Evidence from multiplex molecular assay for complex multi-pathogen interactions in acute respiratory infections

Centre for Translational and Applied Genomics, PHSA Labs; and Children's and Women's Health Centre of BC, PHSA, Vancouver BC

^* To whom correspondence should be addressed. Email: jbrunstein{at}cw.bc.ca.

	Abstract

While most diagnostic processes cease with the detection of the first relevant infectious agent, newer multiplexed molecular methods which provide simultaneous analysis for multiple agents may give a more accurate representation of the true pathogen spectrum in these samples. To examine this in the context of respiratory infections, acute respiratory specimens submitted to our clinical diagnostic microbiology/virology laboratory for our routine VIRAP diagnosis protocol during the spring 2006 peak respiratory infection season were processed in parallel by analysis with the Genaco (QiaPlex) ResPlex I and ResPlex II molecular diagnostic panels. A total of 1742 specimens were examined for 21 relevant targets each. The resulting data reveals that multiple infections are frequent and provides evidence for complex interactions between different infectious agents. Statistically relevant association patterns (both positive and negative) were observed between particular pathogens. While some interactions we observe are substantiated by prior reports in the literature, several of the specific patterns we observe do not appear to have been reported previously. In addition, we report on preliminary clinical evidence which supports a hypothesis that these coinfections are medically relevant and that effective treatment for severe respiratory tract infections will increasingly require diagnosis of all involved pathogens as opposed to single-pathogen reporting.