Suspected triple co-infection with SARS-CoV-2, Legionella pneumophila, and Streptococcus pneumoniae after hot-spring travel: a case report
Abstract
Bacterial co-infection in patients with coronavirus disease 2019 (COVID-19) can complicate diagnosis because of overlapping clinicoradiologic findings among pathogens. We report a case of suspected triple co-infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Legionella pneumophila (L. pneumophila), and Streptococcus pneumoniae (S. pneumoniae) after hot-spring travel in a post-splenectomy patient. A man in his 70s with a history of subtotal esophagectomy and concomitant splenectomy for esophageal cancer was admitted with fever, worsening productive cough, and altered sensorium. He had recently traveled to a hot spring with a group that included his wife, who also developed a fever and was diagnosed with COVID-19. On admission, results of urinary antigen tests for L. pneumophila and S. pneumoniae were positive, a SARS-CoV-2 nucleic acid amplification test was positive, and sputum culture yielded S. pneumoniae. Chest computed tomography revealed multifocal bilateral ground-glass opacities, small bilateral pleural effusions, and relatively well-defined right middle-lobe consolidation with air bronchograms in a peribronchovascular distribution. These microbiological and radiological findings supported a suspected triple co-infection rather than COVID-19 alone. Treatment with remdesivir, ceftriaxone, and levofloxacin was initiated, and the patient’s condition improved, with better oxygenation and decreased inflammatory markers. Remdesivir and ceftriaxone…
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