COVID-19 and Legionella Co-Infection

Introduction Concurrent infections or co-infections in patients diagnosed with Coronavirus Disease-19 (COVID-19) are not uncommon and predict a pejorative prognosis. A co-infection accounts for 1 out of every 5 cases COVID-19 increases the likelihood adverse health outcomes such as mechanical ventilations, ICU admissions, death. Specifically, Legionella spp. presents additional challenges because its rarity, similar clinical presentation to SARS-CoV-2, poorer without prompt treatment. Cases Presentation Case 1. 62-year-old female presented 3-day history subjective fever worsening shortness breath. Room air saturation (saO2) was 70% improved 100 % on noninvasive positivepressure ventilation (NIPPV). Lung auscultation revealed rales BL. Chest X –Ray (CXR) showed patchy airspace opacities bilaterally (BL), SARS-CoV-2 PCR urine legionella antigen tests were positive. The diagnosis hypoxic respiratory failure secondary pneumonia made. Patient admitted intensive care unit (ICU) managed decadron, remdesivir, one convalescent plasma Azithromycin Legionella. subsequently developed acute distress syndrome (ARDS). ARDS protocol initiated. 13 days after, patient compassionately extubated. 2. 41-year-old male 5-day fever, breath, cough diarrhea. ethanol abuse. SaO2 88% oxygen canula. rhonchi CXR extensive left lung consolidation. Urine test negative, but IgG reactive. Legionnaire disease Despite initial treatment Azithromycin, patient's hypoxia continued worsen requiring NIPPV, ICU. adjunction empiric plasma, remdesivir steroids both clinicals laboratory findings. Discussion illustrated practical managing coinfection. spp overlapping incubation periods presentations complications. In absence treatment, has an intrinsic mortality rate up 80%. As some mitigation strategies, closure businesses, have enhanced conditions proliferation, incidence Co-infection may increase. We recommend clinicians high-indexed suspicion order obtain complete work at patient’s presentation.