High frequency of co-infection between SARS-CoV-2 and respiratory Adenoviruses in the Pediatric population in Hamadan, Iran

Abstract

Introduction: The presence of other respiratory pathogens in patients with SARS-CoV-2 infection has
been described as a striking feature. However, data on adenovirus co-infection rates and clinical impacts
in COVID-19 patients is limited. The purpose of this study is to compare the prevalence of respiratory
adenoviruses in children under 15 years of age in Positive and Negative SARS-CoV-2 patients.
Methodology: From September 2020 to January 2021, nasopharyngeal swabs were obtained from 280
patients below 15 years old with influenza-like infection symptoms suspected to be COVID-19 and
referred to hospitals in Hamadan province. Nucleic acid was extracted using a High Pure Viral Nucleic
acid extraction kit for both viral RNA and DNA. Reverse transcription real-time PCR for detecting
SARS-CoV-2 and Real-time PCR for Human Adenoviruses were used.
Results: Out of 280 examined samples, 11.7% tested positive for AdV, of which 18 samples originated
from the SARS-CoV-2 positive group and 15 samples were from the SARS-CoV-2 negative group. Of 18
co-infected samples, which were categorized into three different ranges of age including, 0-5, 6-10, and 11-
15 years old were 11, 4, and 3 patients respectively. Also, 14 patients were hospitalized. Compared with
AdV-positive patients, children with Co-infection with SARS CoV-2 had lower levels of white blood cell
(WBC) count while erythrocyte sedimentation rate (ESR) and C-reaction protein (CRP) had increased
levels.
Conclusion: We report a substantial burden of AdV co-infection in pediatric COVID-19 patients. This
the study revealed most AdV infections lead to hospitalization and change in paraclinical parameters.