Ho Zheng Jie Marc, Zhao Xiahong, Cook Alex R, Loh Jin Phang, Ng Sock Hoon, Tan Boon Huan, Lee Vernon J
HQ Medical Corps, Singapore Armed Forces, Singapore.
Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
Influenza Other Respir Viruses. 2015 Jul;9(4):200-8. doi: 10.1111/irv.12312.
Although it is known that febrile respiratory illnesses (FRI) may be caused by multiple respiratory pathogens, there are no population-level studies describing its impact on clinical disease.
Between May 2009 and October 2012, 7733 FRI patients and controls in the Singapore military had clinical data and nasal wash samples collected prospectively and sent for PCR testing. Patients with one pathogen detected (mono-pathogen) were compared with those with two pathogens (dual pathogen) for differences in basic demographics and clinical presentation.
In total, 45.8% had one pathogen detected, 20.2% had two pathogens detected, 30.9% had no pathogens detected, and 3.1% had more than two pathogens. Multiple pathogens were associated with recruits, those with asthma and non-smokers. Influenza A (80.0%), influenza B (73.0%) and mycoplasma (70.6%) were most commonly associated with mono-infections, while adenovirus was most commonly associated with dual infections (62.9%). Influenza A paired with S. pneumoniae had higher proportions of chills and rigors than their respective mono-pathogens (P = 0.03, P = 0.009). H. influenzae paired with either enterovirus or parainfluenzae had higher proportions of cough with phlegm than their respective mono-pathogens. Although there were observed differences in mean proportions of body temperature, nasal symptoms, sore throat, body aches and joint pains between viral and bacterial mono-pathogens, there were few differences between distinct dual-pathogen pairs and their respective mono-pathogen counterparts.
A substantial number of FRI patients have multiple pathogens detected. Observed clinical differences between patients of dual pathogen and mono-pathogen indicate the likely presence of complex microbial interactions between the various pathogens.
尽管已知发热性呼吸道疾病（FRI）可能由多种呼吸道病原体引起，但尚无针对其对临床疾病影响的人群水平研究。
在2009年5月至2012年10月期间，新加坡军队中的7733名FRI患者及对照者前瞻性地收集了临床数据和洗鼻样本，并送去进行PCR检测。将检测出一种病原体（单病原体）的患者与检测出两种病原体（双病原体）的患者在基本人口统计学和临床表现方面的差异进行比较。
总体而言，45.8%的患者检测出一种病原体，20.2%的患者检测出两种病原体，30.9%的患者未检测出病原体，3.1%的患者检测出两种以上病原体。多种病原体与新兵、哮喘患者及非吸烟者有关。甲型流感（80.0%）、乙型流感（73.0%）和支原体（70.6%）最常与单感染相关，而腺病毒最常与双感染相关（62.9%）。甲型流感与肺炎链球菌同时感染时，寒战和抽搐的比例高于各自的单病原体感染（P = 0.03，P = 0.009）。流感嗜血杆菌与肠道病毒或副流感病毒同时感染时，咳痰咳嗽的比例高于各自的单病原体感染。尽管在病毒和细菌单病原体感染之间，体温、鼻部症状、喉咙痛、身体疼痛和关节疼痛的平均比例存在差异，但不同双病原体组合与其各自的单病原体对应物之间差异不大。
大量FRI患者检测出多种病原体。双病原体和单病原体患者之间观察到的临床差异表明，各种病原体之间可能存在复杂的微生物相互作用。
