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Legionella pneumophila and Staphylococcus aureus co-infections in a patient with SARS-CoV-2
  1. Andrew Sanchez1,
  2. Eric I Elliott1,
  3. Peter Wang1 and
  4. Anne Spichler-Moffarah2
  1. 1Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
  2. 2Department of Internal Medicine, Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut, USA
  1. Correspondence to Dr Andrew Sanchez; andrew.sanchez{at}


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.

  • pneumonia (infectious disease)
  • medical management
  • COVID-19

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  • Contributors This report was supervised by AS-M and written by AS, EIE and PW. Drs AS and PW were responsible for the initial diagnosis and management of this patient, and EIE and AS-M served as infectious disease consultants.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.