Enteric Viral Co-Infections: Pathogenesis and Perspective

Abstract

Enteric viral co-infections, infections involving more than one virus, have been reported for a diverse group of etiological agents, including rotavirus, norovirus, astrovirus, adenovirus, and enteroviruses. These pathogens are causative agents for acute gastroenteritis and diarrheal disease in immunocompetent and immunocompromised individuals of all ages globally. Despite virus–virus co-infection events in the intestine being increasingly detected, little is known about their impact on disease outcomes or human health. Here, we review what is currently known about the clinical prevalence of virus–virus co-infections and how co-infections may influence vaccine responses. While experimental investigations into enteric virus co-infections have been limited, we highlight in vivo and in vitro models with exciting potential to investigate viral co-infections. Many features of virus–virus co-infection mechanisms in the intestine remain unclear, and further research will be critical.

Nonenteric Adenoviruses Associated with Gastroenteritis in Hospitalized Children

“…A dual infection can be explained by the fact that some microorganisms continue to be excreted for some time after the initial acute episode, while another pathogen starts a new acute infection. However, the clinical relevance of the pathogens identified with the gastroenteritis observed was difficult to establish in coinfected patients ( 25 ).…”

“…However, the number studies worldwide that report an association between nonenteric adenoviruses and gastroenteritis has increased ( 15 , 25 , 36 , 37 ).…”

“…In fact, HAdV-B3 has been associated with diarrhea in infants and children ( 36 ); HAdV-C1, HAdV-C2, and HAdV-C5 are genotypes that are frequently detected in patients with AGE ( 36 ). Furthermore, HAdV-A12, HAdV-A18, HAdV-A31, and HAdV-G52 have been associated with enteric symptoms ( 18 , 25 ). Similarly to these studies, our findings also contribute to the growing evidence for a potential role of so-called “nonenteric.”…”

Ligilactobacillus salivarius Strains Isolated From the Porcine Gut Modulate Innate Immune Responses in Epithelial Cells and Improve Protection Against Intestinal Viral-Bacterial Superinfection

“…The most severe effect of infections caused by viruses and bacteria acting together has been associated with two mechanisms that are not mutually exclusive. On the one hand, direct interactions occur when one pathogen exploits a component of the other to facilitate its penetration into the host cells (7,8). On the other hand, indirect interactions result in increased tissue damage and alteration of the immune response as a consequence of the infection with one pathogen that facilitates the colonization and spreading of the second (9,10).…”

Human Astrovirus in Symptomatic and Asymptomatic Children: A Cross-Sectional Study on Hospitalized and Outpatients from Rural Communities of South Africa between 2017–2021

“…Co-infection of enteric viruses causing AGE has been reported [20]. Multiple aetiological agents may contribute to the outcome of diarrhoeal disease [21]. Although this approach was not the scope of this study, we recommend further investigations in the involvement of astrovirus co-infection with other viral agents in AGE.…”