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Review
. 2011 Sep;63(3):200-6.
doi: 10.1016/j.jinf.2011.06.005. Epub 2011 Jun 16.

The nature and consequences of coinfection in humans

Emily C Griffiths  1 , Amy B Pedersen, Andy Fenton, Owen L Petchey
Affiliations
Review

The nature and consequences of coinfection in humans

Emily C Griffiths et al. J Infect. 2011 Sep.

Abstract

Objective: Many fundamental patterns of coinfection (multi-species infections) are undescribed, including the relative frequency of coinfection by various pathogens, differences between single-species infections and coinfection, and the burden of coinfection on human health. We aimed to address the paucity of general knowledge on coinfection by systematically collating and analysing data from recent publications to understand the types of coinfection and their effects.

Methods: From an electronic search to find all publications from 2009 on coinfection and its synonyms in humans we recorded data on i) coinfecting pathogens and their effect on ii) host health and iii) intensity of infection.

Results: The most commonly reported coinfections differ from infections causing highest global mortality, with a notable lack of serious childhood infections in reported coinfections. We found that coinfection is generally reported to worsen human health (76% publications) and exacerbate infections (57% publications). Reported coinfections included all kinds of pathogens, but were most likely to contain bacteria.

Conclusions: These results suggest differences between coinfected patients and those with single infections, with coinfection having serious health effects. There is a pressing need to quantify the tendency towards negative effects and to evaluate any sampling biases in the coverage of coinfection research.

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Figures

Figure 1
Figure 1
Annual coinfection publications (log10) from initial Scopus search. See the Methods section for search criteria.
Figure 2
Figure 2
Direction of reported effects of coinfection on the abundance of infecting pathogens and host health averaged across publications and coinfections published in 2009. Horizontal lines indicate expected values of null hypotheses (black = no-effect, grey = random).
Figure 3
Figure 3
Distribution of grand mean effects of coinfection including simulations of missing values according to the random (grey line) and no-effect (black line) null models. Lines generated by a Gaussian kernel estimator (smoothing bandwidths: random = 5.1 × 10−3, no-effect = 1.2 × 10−3).
Figure 4
Figure 4
Top ten infections from global mortality data (28) (grey bars), compared with percentage of times the infections were reported in coinfections in 2009 publications (black bars).
See this image and copyright information in PMC

Comment in

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