{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T08:02:18Z","timestamp":1773820938683,"version":"3.50.1"},"reference-count":37,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T00:00:00Z","timestamp":1773792000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cell. Infect. Microbiol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Reports on mixed infection with different severe acute respiratory syndrome coronavirus 2 variants and other respiratory pathogens in patients with acute coronavirus disease in China remain scarce. In this study, we analyzed the clinical characteristics of mixed infections involving different severe acute respiratory syndrome coronavirus 2 variants and other respiratory pathogens in patients with acute coronavirus disease in central China.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Nested polymerase chain reactions and metagenomic next-generation sequencing were employed to identify severe acute respiratory syndrome coronavirus 2 variants. Clinical data, including hospitalization days, severity classification, outcomes, and laboratory data, were collected and analyzed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Seven patients had mixed infections with different severe acute respiratory syndrome coronavirus 2 variants in samples collected on different dates. Overall, 54.6% (83\/152) of patients had co-existing respiratory pathogen infection. The most common co-existing respiratory pathogen was\n                      <jats:italic>Mycoplasma pneumoniae<\/jats:italic>\n                      . Longer hospital stays, intensive care unit admission, and prolonged duration from admission to positive severe acute respiratory syndrome coronavirus 2 sample detection were independent risk factors for acute coronavirus disease infection with different respiratory pathogens. Severity classification, mixed infection, cerebral fraction, and fever were independent risk factors for failed treatment. Early detection of white blood cell count, procalcitonin, and D-dimer concentrations can help predict mixed respiratory infections and treatment outcomes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The phenomenon of mixed infection with different variants in patients with coronavirus disease may have been underestimated. Therefore, active surveillance of severe acute respiratory syndrome coronavirus 2 variants should be performed in older patients with comorbidities.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcimb.2026.1653022","type":"journal-article","created":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T07:01:26Z","timestamp":1773817286000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Distinct characteristics on mixed infection of SARS-CoV-2 variants and other respiratory pathogens among patients with acute COVID-19 in central China"],"prefix":"10.3389","volume":"16","author":[{"given":"Yiman","family":"Geng","sequence":"first","affiliation":[{"name":"Department of Polymerase Chain Reaction (PCR), Henan Provincial People\u2019s Hospital, Zhengzhou University People\u2019s Hospital, Henan University People\u2019s Hospital","place":["Zhengzhou, Henan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Youhua","family":"Yuan","sequence":"additional","affiliation":[{"name":"Department of Special Laboratory, Henan Provincial People\u2019s Hospital, Zhengzhou University People\u2019s Hospital, Henan University People\u2019s Hospital","place":["Zhengzhou, Henan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xuhong","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Laboratory, Huaihe Hospital of Henan University","place":["Kaifeng, Henan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jingjing","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Neurology, Jiaozuo Municipal People\u2019s Hospital","place":["Jiaozuo, Henan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qi","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Clinical Microbiology, Henan Provincial People\u2019s Hospital, Zhengzhou University People\u2019s Hospital, Henan University People\u2019s Hospital","place":["Zhengzhou, Henan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaohuan","family":"Mao","sequence":"additional","affiliation":[{"name":"Department of Special Laboratory, Henan Provincial People\u2019s Hospital, Zhengzhou University People\u2019s Hospital, Henan University People\u2019s Hospital","place":["Zhengzhou, Henan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaohuan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Special Laboratory, Henan Provincial People\u2019s Hospital, Zhengzhou University People\u2019s Hospital, Henan University People\u2019s Hospital","place":["Zhengzhou, Henan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiulei","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Microbiome, Henan Provincial People\u2019s Hospital, Zhengzhou University People\u2019s Hospital, Henan University People\u2019s Hospital","place":["Zhengzhou, Henan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Special Laboratory, Henan Provincial People\u2019s Hospital, Zhengzhou University People\u2019s Hospital, Henan University People\u2019s Hospital","place":["Zhengzhou, Henan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jing","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Polymerase Chain Reaction (PCR), Henan Provincial People\u2019s Hospital, Zhengzhou University People\u2019s Hospital, Henan University People\u2019s Hospital","place":["Zhengzhou, Henan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fengxia","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Laboratory, Henan Provincial People\u2019s Hospital, Zhengzhou University People\u2019s Hospital, Henan University People\u2019s Hospital","place":["Zhengzhou, Henan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peiming","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Laboratory, Henan Provincial People\u2019s Hospital, Zhengzhou University People\u2019s Hospital, Henan University People\u2019s Hospital","place":["Zhengzhou, Henan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,18]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"4817","DOI":"10.1038\/s41598-024-84113-9","article-title":"Tracking the genetic diversity of SARS-CoV-2 variants in Nicaragua throughout the COVID-19 pandemic","volume":"15","author":"Alem\u00e1n","year":"2025","journal-title":"Sci. Rep."},{"key":"B2","doi-asserted-by":"publisher","first-page":"578","DOI":"10.1016\/j.rce.2022.04.001","article-title":"Brote nosocomial de COVID-19 enuna planta de medicina interna: Probable transmisi\u00f3na\u00e9rea","volume":"222","author":"Andr\u00e9s","year":"2022","journal-title":"Rev. Clin. Espa\u00f1ola."},{"key":"B3","doi-asserted-by":"publisher","first-page":"103227","DOI":"10.1016\/j.iccn.2022.103227","article-title":"Healthcare-associated infections in adult intensive care unit patients: changes in epidemiology, diagnosis, prevention and contributions of new technologies","volume":"70","author":"Blot","year":"2022","journal-title":"Intensive Crit. Care Nurs."},{"key":"B4","doi-asserted-by":"publisher","first-page":"4597","DOI":"10.1016\/j.cell.2023.08.026","article-title":"SARS-CoV-2 variants evolve convergent strategies to remodel the host response","volume":"186","author":"Bouhaddou","year":"2023","journal-title":"Cell."},{"key":"B5","doi-asserted-by":"publisher","first-page":"512","DOI":"10.3390\/biomedicines11020512","article-title":"Computational analysis predicts correlations among amino acids in SARS-CoV-2 proteomes","volume":"11","author":"Broni","year":"2023","journal-title":"Biomedicines."},{"key":"B6","doi-asserted-by":"publisher","first-page":"109312","DOI":"10.1016\/j.dib.2023.109312","article-title":"SARS-CoV-2 next generation sequencing (NGS) data from clinical isolates from the East Texas Region of the United States","volume":"49","author":"Carpenter","year":"2023","journal-title":"Data Brief."},{"key":"B7","doi-asserted-by":"publisher","first-page":"107056","DOI":"10.1016\/j.actatropica.2023.107056","article-title":"Evidence of SARS-CoV-2 infection and co-infections in stray cats in Brazil","volume":"249","author":"Castillo","year":"2024","journal-title":"Acta Trop."},{"key":"B8","doi-asserted-by":"publisher","first-page":"1955","DOI":"10.1186\/s12889-021-12008-9","article-title":"Risk factors associated with respiratory infectious disease-related presenteeism: a rapid review","volume":"21","author":"Daniels","year":"2021","journal-title":"BMC Public Health"},{"key":"B9","doi-asserted-by":"publisher","first-page":"718","DOI":"10.1016\/j.ajic.2023.02.001","article-title":"Respiratory infectious disease isolation during the COVID-19 pandemic","volume":"51","author":"Deen","year":"2023","journal-title":"Am. J. Infect. Control."},{"key":"B10","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1016\/j.jgar.2024.04.007","article-title":"Clinical characteristics and risk factors for bacterial co-infections in COVID-19 patients: a retrospective study","volume":"38","author":"Gan","year":"2024","journal-title":"J. Glob Antimicrob. Resist."},{"key":"B11","unstructured":"Whole-genome sequencing data of SARS-CoV-2 variants\n          \n          \n          \n          2024"},{"key":"B12","unstructured":"Whole-genome sequencing data of SARS-coV-2 variants\n          \n          \n          \n          2025"},{"key":"B13","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1186\/s40779-020-00270-8","article-title":"Chemoprophylaxis, diagnosis, treatments, and discharge management of COVID-19: an evidence-based clinical practice guideline (updated version)","volume":"7","author":"Jin","year":"2020","journal-title":"Mil. Med. Res."},{"key":"B14","doi-asserted-by":"publisher","first-page":"8550","DOI":"10.1038\/s41467-024-52668-w","article-title":"Immune escape and attenuated severity associated with the SARS-CoV-2 BA.2.86\/JN.1 lineage","volume":"15","author":"Lewnard","year":"2024","journal-title":"Nat. Commun."},{"key":"B15","doi-asserted-by":"publisher","first-page":"114520","DOI":"10.1016\/j.celrep.2024.114520","article-title":"Neutralization escape, infectivity, and membrane fusion of JN.1-derived SARS-CoV-2 SLip, FLiRT, and KP.2 variants","volume":"43","author":"Li","year":"2024","journal-title":"Cell Rep."},{"key":"B16","doi-asserted-by":"publisher","first-page":"60","DOI":"10.21037\/apm-22-1111","article-title":"A comparative bibliometric analysis of Omicron and Delta variants during the COVID-19 pandemic","volume":"12","author":"Liu","year":"2023","journal-title":"Ann. Palliat. Med."},{"key":"B17","doi-asserted-by":"publisher","first-page":"1222","DOI":"10.3390\/v16081222","article-title":"SARS-CoV-2 variants and clinical outcomes of special populations: a scoping review of the literature","volume":"16","author":"Livieratos","year":"2024","journal-title":"Viruses."},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2021.797117","article-title":"SARS-CoV-2 and HIV-1: Should HIV-1-infected individuals in sub-Saharan Africa be considered a priority group for the COVID-19 vaccines","volume":"12","author":"Mandala","year":"2021","journal-title":"Front. Immunol."},{"key":"B19","doi-asserted-by":"publisher","first-page":"1790","DOI":"10.3390\/v14081790","article-title":"SARS-CoV-2 nsp14 Exoribonuclease removes the natural antiviral 3\u2019-Deoxy-3\u2019,4\u2019-didehydro-cytidine nucleotide from RNA","volume":"14","author":"Moeller","year":"2022","journal-title":"Viruses."},{"key":"B20","unstructured":"Whole genome sequencing data of SARS-CoV-2 variants"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1111\/ped.15777","article-title":"Clinical severity of Omicron and Delta SARS-CoV-2 infections in children","volume":"66","author":"Ng","year":"2024","journal-title":"Pediatr. Int."},{"key":"B22","doi-asserted-by":"publisher","first-page":"e43","DOI":"10.1017\/S0950268824000360","article-title":"Comparative epidemiology of outbreaks caused by SARS-CoV-2 Delta and omicron variants in China","volume":"152","author":"Peng","year":"2024","journal-title":"Epidemiol. Infect."},{"key":"B23","doi-asserted-by":"publisher","first-page":"10050","DOI":"10.3390\/ijms251810050","article-title":"Staphylococcus aureus Co-Infection in COVID-19 Patients: virulence genes and their influence on respiratory epithelial cells in light of risk of severe secondary infection","volume":"25","author":"Piechowicz","year":"2024","journal-title":"Int. J. Mol. Sci."},{"key":"B24","doi-asserted-by":"publisher","first-page":"2745","DOI":"10.1038\/s41467-022-30518-x","article-title":"Co-infection with SARS-CoV-2 Omicron and Delta variants revealed by genomic surveillance","volume":"13","author":"Rockett","year":"2022","journal-title":"Nat. Commun."},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pbio.3002463","article-title":"Combined analyses of within-host SARS-CoV-2 viral kinetics and information on past exposures to the virus in a human cohort identifies intrinsic differences of Omicron and Delta variants","volume":"22","author":"Russell","year":"2024","journal-title":"PloS Biol."},{"key":"B26","doi-asserted-by":"publisher","first-page":"855","DOI":"10.3201\/eid2904.221700","article-title":"SARS-CoV-2 Omicron replacement of delta as predominant variant, Puerto Rico","volume":"29","author":"Santiago","year":"2023","journal-title":"Emerg. Infect. Dis."},{"key":"B27","doi-asserted-by":"publisher","first-page":"104950","DOI":"10.1016\/j.ebiom.2023.104950","article-title":"Combination therapy with oral antiviral and anti-inflammatory drugs improves the efficacy of delayed treatment in a COVID-19 hamster model","volume":"99","author":"Sasaki","year":"2024","journal-title":"EBiomedicine"},{"key":"B28","doi-asserted-by":"publisher","first-page":"e13340","DOI":"10.1111\/irv.13340","article-title":"Identification of various recombinants in a patient coinfected with the different SARS-CoV-2 variants","volume":"18","author":"Sayama","year":"2024","journal-title":"Influ. Other Respir. Viruses."},{"key":"B29","doi-asserted-by":"publisher","first-page":"e2124343","DOI":"10.1001\/jamanetworkopen.2021.24343","article-title":"Characteristics of SARS-CoV-2 infections in Israeli children during the circulation of different SARS-CoV-2 variants","volume":"4","author":"Somekh","year":"2021","journal-title":"JAMA Netw. Open"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2024.1327093","article-title":"A review of the Clinical characteristics and management of immunosuppressed patients living with HIV or solid organ transplants infected with SARS-CoV-2 omicron variants","volume":"12","author":"Song","year":"2024","journal-title":"Front. Public Health"},{"key":"B31","doi-asserted-by":"publisher","first-page":"e122","DOI":"10.1016\/S1473-3099(25)00007-6","article-title":"The KP.2-adapted COVID-19 vaccine improves neutralising activity against the XEC variant","volume":"25","author":"Suthar","year":"2025","journal-title":"Lancet Infect. Dis."},{"key":"B32","doi-asserted-by":"publisher","first-page":"212","DOI":"10.1016\/j.ijid.2022.05.043","article-title":"Genomic evidence of co-identification with Omicron and Delta SARS-CoV-2 variants: a report of two cases","volume":"122","author":"Wawina-Bokalanga","year":"2022","journal-title":"Int. J. Infect. Dis."},{"key":"B33","doi-asserted-by":"publisher","first-page":"e0111724","DOI":"10.1128\/spectrum.01117-24","article-title":"Heterogeneity of SARS-CoV-2 immune responses after the nationwide omicron wave in China","volume":"12","author":"Wu","year":"2024","journal-title":"Microbiol. Spec."},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.3389\/fcimb.2025.1605198","article-title":"Novel method for the identification of circulating SARS-CoV-2 variants and clinical characteristics of patient infection with SARS-CoV-2 variants in Central China","volume":"15","author":"Yuan","year":"2025","journal-title":"Front. Cell. Infect. Microbiol."},{"key":"B35","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1038\/d41586-020-01032-1","article-title":"COVID-19: Review indigenous peoples\u2019 data","volume":"580","author":"Zavaleta","year":"2020","journal-title":"Nature"},{"key":"B36","doi-asserted-by":"publisher","first-page":"614","DOI":"10.3967\/bes2023.047","article-title":"Neutralizing antibody responses against five SARS-CoV-2 variants and T lymphocyte change after vaccine breakthrough infections from the SARS-CoV-2 Omicron BA.1 Variant in Tianjin, China: a Prospective Study","volume":"36","author":"Zhang","year":"2023","journal-title":"Biomed. Environ. Sci."},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1002\/jcla.24177","article-title":"Early predictors of severe COVID-19 among hospitalized patients","volume":"36","author":"Zhao","year":"2022","journal-title":"J. Clin. Lab. Anal."}],"container-title":["Frontiers in Cellular and Infection Microbiology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcimb.2026.1653022\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T07:01:29Z","timestamp":1773817289000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcimb.2026.1653022\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,18]]},"references-count":37,"alternative-id":["10.3389\/fcimb.2026.1653022"],"URL":"https:\/\/doi.org\/10.3389\/fcimb.2026.1653022","relation":{},"ISSN":["2235-2988"],"issn-type":[{"value":"2235-2988","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,18]]},"article-number":"1653022"}}