Respiratory pathogen diversity and co-infections in rural Zambia

Abstract

Objectives: The role of respiratory co-infections in modulating disease severity remains understudied in southern Africa, particularly in rural areas. This study was performed to characterize the spectrum of respiratory pathogens in rural southern Zambia and the prognostic impact of co-infections. Methods: Respiratory specimens collected from inpatient and outpatient participants in a viral surveillance program in 2018–2019 were tested for selected viruses and a typical bacteria using the Xpert Xpress Flu/RSV assay and FilmArray Respiratory Panel EZ. Participants were followed for 3–5 weeks to assess their clinical course. Multivariable regression was used to examine the role of co-infections in influencing disease severity. Results: A respiratory pathogen was detected in 63.2% of samples from 671 participants who presented with influenza-like illness. Common pathogens identified included influenza virus (18.2% of samples), respiratory syncytial virus (RSV) (11.8%), rhinovirus (26.4%), and coronavirus (6.0%). Overall, 6.4% of participants were co-infected with multiple respiratory pathogens. Compared to mono-infections, co-infections were found not to be associated with severe clinical illness either overall (relative risk (RR) 0.72, 95% confidence interval (CI) 0.39–1.32) or specifically with influenza virus (RR 0.80, 95% CI 0.14–4.46) or RSV infections (RR 0.44, 95% CI 0.17–1.11). Conclusions: Respiratory infections in rural southern Zambia were associated with a wide range of viruses. Respiratory co-infections in this population were not associated with clinical severity.

Epidemiology and clinical features of common community human coronavirus disease

“…In our study, the majority of patients (71%) with coronavirus were under 18 years old. There were 45% of (18). It can be seen that coronavirus infection occurs frequently at younger age.…”

“…Another study of respiratory pathogen diversity and coinfections in rural Zambia (18) showed that respiratory viral co-infection was less in adults than in children, but it was not related to the difference with clinical severity.…”

Comparison of Clinical, Demographic Features, and Costs in Respiratory Syncytial Virus, Rhinovirus, and Viral Co-infections in Children Hospitalized with Viral Infections of the Lower Respiratory Tract

“…Due to the wide variety of LRTI viruses and their difficulty to detect, viral examinations were often performed for epidemiological purposes. However, the awareness that viral infections cause hospital infections and early diagnosis of viral agents will decrease use of antibiotics has shown that diagnosis of respiratory tract infection viruses is very important (3).…”

The Complexity of Co-Infections in the Era of COVID-19

“…The finding of the above coronaviruses in co-infection did not consistently associate with worse outcome, type of illness, or age groups with some exceptions [2,29]. Few studies validated co-infections with secondary confirmatory diagnostics which raises concern for specificity [2,30].…”