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Co-infection and interaction of enteric pathogens in acute diarrhea among children under five years: a large-scale

Shun-Xian Zhang1,2, Qin-Yan Zuo1, Jin-Xin Zheng2

  • 1Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China.

Infectious Diseases of Poverty
|December 2, 2025
PubMed

Insights

Co-infections with enteric pathogens are common in children with diarrhea, and group A rotavirus (RVA) significantly worsens disease severity. RVA vaccination is crucial for reducing diarrhea burden and illness severity in children.

Area of Science:

  • Pediatric Infectious Diseases
  • Gastroenterology
  • Epidemiology

Background:

  • Diarrhea is a major health issue in children under five, with enteric pathogens playing a key role.
  • Understanding pathogen interactions and their impact on diarrhea severity is crucial but not well-established.

Purpose of the Study:

  • To investigate the interactions among co-infecting enteric pathogens and their impact on diarrhea pathogenesis.
  • To analyze the epidemiological framework of enteric pathogen co-infections in children.

Main Methods:

  • A large-scale, multicenter case-control study conducted across four tertiary hospitals in Guangzhou, China.
  • Collected stool samples from diarrheal and non-diarrheal children under five.
  • Identified 21 enteric pathogens and assessed interactions using additive and multiplicative models.

Main Results:

  • Enteric pathogens were detected more frequently in children with diarrhea (53.6%) than in controls (27.8%).
  • Co-infections were significantly higher in diarrheal children (16.1%) vs. controls (4.5%).
  • Synergistic interactions were found for RVA+DEC, RVA+CD, RVA+NoVs GII, and DEC+Bh, with RVA playing a central role in exacerbating severity.

Conclusions:

  • Co-infections with enteric pathogens are frequent in diarrheal children and can interact synergistically.
  • Group A rotavirus (RVA) plays a central role in exacerbating the severity of co-infections.
  • RVA vaccination is emphasized as critical for reducing the burden and severity of childhood diarrhea.
Abstract

Keywords:
ChildrenCo-infectionDiarrheal diseaseEnteric pathogensSynergistic interactions

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