Respiratory co-infections: clinical presentations, treatment approaches

S.V. Nikolaeva¹, E.V. Kanner¹, I.D. Kanner², N.M, Lapkin³, A.V. Gorelov^1,4

¹Central Research Institute of Epidemiology of the Russian Federal Service 

for Supervision of Consumer Rights Protection and Human Well-Being, Moscow

²Lomonosov Moscow State University, Moscow

³Yaroslavl State Medical University, Yaroslavl

⁴I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow

Acute respiratory infections (ARIs) are still an important issue. They rank fifth among infectious and parasitic diseases. In Russia, ARIs are included in diseases with the highest economic relevance. Currently, co-infection is of particular importance. This paper addresses hypotheses that explain the role of dysbiosis (associated with the increased count of pathobionts) in the development of inflammation and reduction in epithelial integrity favoring viral invasion into upper airway mucosa. Three scenarios of the interaction of respiratory pathogens between each other (i.e., synergy, antagonism, or indifference), which account for predominant clinical presentations and disease course in co-infection, are described. The paper also discusses some clinical features of flu and SARS-CoV-2-infection and highlights symptoms typical for both disorders, allowing for differential diagnosis. Challenges in treating viral infections of the respiratory tract are accounted for by unreasonably freq uent use of systemic antibiotics that result in poor prognosis, increased risk of adverse reactions, and a growing number of antibiotic-resistant microbial strains. Finally, the use of medications stimulating the production of interferons, the critical element of antiviral defense, is substantiated.

Keywords: respiratory infections, co-infections, pathobionts, flu, SARS-CoV-2, therapy.

For citation: Nikolaeva S.V., Kanner E.V., Kanner I.D. et al. Respiratory co-infections: clinical presentations, treatment approaches. RMJ. 2021;10:21–26.