Viral coinfections in COVID-19

Abstract

The most consequential challenge raised by coinfection is perhaps the inappropriate generation of recombinant viruses through the exchange of genetic material among different strains. These genetically similar viruses can interfere with the replication process of each other and even compete for the metabolites required for the maintenance of the replication cycle. Due to the similarity in clinical symptoms of most viral respiratory tract infections, and their coincidence with COVID-19, caused by SARS-CoV-2, it is recommended to develop a comprehensive diagnostic panel for detection of respiratory and nonrespiratory viruses through the evaluation of patient samples. Given the resulting changes in blood markers, such as coagulation factors and white blood cell count following virus infection, these markers can be of diagnostic value in the detection of mixed infection in individuals already diagnosed with a certain viral illness. In this review, we seek to investigate the coinfection of SARS-CoV-2 with other respiratory and nonrespiratory viruses to provide novel insights into the development of highly sensitive diagnostics and effective treatment modalities.

Keywords: COVID-19; SARS-CoV-2; diagnosis; mixed infection; viral coinfection; viral respiratory tract infection; virus infection.

Figure 1

Coinfection of COVID‐19 with other viruses. Coinfection of SARS‐CoV‐2 with other respiratory viruses, such as Flu, HRV, hMPV, RSV, and parainfluenza viruses, as well as systemic viruses, such as HIV, HBV, and CMV, can aggravate the clinical symptoms of the disease, increase the migration of inflammatory cells, such as macrophages and neutrophils, to the site of infection, and ultimately elevate the secretion of proinflammatory cytokines in organs infected with specific pathogens. Therefore, these events might lead to a severe form of the disease. In contrast, SARS‐CoV‐2 infection alone may only result in mild or absent clinical symptoms, as is the case with asymptomatic patients. In this respect, identification of coinfection of SARS‐CoV‐2 with other viruses can contribute to the development of novel approaches for the treatment of COVID‐19. CMV, cytomegalovirus; HBV, hepatitis B virus; HIV, human immunodeficiency virus; HRV, human rhinovirus; hMPV, human metapneumovirus; SARS‐CoV‐2, severe acute respiratory Coronavirus 2