Background
In the setting of a global pandemic, the specter of SARS-CoV-2 infection has understandably dominated the differential diagnosis for respiratory symptoms. However, it is crucial to remember that other respiratory pathogens continue to circulate, potentially leading to varied clinical presentations in patients who share the same exposure or living environment.
Case Presentation
A 36-year-old female (Patient A) and her 10-year-old male son (Patient B) presented to an Urgent Care facility, both with two days of a worsening cough. They reported no known close exposures to individuals diagnosed with COVID-19, but both were recently on vacation in Florida.
Upon assessment, Patient A’s vital signs were within the normal range, except for a low-grade fever of 99.9°F. Her primary complaints were of a persistent cough and a generalized feeling of achiness. In contrast, her son, Patient B, was afebrile. However, he displayed a slightly elevated heart rate of 104 bpm and complained of a slight headache.
Given the present scenario and overlapping symptoms, the initial working diagnosis was an assumption that both mother and son might be infected with SARS-CoV-2.
Investigations
To confirm the diagnosis, anterior nasal swabs were collected from both patients. Under instruction from the provider, Patient A self-collected her sample, while Patient B’s sample was provider-collected to expedite the process.
The collected samples were tested using the Visby Medical Respiratory Health Test, a fully integrated, rapid, automated RT-PCR in vitro diagnostic test intended for the simultaneous qualitative detection and differentiation of SARS-CoV-2, influenza A, and influenza B viral RNA.
Results
30 minutes later, Patient A tested positive for COVID-19, whereas Patient B tested positive for Influenza A. This deviation from the initial hypothesis underscores the importance of comprehensive testing, especially in an era where symptoms of multiple diseases can overlap significantly.
Treatment and Recommendations
Patient A was prescribed a standard dose nirmatrelvir/ritonavir, a COVID-19 antiviral treatment, while Patient B was started on a standard pediatric dose of oseltamivir, an antiviral medication for Influenza A. Given the communicable nature of their respective illnesses, both patients were advised to self-isolate at home. Furthermore, they were educated on the importance of wearing masks, especially around vulnerable family members, to prevent the potential spread of both pathogens.
Discussion
This case emphasizes the critical importance of thorough testing, especially in an environment where presumptive diagnoses can be heavily influenced by prevalent health crises, such as the COVID-19 pandemic. By assuming that shared symptoms in close contacts are due to the same pathogen, clinicians risk overlooking co-circulating infections.
The coexistence of COVID-19 and Influenza A in a mother and son duo, sharing the same environment and having similar symptom onset, reminds clinicians to maintain a broad differential diagnosis. It’s a testament to the fact that while COVID-19 is a dominant concern, other respiratory pathogens are still very much in play.
Conclusion
In the era of the COVID-19 pandemic, while it remains a primary suspect in patients with respiratory symptoms, healthcare providers must continue to approach each case with an open mind, understanding that the clinical presentation of respiratory viruses can overlap considerably. Comprehensive testing is pivotal, not only for accurate diagnosis but also for ensuring appropriate patient care and public health interventions
