Respiratory Viral Coinfections: Insights into Epidemiology, Immune Response, Pathology, and Clinical Outcomes

Abstract

Respiratory viral coinfections are a global public health threat that poses an economic burden on individuals, families, and healthcare infrastructure. Viruses may coinfect and interact synergistically or antagonistically, or their coinfection may not affect their replication rate. These interactions are specific to different virus combinations, which underlines the importance of understanding the mechanisms behind these differential viral interactions and the need for novel diagnostic methods to accurately identify multiple viruses causing a disease in a patient to avoid misdiagnosis. This review examines epidemiological patterns, pathology manifestations, and the immune response modulation of different respiratory viral combinations that occur during coinfections using different experimental models to better understand the dynamics respiratory viral coinfection takes in driving disease outcomes and severity, which is crucial to guide the development of prevention and treatment strategies.

Keywords: coinfection; infectious disease; respiratory via infections; viral; virus.

Figure 1

Common combinations of respiratory viral coinfections and viral replication outcomes. RSV: respiratory syncytial virus, HMPV: human metapneumovirus, IAV: influenza A virus, RV: rhinovirus, SARS-CoV-2: Severe Acute Respiratory Syndrome Coronavirus 2, hPIV: human parainfluenza virus, AdV: adenovirus, HBoV: human bocavirus. Created with Biorender.com.

Figure 2

Multiple factors influencing respiratory viral coinfections. Environmental factors, host factors, and viral factors can modulate the coinfection outcome in the host respiratory tract. Created with Biorender.com.