key: cord-303023-rwfiug2c
authors: Toombs, Jessica; Van den Abbeele, Koenraad; Democratis, Jane; Mandal, Amit K J; Missouris, Constantinos G
title: Pneumococcal co‐infection in Covid‐19 patients
date: 2020-07-08
journal: J Med Virol
DOI: 10.1002/jmv.26278
sha: 
doc_id: 303023
cord_uid: rwfiug2c

We would like to report our experience of 2 patients co‐infected with Streptococcus pneumoniae (S. pneumoniae) and coronavirus disease 2019 (Covid‐19) in the United Kingdom. This article is protected by copyright. All rights reserved.

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It is well established that seasonal viral respiratory tract infections have been linked to increased risk of bacterial co-infection [1] and current evidence suggests that the This article is protected by copyright. All rights reserved. We present 2 (0.4%) Covid-19 patients with confirmed S. pneumoniae co-infection, one of whom died. Older adults can respond and present differently (often subclinically) compared to young adults. These are due to differences in physiological and immune responses, which are beyond the scope of our article. Notably, however, it has been argued, although not validated in large sample sizes, that older adults are more prone to bacterial superinfection and that empirical treatment with antibiotics may be justified (8) . In keeping with good medical practice, these should only be continued when there is strong clinical or microbiological evidence of bacterial infection, regardless of Covid-19 test results, and should be de-escalated once the specific organisms are identified. This article is protected by copyright. All rights reserved.

Although these cases might suggest bacterial co-infection is rare and difficult to clinically distinguish from Covid-19, larger studies are required to clarify this. The necessity of microbiological diagnostic testing, perhaps with a panel consisting of multiplex PCR for seasonal respiratory viruses on swab and urinary antigens for S. pneumoniae and Legionella pneumophila alongside blood cultures for characterisation of bacterial co-infections, is highlighted. Emphasis is also laid on the importance of influenza and pneumococcal vaccination. 

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Clinical features of COVID-19 in elderly patients: A comparison with young and middle-aged patients