericàs  2 , Josep Riera  3 , Roberto Gumucio  4 , Emmanuel Coloma Md  5 , David Nicolás  6 ; Hospital Clínic 4H Team
Affiliations
Case Reports

Pneumococcal superinfection in COVID-19 patients: A series of 5 cases

[Article in English, Spanish]
David Cucchiari et al. Med Clin (Barc). .

Abstract
in English, Spanish

Background: In the context of the COVID-19 pandemic the risk of misdiagnosis of other causes of respiratory infection is likely. In this work we aim to describe the clinical characteristics, treatment and outcome of pneumococcal infection in COVID-19 patients.

Patients and methods: Every COVID-19 patient presenting with concomitant pneumococcal pneumonia during March 2020 in a tertiary teaching Hospital In Barcelona, Spain.

Results: Five patients with PCR confirmed COVID19 or clinical and radiological suspicion were diagnosed of pneumococcal infection. In all cases chest X-ray were abnormal, with unilateral or bilateral infiltrates. Procalcitonin showed to be not sensitive enough to detect pneumococcal infection. Antibiotherapy was promptly started in all five cases with subsequent satisfactory evolution.

Conclusion: International guidelines do not include the universal screening for bacterial co-infection. Radiological pattern of COVID-19 can be indistinguishable from that of pneumococcus pneumonia and frequency of co-infection is not well stablished, therefore clinicians should be aware of the possible SARS-CoV-2-pneumococcus association to avoid misdiagnosis and delay antibiotic therapy.

Introducción: En el contexto de la pandemia por COVID-19 el riesgo de errores en el diagnóstico de otras causas de infección respiratoria es elevado. En este trabajo describimos las características clínicas, el tratamiento y la evolución de los pacientes con coinfección por COVID-19 y neumococo.

Pacientes y métodos: Todos los pacientes con COVID-19 que presentaron neumonía neumocócica durante marzo 2020 en un hospital universitario de Barcelona, España.

Resultados: Cinco pacientes con COVID-19 confirmada por PCR o sospecha radiológica fueron diagnosticados de infección por neumococo. En todos los casos la radiografía de tórax era patológica con infiltrado unilateral o bilateral. La procalcitonina demostró no ser suficientemente sensible para detectar la infección neumocócica. La antibioterapia fue iniciada de manera precoz en los 5 casos con evolución satisfactoria.

Conclusiones: Las guías internacionales no incluyen el cribado universal para coinfección bacteriana. El patrón radiológico del COVID-19 puede ser indistinguible de la neumonía neumocócica, y la frecuencia de la coinfección no ha sido establecida. Los clínicos deben de ser conscientes de la posible asociación de SARS-CoV-2 y neumococo para evitar errores diagnósticos y retrasos en el tratamiento antibiótico.

Keywords: COVID-19; Coinfección; Diagnosis; Diagnóstico; S. pneumoniae; Tratamiento; Treatment; co-infection.

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Figures

Fig. 1
Fig. 1
Chest X-ray in our series show bilateral infiltrates with an interstitial pattern in patients 2, 3 and 5 (image b, c, e) and a more consolidative pattern in patient 4 (image d). In patient 1, the appearance was that of a lobar consolidative pneumonia (image a). Subsequent CT scan of this patient (image f) also revealed ground-glass opacities suggesting organizing pneumonia.
See this image and copyright information in PMC

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