Co-infections among patients with COVID-19: The need for combination therapy with non-anti-SARS-CoV-2 agents?

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Co-infection has been reported in patients with severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome, but there is limited knowledge on co-infection among patients with coronavirus disease 2019 (COVID-19). The prevalence of co-infection was variable among COVID-19 patients in different studies, however, it could be up to 50% among non-survivors. Co-pathogens included bacteria, such as

  • Streptococcus pneumoniae
  • Staphylococcus aureus
  • Klebsiella pneumoniae
  • Mycoplasma pneumoniae
  • Chlamydia pneumonia
  • Legionella pneumophila
  • Acinetobacter baumannii
  • Candida species
  • Aspergillus flavus
  • viruses such as influenza, coronavirus, rhinovirus/enterovirus, parainfluenza, metapneumovirus, influenza B virus, and human immunodeficiency virus

Influenza A was one of the most common co-infective viruses, which may have caused initial false-negative results of real-time reverse-transcriptase polymerase chain reaction for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Laboratory and imaging findings alone cannot help distinguish co-infection from SARS-CoV-2 infection. Newly developed syndromic multiplex panels that incorporate SARS-CoV-2 may facilitate the early detection of co-infection among COVID-19 patients. By contrast, clinicians cannot rule out SARS-CoV-2 infection by ruling in other respiratory pathogens through old syndromic multiplex panels at this stage of the COVID-19 pandemic. Therefore, clinicians must have a high index of suspicion for coinfection among COVID-19 patients. Clinicians can neither rule out other co-infections caused by respiratory pathogens by diagnosing SARS-CoV-2 infection nor rule out COVID-19 by detection of non-SARS-CoV-2 respiratory pathogens.

After recognizing the possible pathogens causing co-infection among COVID-19 patients, appropriate antimicrobial agents can be recommended.



This would explain why COVID-19 does not resemble a simple virus, just as Lyme disease doesn’t present identically from individual to individual. Lyme/MSIDS is also best treated with combination therapy; however, most regular practitioners follow the antiquated and unscientific CDC treatment guidelines which haven’t worked for over 40 years (which in a nutshell is 21 days of doxycycline for all despite body weight and coinfections).

With each day there seems to be more and more similarities to Lyme/MSIDS in that cases are complex and individual. Medicine needs to acknowledge and embrace this complexity:

This also explains why things like antibiotics and anti-parasitics work.  The pathogen list did not include tick-borne pathogens but should, as undoubtedly many of these people could very well have undiagnosed infections that COVID-19, much like vaccines, can reactivate latent infections: