Co‑infection of COVID-19 patients with atypical bacteria: A study based in Jordan

Main Article Content

Ahmad R Alsayed
Luai Hasoun
Heba A Khader
Mahmoud S Abu-Samak
Laith MH Al-Shdifat
Basheer Al-Shaimari
Mohammed Al Maqbali


Chlamydophila pneumoniae, Coronavirus, Jordan, Mycoplasma pneumoniae, Polymerase chain reaction


Objective: The aim of this work was to know the prevalence of Chlamydophila pneumoniae and Mycoplasma pneumoniae in coronavirus disease 2019 (COVID-19) patients in Jordan. Also, to assess a TaqMan real-time polymerase chain reaction (PCR) assay in detecting these two bacteria. Methods: This is a retrospective study performed over the last five months of the 2021. All nasopharyngeal specimens from COVID-19 patients were tested for C. pneumonia, and M. pneumoniae. The C. pneumoniae Pst-1 gene and M. pneumoniae P1 cytadhesin protein gene were the targets. Results: In this study, 14 out of 175 individuals with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (8.0%) were co‐infected with C. pneumoniae or M. pneumoniae. Co‐infection with SARS‐CoV‐2 and C. pneumoniae was reported in 5 (2.9%) patients, while 9 (5.1%) patients had M. pneumoniae and SARS‐CoV‐2 co-infection. The mean (± std) of the correlation coefficient of the calibration curve for real-time PCR analysis was –0.993 (± 0.001) for C. pneumoniae and –0.994 (± 0.003) for M. pneumoniae. The mean amplification efficiencies of C. pneumoniae and M. Pneumoniae were 187.62% and 136.86%, respectively. Conclusion: In this first study based in Jordan, patients infected with COVID-19 have a low rate of atypical bacterial co-infection. However, clinicians should suspect co-infections with both common and uncommon bacteria in COVID-19 patients. Large prospective investigations are needed to give additional insight on the true prevalence of these co-infections and their impact on the clinical course of COVID-19 patients.

Abstract 575 | PDF Downloads 515


1. Chen X, Liao B, Cheng L, et al. The microbial coinfection in COVID-19. Appl Microbiol Biotechnol. 2020;104(18):7777-7785.
2. Calza L, Bon I, Tadolini M, et al. COVID-19 in patients with HIV-1 infection: a single-centre experience in northern Italy. Infection. 2021;49(2):333-337.
3. Chong WH, Saha BK, Ananthakrishnan R, et al. State-of-the-art review of secondary pulmonary infections in patients with COVID-19 pneumonia. Infection. 2021;49(4):591-605.
4. Chong WH, Neu KP. Incidence, diagnosis and outcomes of COVID-19-associated pulmonary aspergillosis (CAPA): a systematic review. The Journal of Hospital Infection. 2021;113:115-129.
5. Chong WH, Chieng H, Tiwari A, et al. Incidence and Risk Factors for Secondary Pulmonary Infections in Patients Hospitalized With Coronavirus Disease 2019 Pneumonia. Am J Med Sci. 2022;363(6):476-483.
6. Al-Dulaimi A, Alsayed AR, Maqbali MA, et al. Investigating the human rhinovirus co-infection in patients with asthma exacerbations and COVID-19. Pharmacy Practice. 2022;20(2):2665.
7. Alsayed AR, Talib W, Al-Dulaimi A, et al. The first detection of Pneumocystis jirovecii in asthmatic patients post COVID-19 in Jordan. Bosnian Journal of Basic Medical Sciences. 2022;22(5):784-790.
8. Joseph C, Togawa Y, Shindo N. Bacterial and viral infections associated with influenza. Influenza Other Respir Viruses. 2013;7 Suppl 2:105-113.
9. Desai H, Eschberger K, Wrona C, et al. Bacterial colonization increases daily symptoms in patients with chronic obstructive  pulmonary disease. Annals of the American Thoracic Society. 2014;11(3):303-309. 350OC
10. Sethi S, Murphy TF. Infection in the pathogenesis and course of chronic obstructive pulmonary disease. New England Journal of Medicine. 2008;359(22):2355-2365.
11. Murdoch DR. Molecular genetic methods in the diagnosis of lower respiratory tract infections. Apmis. 2004;112(11-12):713-727.
12. Choubey A, Sagar D, Cawley P, et al. Retrospective review analysis of COVID-19 patients co-infected with Mycoplasma pneumoniae. Lung India. 2021;38:S22-s26.
13. Gayam V, Konala VM, Naramala S, et al. Presenting characteristics, comorbidities, and outcomes of patients coinfected with COVID-19 and Mycoplasma pneumoniae in the USA. J Med Virol. 2020;92(10):2181-2187.
14. Chaudhry R, Sreenath K, Vinayaraj EV, et al. Mycoplasma pneumoniae co-infection with SARS-CoV-2: A case report. Access Microbiology. 2021;3(3):000212.
15. Liu L, Lei X, Xiao X, et al. Epidemiological and Clinical Characteristics of Patients With Coronavirus Disease-2019 in Shiyan City, China. Frontiers in Cellular and Infection Microbiology. 2020;10:284.
16. Metz C, Rixecker T, Mang S, et al. Acute Respiratory Distress Syndrome due to Mycoplasma pneumoniae Misinterpreted as SARS-CoV-2 Infection. Case Reports in Pulmonology. 2021;2021:5546723.
17. Chaudhry R, Sreenath K, Batra P, et al. Atypical bacterial co-infections among patients with COVID-19: A study from India. J Med Virol. 2022;94(1):303-309.
18. Alsayed A, Al-Doori A, Al-Dulaimi A, et al. Influences of bovine colostrum on nasal swab microbiome and viral upper respiratory tract infections–A case report. Respiratory Medicine Case Reports. 2020;31:101189.
19. Oliva A, Siccardi G, Migliarini A, et al. Co-infection of SARS-CoV-2 with Chlamydia or Mycoplasma pneumoniae: a case series and review of the literature. Infection. 2020;48(6):871-877.
20. Wu C, Chen X, Cai Y, et al. Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China. JAMA Intern Med. 2020;180(7):934-943.
21. Wang Z, Yang B, Li Q, et al. Clinical Features of 69 Cases With Coronavirus Disease 2019 in Wuhan, China. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. Clin Infect Dis. 2020;71(15):769-777. https://
22. Du RH, Liu LM, Yin W, et al. Hospitalization and Critical Care of 109 Decedents with COVID-19 Pneumonia in Wuhan, China. Ann Am Thorac Soc. 2020;17(7):839-846.
23. Wan S, Xiang Y, Fang W, et al. Clinical features and treatment of COVID-19 patients in northeast Chongqing. J Med Virol. 2020;92(7):797-806.
24. Xia W, Shao J, Guo Y, et al. Clinical and CT features in pediatric patients with COVID-19 infection: Different points from adults. Pediatr Pulmonol. 2020;55(5):1169-1174.
25. Alsayed A, El Hajji FD, Al-Najjar MA, et al. Patterns of antibiotic use, knowledge, and perceptions among different population categories: A comprehensive study based in Arabic countries. Saudi Pharmaceutical Journal. 2022;30(3):317-328. https://doi.

Most read articles by the same author(s)