Higher rate of Epstein–Barr virus co-infection with SARS-CoV-2 compared to adenovirus, Influenza A, and B viruses in Northeast Iran

Background Acute respiratory infections (ARIs) are one of the major causes of morbidity and mortality in coronavirus disease 2019 (COVID-19) patients. We evaluated the frequencies and outcomes of co-infections with Influenza A virus (IAV), Influenza B virus (IBV), Epstein–Barr virus (EBV), and Adenovirus (ADV) among Iranian COVID-19 patients.Material and methods Real-time polymerase chain reaction (RT-PCR) based on the TaqMan and SYBR Green methods was used to detect RNA and DNA viruses, respectively, and the data were analyzed.Results Of the 427 patients, 214 (50.1%) were male and 213 (49.9%) female, with a mean age of 58.08 ± 18.13 years. EBV co-infections were 75 cases (17.6%), followed by ADV (15%), IAV (5.4%), and IBV (0.9%). Seven samples (1.6%) showed co-infections with IAV, ADV, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Significant relationships were found between underlying diseases like asthma and severe outcomes – including intensive care unit (ICU) admission and mortality – in patients with concurrent IAV infection. Co-infection with EBV and IBV was significantly associated with kidney disease, and IBV co-infection was significantly linked to asthma, sore throat, and increased mortality.Conclusion EBV co-infection was higher than that of other viruses, highlighting the necessity of such studies, especially during pandemics.