Multiple-genotype infections and their complex effect on virulence

Multiple infections are common. Although in recent years our understanding of multiple infections has increased significantly, it has also become clear that a diversity of aspects has to be considered to understand the interplay between co-infecting parasite genotypes of the same species and its implications for virulence and epidemiology, resulting in high complexity. Here, we review different interaction mechanisms described for multiple infections ranging from competition to cooperation. We also list factors influencing the interaction between co-infecting parasite genotypes and their influence on virulence. Finally, we emphasise the importance of between-host effects and their evolution for understanding multiple infections and their implications.