{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T11:30:02Z","timestamp":1778585402153,"version":"3.51.4"},"reference-count":40,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2015,6,9]],"date-time":"2015-06-09T00:00:00Z","timestamp":1433808000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Influenza Resp Viruses"],"published-print":{"date-parts":[[2015,7]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Although it is known that febrile respiratory illnesses (<jats:styled-content style=\"fixed-case\">FRI<\/jats:styled-content>) may be caused by multiple respiratory pathogens, there are no population\u2010level studies describing its impact on clinical disease.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Between May 2009 and October 2012, 7733 <jats:styled-content style=\"fixed-case\">FRI<\/jats:styled-content> patients and controls in the Singapore military had clinical data and nasal wash samples collected prospectively and sent for <jats:styled-content style=\"fixed-case\">PCR<\/jats:styled-content> testing. Patients with one pathogen detected (mono\u2010pathogen) were compared with those with two pathogens (dual pathogen) for differences in basic demographics and clinical presentation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>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\u2010smokers. Influenza A (80.0%), influenza B (73.0%) and mycoplasma (70.6%) were most commonly associated with mono\u2010infections, while adenovirus was most commonly associated with dual infections (62.9%). Influenza A paired with <jats:italic>S. pneumoniae<\/jats:italic> had higher proportions of chills and rigors than their respective mono\u2010pathogens (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.03, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.009). <jats:italic>H.\u00a0influenzae<\/jats:italic> paired with either enterovirus or parainfluenzae had higher proportions of cough with phlegm than their respective mono\u2010pathogens. 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\u2010pathogens, there were few differences between distinct dual\u2010pathogen pairs and their respective mono\u2010pathogen counterparts.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>A substantial number of <jats:styled-content style=\"fixed-case\">FRI<\/jats:styled-content> patients have multiple pathogens detected. Observed clinical differences between patients of dual pathogen and mono\u2010pathogen indicate the likely presence of complex microbial interactions between the various pathogens.<\/jats:p><\/jats:sec>","DOI":"10.1111\/irv.12312","type":"journal-article","created":{"date-parts":[[2015,4,1]],"date-time":"2015-04-01T18:15:52Z","timestamp":1427912152000},"page":"200-208","source":"Crossref","is-referenced-by-count":5,"title":["Clinical differences between respiratory viral and bacterial mono\u2010 and dual pathogen detected among <scp>S<\/scp>ingapore military servicemen with febrile respiratory illness"],"prefix":"10.1111","volume":"9","author":[{"given":"Zheng Jie Marc","family":"Ho","sequence":"first","affiliation":[{"name":"HQ Medical Corps Singapore Armed Forces Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiahong","family":"Zhao","sequence":"additional","affiliation":[{"name":"Saw Swee Hock School of Public Health National University of Singapore 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