Immunopathological similarities between COVID-19 and influenza: Investigating the consequences of Co-infection

Abstract

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been a global public health emergency since December 2019, and so far, more than 980,000 people (until September 24, 2020) around the world have died. SARS-CoV-2 mimics the influenza virus regarding methods and modes of transmission, clinical features, related immune responses, and seasonal coincidence. Accordingly, co-infection by these viruses is imaginable because some studies have reported several cases with SARS-CoV-2 and influenza virus co-infection. Given the importance of the mentioned co-infection and the coming influenza season, it is essential to recognize the similarities and differences between the symptoms, immunopathogenesis and treatment of SARS-CoV-2 and influenza virus. Therefore, we reviewed the virology, clinical features, and immunopathogenesis of both influenza virus and SARS-CoV-2 and evaluated outcomes in cases with SARS-CoV-2 and influenza virus co-infection.

Keywords: COVID-19; Co-infection; Influenza; Pathogenesis; SARS-COV-2.

Fig. 1

Immunopathological similarities between influenza and COVID-19. The similarities between the two viruses are shown. Both infections eventually lead to pathological events and disorders such as fever, inflammation, lymphopenia, coagulation, DIC, gastrointestinal disorders, increased APPs, ARDS, multi-organ failure, and death. However, the severity of these symptoms can vary between the two infectious diseases. (SARS-CoV-2; severe acute respiratory syndrome coronavirus 2, S; spike, N; nucleoprotein, M; membrane, E; envelope), (Influenza, N; neuraminidase, H; hemagglutinin, M; membrane, E; envelope, NP; nucleoprotein), ss RNA; single strain RNA, ACE2; angiotensin-converting enzyme 2, DC-SIGN; dendritic cell-specific intercellular adhesion molecule-3-grabbing non-integrin, APPs; acute phase proteins, ARDS; acute respiratory distress syndrome, DIC; disseminated intravascular coagulation.