Legionella pneumophila and Staphylococcus aureus co-infections in a patient with SARS-CoV-2

A man fully mRNA-vaccinated against COVID-19 presented to our hospital with an acute febrile illness, respiratory symptoms and a positive test for SARS-CoV-2. He was later found early into hospitalisation to have two morbid bacterial co-infections: Legionella pneumophila serogroup 1 and methicillin-resistant Staphylococcus aureus (MRSA). Although this patient was initially admitted for COVID-19 management, his initial presentation was remarkable for lobar pneumonia, hyponatraemia and rhabdomyolysis more compatible with Legionnaire's disease than severe COVID-19. On discovery of MRSA pneumonia as a second bacterial infection, immunosuppressive COVID-19 therapies were discontinued and targeted antibiotics towards both bacterial co-infections were initiated. The patient's successful recovery highlighted the need to have high suspicion for bacterial co-infections in patients presenting with community-acquired pneumonia and a positive SARS-CoV-2 test, as patients with serious bacterial co-infections may have worse outcomes with use of immunosuppressive COVID-19 therapies.

Automated summary

This is a case report of a fully mRNA-vaccinated individual who presented with bacterial co-infections alongside COVID-19. The patient initially showed symptoms more consistent with Legionnaire's disease rather than severe COVID-19, including pneumonia, hyponatremia, and rhabdomyolysis. The successful recovery of the patient highlights the importance of considering bacterial co-infections in COVID-19 patients, as the use of immunosuppressive COVID-19 therapies may result in worse outcomes.