Editorial: Challenges and perspectives for improved understanding and management of multifaceted co-infection
Résumé
Infectious diseases rarely occur in isolation, and co-infections involving multiple pathogens are increasingly recognized as a major challenge for clinicians, researchers, and public health authorities. Multifaceted co-infection can alter disease severity, compromise diagnostic accuracy, and complicate therapeutic decision-making, yet current frameworks for understanding and managing these interactions remain fragmented. Despite growing evidence from clinical and experimental studies, significant gaps persist in how different pathogens, host immune responses, and environmental factors interact over time, especially in vulnerable populations. Therefore, advancing therapeutic strategies and improving clinical outcomes requires a detailed study of how co-infecting pathogens evolve over time, clarification of the molecular mechanisms that shape their interplay, and evaluation of their combined effects on host cellular pathways.In this Research Topic, several studies provide novel insights into the complex immune dynamics underlying various types of co-infection. For instance, a study by Wang et al. focused on Epstein-Barr virus (EBV) infection, which is frequently observed in patients with severe fever with thrombocytopenia syndrome (SFTS). Their study aimed to characterize the impact of EBV infection on clinical outcomes and the associated immunological and inflammatory profiles in SFTS patients. The researchers found that the impact of EBV DNA positivity on mortality was especially evident in older patients, individuals admitted later in the disease course, and those with underlying comorbidities. In addition, immunological analysis of EBV-positive patients showed a substantial increase in B-cell frequency, accompanied by marked decreases in CD3+, CD4+, and CD8+ T-cell counts, with EBV DNA levels closely associated with the proportion of B cells. Furthermore, circulating IL-6 and IL-10 concentrations were significantly elevated in the EBVpositive group, and EBV DNA levels showed a strong positive correlation with IL-10.Another contribution by Hu and co-authors sought to characterize the bacterial and fungal coinfecting pathogens in Severe Fever with Thrombocytopenia Syndrome (SFTS) and identify prognostic factors associated with mortality among co-infected patients. SFTS is an emerging infectious disease that is becoming a growing concern for global public health authorities. Most isolates were obtained from respiratory specimens. Among all isolated fungal pathogens, Aspergillus fumigatus was the most frequently detected species, followed by Candida albicans. Among bacterial isolates, Klebsiella pneumoniae and Acinetobacter baumannii were the predominant organisms. Patients with these co-infections experienced significantly prolonged hospitalizations, incurred higher medical expenses, and showed increased mortality. The authors concluded that bacterial/fungal co-infections are highly prevalent and clinically impactful in SFTS patients, warranting enhanced microbial surveillance and targeted intervention. In conclusion, the studies presented in this research topic highlight the complexity and clinical significance of co-infections, particularly in immuno-compromised populations. Collectively, these contributions elucidate the multifaceted interplay between host immunity and pathogenic organisms. As our understanding of co-infection biology continues to advance, it is increasingly evident that effective strategies for diagnosis, treatment, and prevention must adopt an integrated approach that considers both pathogen dynamics and host-specific factors
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