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High Burden of Coinfections With Epidemic-Prone Pathogens Among Febrile Patients in Nigeria: A Multi-Pathogen
Cyril Erameh1, Lauren P Courtney2, Vivian Kwaghe3
1Institute of Viral and Emergent Pathogens Control and Research, Irrua Specialist Teaching Hospital, Edo, Nigeria.
Background:
Characterizing the etiology of acute febrile illness (AFI) remains a critical public health priority in malaria-endemic regions such as Nigeria, where constrained diagnostic capacity frequently contributes to misdiagnosis and delays in outbreak detection and response. This study aimed to explore the burden and nature of pathogen coinfections among febrile patients and to assess whether coinfection patterns were associated with clinical or epidemiologic differences.
Methods:
Patients presenting with AFI at tertiary hospitals in north-central and southern Nigeria were screened for 25 pathogens using the TaqMan Array Card multi-pathogen polymerase chain reaction. Enrollment was conducted over a 12-month period at each site, August 2023 to September 2024. The analysis focused on the pathogen distribution in coinfections and any associated outcomes for coinfected patients.
Results:
Among the 1200 participants enrolled, 20 pathogens were detected in 57.9% of enrollees. Coinfections were detected in 12.6%. Among them, 2 pathogens were detected in 36.0% and 3 or 4 pathogens were detected in 1.2%. Nearly all coinfections included either Plasmodium or Rickettsia. Notably, coinfected patients were not clinically distinguishable from those with single-pathogen infections based on severity of the illness, presence of underlying health conditions, or risk behaviors such as use of mosquito nets. Among those with viral hemorrhagic fevers, those with coinfections exhibited a notably higher case fatality rate (11.5%) than those with single-pathogen infections (4.2%).
Conclusions:
Given the challenge of clinically distinguishing between infections with overlapping symptomology, there is an urgent need for multi-pathogen diagnostics for clinical and public health use.
Insights
Coinfections are common in Nigerian febrile illness patients, often involving Plasmodium or Rickettsia. Multi-pathogen diagnostics are crucial due to similar symptoms and higher fatality rates in coinfected patients with viral hemorrhagic fevers.
Area of Science:
- Infectious Diseases
- Public Health
- Molecular Diagnostics
Background:
- Acute febrile illness (AFI) diagnosis is challenging in Nigeria due to limited diagnostic capacity.
- Coinfections complicate diagnosis, outbreak detection, and response in malaria-endemic regions.
Purpose of the Study:
- To determine the prevalence and types of pathogen coinfections in Nigerian AFI patients.
- To investigate clinical and epidemiological differences associated with coinfections.
Main Methods:
- Screened 1200 AFI patients in Nigeria for 25 pathogens using multi-pathogen PCR (TaqMan Array Card).
- Analyzed pathogen distribution and outcomes in coinfected individuals over a 12-month period.
Main Results:
- 20 pathogens detected in 57.9% of patients; 12.6% had coinfections.
- Plasmodium and Rickettsia were common in coinfections. Coinfected patients were clinically indistinguishable from single-infection cases.
- Viral hemorrhagic fever coinfections had a higher case fatality rate (11.5%) than single infections (4.2%).
Conclusions:
- Clinically distinguishing coinfections from single infections is difficult due to overlapping symptoms.
- Urgent need for multi-pathogen diagnostic tools for effective clinical and public health management of febrile illnesses.
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