Systematic Review and Meta-Analysis of the Association Between Clinical Severity and Co-Infection of Human Adenovirus With Other Respiratory Pathogens in Children.

The correlation between the co-infection of human respiratory adenovirus (HAdV) and clinical severity has not been firmly established yet. We carried out a systematic review and meta-analysis. We scoured six databases for studies published up to 16 May 2024. A total of 66 cohort studies, which involved 16 251 participants, were incorporated. When compared with patients suffering from HAdV single infection, those with co-infection of viruses (risk ratios [RRs] = 1.40, 95% confidence interval [CI]: 1.05-1.86), bacteria (RR = 1.50, 95% CI: 1.05-2.16), or fungi (RR = 2.86, 95% CI: 2.17-3.76) were more prone to experience severe clinical outcomes. Co-infection with Mycoplasma pneumoniae had a tendency to elevate the risk of common pneumonia (RR = 1.81, 95% CI: 1.66-1.97), and bacterial co-infection was likely to extend the hospital stay (mean differences = 2.23 days, 95% CI: 0.44-4.03). In summary, the co-infection of HAdV with other viral, bacterial, fungal respiratory pathogens or Mycoplasma pneumoniae heightened the risk of severe clinical outcomes in pediatric patients, leading to an increased utilization of medical resources. This implied that the ecological and biological mechanisms underlying the potential interactions between HAdV and other microorganisms merited further investigation.