Abstract
Purpose of reviewAdvances in diagnostic methods mean that co-infections are increasingly being detected in clinical practice, yet their significance is not always obvious. In parallel, basic science studies are increasingly investigating interactions between pathogens to try to explain real-life observations and elucidate biological mechanisms.Recent findingsCo-infections may be insignificant, detrimental, or even beneficial, and these outcomes can occur through multiple levels of interactions which include modulation of the host response, altering the performance of diagnostic tests, and drug–drug interactions during treatment. The harmful effects of chronic co-infections such as tuberculosis or Hepatitis B and C in association with HIV are well established, and recent studies have focussed on strategies to mitigate these effects. However, consequences of many acute co-infections are much less certain, and recent conflicting findings simply highlight many of the challenges of studying naturally acquired infections in humans.SummaryTackling these challenges, using animal models, or careful prospective studies in humans may prove to be worthwhile. There are already tantalizing examples where identification and treatment of relevant co-infections seems to hold promise for improved health outcomes.
Highlights
Co-infections are almost certainly the norm rather than a rare curiosity
Of four large studies, three concluded that malaria co-infection resulted in increased mortality in individuals with Ebola virus disease (EVD) [40&,41&&,42], whereas one study concluded the opposite [43&]
Consistent with this, Mycobacterium bovis bacterial loads were decreased in cattle by co-infection with the fluke Fasciola hepatica, and co-infection was associated with reduced phagocytosis of mycobacteria [49&]
Summary
We are continuously exposed to multiple potential pathogens, most people are chronically or latently infected (be it with herpes viruses, helminths, or tuberculosis), and we all carry potential pathogens in our colonizing microbial flora. Determining the consequences of co-infection through observation of natural infections in humans is rife with problems because there aPaediatric Infectious Diseases, St George’s Hospital, bMRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London and cSection of Paediatrics, Imperial College, London, UK
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