Viral reactivations and co-infections in COVID-19 patients: a systematic review.

Abstract

Background Viral reactivations and co-infections have been reported among COVID-19 patients. However, studies on the clinical outcomes of diferent viral reactivations and co-infections are currently in limit. Thus, the primary pur‑ pose of this review is to perform an overarching investigation on the cases of latent virus reactivation and co-infection in COVID-19 patients to build collective evidence contributing to improving patient health. The aim of the study was to conduct a literature review to compare the patient characteristics and outcomes of reactivations and co-infections of diferent viruses. Methods Our population of interest included confrmed COVID-19 patients who were diagnosed with a viral infec‑ tion either concurrently or following their COVID-19 diagnosis. We extracted the relevant literature through a system‑ atic search using the key terms in the online databases including the EMBASE, MEDLINE, Latin American Caribbean Health Sciences Literature (LILACS), from inception onwards up to June 2022. The authors independently extracted data from eligible studies and assessed the risk of bias using the Consensus-based Clinical Case Reporting (CARE) guidelines and the Newcastle–Ottawa Scale (NOS). Main patient characteristics, frequency of each manifestation, and diagnostic criteria used in studies were summarized in tables. Results In total, 53 articles were included in this review. We identifed 40 reactivation studies, 8 coinfection stud‑ ies, and 5 studies where concomitant infection in COVID-19 patients was not distinguished as either reactivation or coinfection. Data were extracted for 12 viruses including IAV, IBV, EBV, CMV, VZV, HHV-1, HHV-2, HHV-6, HHV-7, HHV-8, HBV, and Parvovirus B19. EBV, HHV-1, and CMV were most frequently observed within the reactivation cohort, whereas IAV and EBV within the coinfection cohort. In both reactivation and coinfection groups, patients reported cardiovas‑ cular disease, diabetes, and immunosuppression as comorbidities, acute kidney injury as complication, and lympho‑ penia and elevated D-dimer and CRP levels from blood tests. Common pharmaceutical interventions in two groups included steroids and antivirals. Conclusion Overall, these fndings expand our knowledge on the characteristics of COVID-19 patients with viral reactivations and co-infections. Our experience with current review indicates a need for further investigations on virus reactivation and coinfection among COVID-19 patients.