Co-infections and secondary infections in patients with COVID-19, with particular reference to fungal infections

From early on in the COVID-19 pandemic, concern was raised about the potential occurrence and subsequent consequences of co-infections, or secondary infections, in patients infected with the SARS-CoV-2 virus. This was based on the knowledge that viral respiratory infections, in particular influenza infections, have been documented to predispose to co-infections/secondary infections and that these associated infections led to an increase in disease severity, as well as mortality; however, it was also recognised that diagnosing these infections was difficult, and standardised diagnostic protocols were not initially available in the pandemic. In addition, several of the initial studies of patients with COVID-19, did not clearly differentiate co-infections from secondary infections. The Centers for Disease Control and Prevention in the United States (US) defines co-infections as additional infections occurring concurrently with the initial (in this case COVID-19) infection, whereas secondary/superinfections were defined as infections that occurred sometime after the initial (in this case COVID-19) infection, the difference being purely temporal. The aim of this manuscript is to review co-infection and secondary infections in patients with COVID-19, with particular emphasis on fungal infections.

South African ESKAPE pathogen antimicrobial resistance landscape post-COVID: Time to reframe the antimicrobial stewardship agenda

The number of A. baumannii complex bloodstream isolates from the private sector increased by more than 100% in the year 2021 (n = 879) in comparison to 2020 and 2019 (n = 430 and 411 respectively). The sustained increase in carbapenem resistance in these isolates is also evident, from 55% in 2019 to 84% in 2021 (averaged meropenem and imipenem resistance). At public sector sentinel sites, the number of A. baumannii complex bloodstream isolates remain an order of magnitude greater with 2363 individual isolates in 2021 and a 87% carbapenem resistance rate (averaged meropenem and imipenem resistance). In 2019 the carbapenem resistance rate was 84%. 

An update on syphilis

Syphilis is a multisystem chronic disease caused by infection with the non-cultivable spirochaete Treponema pallidum subspecies pallidum. It is a sexually transmitted infection and can also be transmitted vertically from mother to child. In 2017, there were an estimated 23,175 new cases of syphilis amongst women aged between 15 and 49 years in South Africa. The National Institute of Communicable Diseases reported that over the time period 1 July 2017 to 31 December 2020 there were a total of 794 clinical notifications of congenital syphilis, and 11,170 rapid plasma reagin (RPR) positive results from children under the age of 2 years. The concerning fact is that over this time period, there was a steady increase in both the number of clinical notifications of congenital syphilis as well as RPR positive tests in children under the age of 2 years. Left untreated, syphilis can have a devastating effect, especially on a pregnancy. In addition, syphilis increases the risk of acquiring and transmitting HIV. Syphilis is still relevant today and should be tested for in patients with appropriate clinical presentations or in at-risk patients.


Health Professions Councils of South Africa


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Infectious Diseases Updates - 2022 Vol 11 no 3