{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T05:35:15Z","timestamp":1789623315852,"version":"build-2803163510"},"reference-count":54,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,11,30]],"date-time":"2025-11-30T00:00:00Z","timestamp":1764460800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Science for Africa Foundation to the Developing Excellence in Leadership, Training and Science in Africa","award":["DEL-22-012"],"award-info":[{"award-number":["DEL-22-012"]}]},{"name":"Wellcome Trust and the UK Foreign, Commonwealth & Development Office"},{"name":"ELMA Cholera Relief Foundation"},{"name":"European Union and National Institute of Allergy and Infectious Disease to DAS","award":["5R01AI123422"],"award-info":[{"award-number":["5R01AI123422"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathogens"],"abstract":"<jats:p>Cholera remains a major public health challenge, and co-infections can complicate clinical outcomes. In a cross-sectional study, we investigated the prevalence and patterns of enteric co-infections during Zambia\u2019s 2023\u20132024 cholera outbreak and evaluated their implications for disease severity. 240 suspected cholera patients were enrolled from five healthcare facilities in Lusaka. Stools were tested for 11 enteric pathogens using the Bosphore\u00ae Gastroenteritis Panel Kit v2 on the QuantStudio 5 qPCR, with Vibrio cholerae confirmed by real-time PCR (quantitative PCR). Co-infections were highly prevalent, affecting 79.2% of participants. Campylobacter was the most frequently detected pathogen (70.0%), followed by Norovirus GI\/GII (20.0%). Persons living with HIV were significantly more likely to present with co-infections than their counterparts (adjusted PR 1.27, 95% CI: 1.07\u20131.51; p = 0.008). Participants with confirmed V. cholerae + coinfections (N = 62) were less likely to developed moderate to severe disease compared to those with mono-infections (adjusted PR 0.59, 95% CI: 0.38\u20130.90; p = 0.014). These findings highlight the high prevalence and complexity of co-infections during cholera outbreaks, potentially contributing to antimicrobial resistance. They also highlight the need for targeted clinical management, particularly among persons living with HIV.<\/jats:p>","DOI":"10.3390\/pathogens14121224","type":"journal-article","created":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T09:34:37Z","timestamp":1764581677000},"page":"1224","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Prevalence and Patterns of Enteric Co-Infections Among Individuals Presenting with Cholera-like Diarrheal Disease During Seasonal Cholera Outbreaks"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7813-8881","authenticated-orcid":false,"given":"Dhvani H.","family":"Kuntawala","sequence":"first","affiliation":[{"name":"Basic Sciences and Immunology, Centre for Infectious Disease Research in Zambia, Lusaka 10101, Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2826-3887","authenticated-orcid":false,"given":"Samuel","family":"Bosomprah","sequence":"additional","affiliation":[{"name":"Basic Sciences and Immunology, Centre for Infectious Disease Research in Zambia, Lusaka 10101, Zambia"},{"name":"Department of Biostatistics, School of Public Health, University of Ghana, Accra P.O. Box LG13, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-2657-8913","authenticated-orcid":false,"given":"Bernard","family":"Phiri","sequence":"additional","affiliation":[{"name":"Basic Sciences and Immunology, Centre for Infectious Disease Research in Zambia, Lusaka 10101, Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harriet","family":"Ng\u2019ombe","sequence":"additional","affiliation":[{"name":"Basic Sciences and Immunology, Centre for Infectious Disease Research in Zambia, Lusaka 10101, Zambia"},{"name":"Faculty of Science, Stellenbosch University, Private Bag X1, Matieland 7602, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fraser","family":"Liswaniso","sequence":"additional","affiliation":[{"name":"Basic Sciences and Immunology, Centre for Infectious Disease Research in Zambia, Lusaka 10101, Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3163-712X","authenticated-orcid":false,"given":"Mutinta","family":"Muchimba","sequence":"additional","affiliation":[{"name":"Basic Sciences and Immunology, Centre for Infectious Disease Research in Zambia, Lusaka 10101, Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8038-7107","authenticated-orcid":false,"given":"Suwilanji","family":"Silwamba","sequence":"additional","affiliation":[{"name":"Basic Sciences and Immunology, Centre for Infectious Disease Research in Zambia, Lusaka 10101, Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9539-4756","authenticated-orcid":false,"given":"Kennedy","family":"Chibesa","sequence":"additional","affiliation":[{"name":"Basic Sciences and Immunology, Centre for Infectious Disease Research in Zambia, Lusaka 10101, Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bertha T.","family":"Nzangwa","sequence":"additional","affiliation":[{"name":"Basic Sciences and Immunology, Centre for Infectious Disease Research in Zambia, Lusaka 10101, Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlie C.","family":"Luchen","sequence":"additional","affiliation":[{"name":"Basic Sciences and Immunology, Centre for Infectious Disease Research in Zambia, Lusaka 10101, Zambia"},{"name":"Department of Global Health, University Medical Center, Amsterdam Institute for Global Health and Development, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Innocent","family":"Mwape","sequence":"additional","affiliation":[{"name":"Basic Sciences and Immunology, Centre for Infectious Disease Research in Zambia, Lusaka 10101, Zambia"},{"name":"Faculty of Science, Stellenbosch University, Private Bag X1, Matieland 7602, South Africa"},{"name":"Zambia National Public Health Institute, Lusaka 10101, Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-4164-8060","authenticated-orcid":false,"given":"Sekayi F.","family":"Tigere","sequence":"additional","affiliation":[{"name":"Basic Sciences and Immunology, Centre for Infectious Disease Research in Zambia, Lusaka 10101, Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7348-2835","authenticated-orcid":false,"given":"Michelo","family":"Simuyandi","sequence":"additional","affiliation":[{"name":"Basic Sciences and Immunology, Centre for Infectious Disease Research in Zambia, Lusaka 10101, Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3309-0538","authenticated-orcid":false,"given":"Nyuma","family":"Mbewe","sequence":"additional","affiliation":[{"name":"Zambia National Public Health 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UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9338-5119","authenticated-orcid":false,"given":"David A.","family":"Sack","sequence":"additional","affiliation":[{"name":"Center for Immunization Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7850-7915","authenticated-orcid":false,"given":"Caroline C.","family":"Chisenga","sequence":"additional","affiliation":[{"name":"Basic Sciences and Immunology, Centre for Infectious Disease Research in Zambia, Lusaka 10101, Zambia"},{"name":"Parasites and Microbes Programme, Wellcome Sanger Institute, Cambridge CB10 1SA, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,30]]},"reference":[{"key":"ref_1","unstructured":"World Health Organisation (WHO) (2024). Cholera Annual Report 2023, World Health Organisation."},{"key":"ref_2","unstructured":"World Health Organisation (WHO) (2024). Multi-Country Outbreak of Cholera, External Situation Report, World Health Organisation."},{"key":"ref_3","unstructured":"World Health Organization (WHO-AFRO) (2024). Monthly Regional Cholera Bulletin, World Health Organisation."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"107365","DOI":"10.1016\/j.ijid.2024.107365","article-title":"Coinfection and Clinical Impact of Enterotoxigenic Escherichia coli Harboring Diverse Toxin Variants and Colonization Factors: 2017\u20132022","volume":"151","author":"Amin","year":"2025","journal-title":"Int. J. Infect. Dis."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Chen, W.-C., and Lin, Y.E. (2024). Recent Advances in the Epidemiology of Pathogenic Agents. Pathogens, 13.","DOI":"10.3390\/pathogens13030263"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Islam, A., Labbate, M., Djordjevic, S.P., Alam, M., Darling, A., Melvold, J., Holmes, A.J., Johura, F.T., Cravioto, A., and Charles, I.G. (2013). Indigenous Vibrio cholerae Strains from a Non-Endemic Region Are Pathogenic. Open Biol., 3.","DOI":"10.1098\/rsob.120181"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Montero, D.A., Vidal, R.M., Velasco, J., George, S., Lucero, Y., G\u00f3mez, L.A., Carre\u00f1o, L.J., Garc\u00eda-Betancourt, R., and O\u2019Ryan, M. (2023). Vibrio cholerae, Classification, Pathogenesis, Immune Response, and Trends in Vaccine Development. Front. Med., 10.","DOI":"10.3389\/fmed.2023.1155751"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e082385","DOI":"10.1136\/bmjopen-2023-082385","article-title":"Acute Watery Diarrhoea Cases during Cholera Outbreak in Syria: A Cohort Study","volume":"14","author":"Arnaout","year":"2024","journal-title":"BMJ Open"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Kuma, G.K., Opintan, J.A., Sackey, S., Nyarko, K.M., Opare, D., Aryee, E., Dongdem, A.Z., Antwi, L., Ofosu-Appiah, L.H., and Owusu-Okyere, G. (2014). Antibiotic Resistance Patterns amongst Clinical Vibrio cholerae O1 Isolates from Accra, Ghana. Int. J. Infect. Control, 10.","DOI":"10.1016\/j.ijid.2014.03.594"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"845","DOI":"10.4269\/ajtmh.24-0558","article-title":"Increased Prevalence of Antimicrobial Resistance in Vibrio cholerae in the Capital and Provincial Areas of Zambia, January 2023\u2013February 2024","volume":"112","author":"Phiri","year":"2025","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2573-0282","DOI":"10.21767\/2573-0282.100064","article-title":"Aetiology of Diarrhoea in Children under Five in Zambia Detected Using Luminex xTAG Gastrointestinal Pathogen Panel","volume":"3","author":"Chisenga","year":"2018","journal-title":"Pediatr. Infect. Dis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"3077","DOI":"10.1128\/AEM.03516-14","article-title":"A Novel Triplex Quantitative PCR Strategy for Quantification of Toxigenic and Nontoxigenic Vibrio cholerae in Aquatic Environments","volume":"81","author":"Bliem","year":"2015","journal-title":"Appl. Environ. Microbiol."},{"key":"ref_13","first-page":"153","article-title":"Prevalence and Genetic Diversity of Norovirus in Acute Gastroenteritis Cases in the Southwest Province of Turkey","volume":"39","year":"2022","journal-title":"Balk. Med. J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1291","DOI":"10.1016\/S0140-6736(16)31529-X","article-title":"Use of Quantitative Molecular Diagnostic Methods to Identify Causes of Diarrhoea in Children: A Reanalysis of the GEMS Case-Control Study","volume":"388","author":"Liu","year":"2016","journal-title":"Lancet"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e30","DOI":"10.4081\/jphia.2011.e30","article-title":"Prevalence of Gastrointestinal Pathogens in Sub-Saharan Africa: Systematic Review and Meta-Analysis","volume":"2","author":"Fletcher","year":"2011","journal-title":"J. Public Health Afr."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Hlashwayo, D.F., Sigauque, B., Noormahomed, E.V., Afonso, S.M., Mandomando, I.M., and Bila, C.G. (2021). A Systematic Review and Meta-Analysis Reveal That Campylobacter Spp. and Antibiotic Resistance Are Widespread in Humans in Sub-Saharan Africa. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0245951"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Gahamanyi, N., Mboera, L.E.G., Matee, M.I., Mutangana, D., and Komba, E.V.G. (2020). Prevalence, Risk Factors, and Antimicrobial Resistance Profiles of Thermophilic Campylobacter Species in Humans and Animals in Sub-Saharan Africa: A Systematic Review. Int. J. Microbiol., 2020.","DOI":"10.1155\/2020\/2092478"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Corcionivoschi, N., and Gundogdu, O. (2021). Foodborne Pathogen Campylobacter. Microorganisms, 9.","DOI":"10.3390\/microorganisms9061241"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Veronese, P., and Dodi, I. (2024). Campylobacter Jejuni\/Coli Infection: Is It Still a Concern?. Microorganisms, 12.","DOI":"10.3390\/microorganisms12122669"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Potgieter, N., Heine, L., Ngandu, J.P., Ledwaba, S.E., Zitha, T., Mudau, L.S., Becker, P., Traore, A.N., and Barnard, T.G. (2023). High Burden of Co-Infection with Multiple Enteric Pathogens in Children Suffering with Diarrhoea from Rural and Peri-Urban Communities in South Africa. Pathogens, 12.","DOI":"10.3390\/pathogens12020315"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Hugho, E.A., Kumburu, H.H., Amani, N.B., Mseche, B., Maro, A., Ngowi, L.E., Kyara, Y., Kinabo, G., Thomas, K.M., and Houpt, E.R. (2023). Enteric Pathogens Detected in Children under Five Years Old Admitted with Diarrhea in Moshi, Kilimanjaro, Tanzania. Pathogens, 12.","DOI":"10.3390\/pathogens12040618"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Nhampossa, T., Mandomando, I., Acacio, S., Quint\u00f3, L., Vubil, D., Ruiz, J., Nhalungo, D., Sacoor, C., Nhabanga, A., and Nhacolo, A. (2015). Diarrheal Disease in Rural Mozambique: Burden, Risk Factors and Etiology of Diarrheal Disease among Children Aged 0\u201359 Months Seeking Care at Health Facilities. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0119824"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Breurec, S., Vanel, N., Bata, P., Chartier, L., Farra, A., Favennec, L., Franck, T., Giles-Vernick, T., Gody, J.-C., and Luong Nguyen, L.B. (2016). Etiology and Epidemiology of Diarrhea in Hospitalized Children from Low Income Country: A Matched Case-Control Study in Central African Republic. PLoS Negl. Trop. Dis., 10.","DOI":"10.1371\/journal.pntd.0004283"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Fran\u00e7ois, R., Yori, P.P., Rouhani, S., Siguas Salas, M., Paredes Olortegui, M., Rengifo Trigoso, D., Pisanic, N., Burga, R., Meza, R., and Meza Sanchez, G. (2018). The Other Campylobacters: Not Innocent Bystanders in Endemic Diarrhea and Dysentery in Children in Low-Income Settings. PLoS Negl. Trop. Dis., 12.","DOI":"10.1371\/journal.pntd.0006200"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Das, R., Nasrin, S., Palit, P., Sobi, R.A., Sultana, A.-A., Khan, S.H., Haque, M.A., Nuzhat, S., Ahmed, T., and Faruque, A.S.G. (2023). Vibrio cholerae in Rural and Urban Bangladesh, Findings from Hospital-Based Surveillance, 2000\u20132021. Sci. Rep., 13.","DOI":"10.1038\/s41598-023-33576-3"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1074","DOI":"10.1093\/aje\/kwx173","article-title":"Comprehensive Analysis of Prevalence, Epidemiologic Characteristics, and Clinical Characteristics of Monoinfection and Coinfection in Diarrheal Diseases in Children in Tanzania","volume":"186","author":"Moyo","year":"2017","journal-title":"Am. J. Epidemiol."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Imbrea, A.-M., Balta, I., Dumitrescu, G., McCleery, D., Pet, I., Iancu, T., Stef, L., Corcionivoschi, N., and Liliana, P.-C. (2024). Exploring the Contribution of Campylobacter Jejuni to Post-Infectious Irritable Bowel Syndrome: A Literature Review. Appl. Sci., 14.","DOI":"10.3390\/app14083373"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2725","DOI":"10.1007\/s00253-023-12456-w","article-title":"Campylobacter Jejuni: Targeting Host Cells, Adhesion, Invasion, and Survival","volume":"107","author":"Kemper","year":"2023","journal-title":"Appl. Microbiol. Biotechnol."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Tikhomirova, A., McNabb, E.R., Petterlin, L., Bellamy, G.L., Lin, K.H., Santoso, C.A., Daye, E.S., Alhaddad, F.M., Lee, K.P., and Roujeinikova, A. (2024). Campylobacter Jejuni Virulence Factors: Update on Emerging Issues and Trends. J. Biomed. Sci., 31.","DOI":"10.1186\/s12929-024-01033-6"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Makimaa, H., Ingle, H., and Baldridge, M.T. (2020). Enteric Viral Co-Infections: Pathogenesis and Perspective. Viruses, 12.","DOI":"10.3390\/v12080904"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"40","DOI":"10.4103\/0253-7184.156707","article-title":"Pattern of Co-Infection by Enteric Pathogenic Parasites among HIV Sero-Positive Individuals in a Tertiary Care Hospital, Mumbai, India","volume":"36","author":"Ahmed","year":"2015","journal-title":"Indian J. Sex. Transm. Dis. AIDS"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"40","DOI":"10.17140\/HARTOJ-4-126","article-title":"Intestinal Parasitemia and HIV\/AIDS Co-Infections at Varying CD4+ T-Cell Levels","volume":"4","author":"Tay","year":"2017","journal-title":"HIVAIDS Res. Treat.-Open J."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Caputo, V., Libera, M., Sisti, S., Giuliani, B., Diotti, R.A., and Criscuolo, E. (2023). The Initial Interplay between HIV and Mucosal Innate Immunity. Front. Immunol., 14.","DOI":"10.3389\/fimmu.2023.1104423"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1186\/1742-4690-7-54","article-title":"Innate Immune Recognition and Activation during HIV Infection","volume":"7","author":"Mogensen","year":"2010","journal-title":"Retrovirology"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1457","DOI":"10.4161\/hv.29199","article-title":"Maximizing Protection from Use of Oral Cholera Vaccines in Developing Country Settings","volume":"10","author":"Desai","year":"2014","journal-title":"Hum. Vaccines Immunother."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1586\/eri.12.23","article-title":"Immune Responses to Cholera in Children","volume":"10","author":"Leung","year":"2012","journal-title":"Expert Rev. Anti Infect. Ther."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1016\/j.vaccine.2012.11.012","article-title":"Immune Responses and Protection in Children in Developing Countries Induced by Oral Vaccines","volume":"31","author":"Qadri","year":"2013","journal-title":"Vaccine"},{"key":"ref_38","first-page":"71","article-title":"Determinants of Responses to Oral Vaccines in Developing Countries","volume":"66","author":"Sack","year":"2008","journal-title":"Ann. Nestl\u00e9 Engl. Ed."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"uxae124","DOI":"10.1093\/cei\/uxae124","article-title":"Geographic Disparities Impacting Oral Vaccine Performance: Observations and Future Directions","volume":"219","author":"Burke","year":"2025","journal-title":"Clin. Exp. Immunol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1111\/imr.12063","article-title":"HIV and Co-Infections","volume":"254","author":"Chang","year":"2013","journal-title":"Immunol. Rev."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jinf.2003.09.001","article-title":"AIDS in Africa: The Impact of Coinfections on the Pathogenesis of HIV-1 Infection","volume":"48","author":"Lawn","year":"2004","journal-title":"J. Infect."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"wraf104","DOI":"10.1093\/ismejo\/wraf104","article-title":"Pathogen-Pathogen Interactions during Co-Infections","volume":"19","author":"Ferreira","year":"2025","journal-title":"ISME J."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"8595","DOI":"10.1038\/s41467-024-52905-2","article-title":"Viral-Bacterial Co-Infections Screen in Vitro Reveals Molecular Processes Affecting Pathogen Proliferation and Host Cell Viability","volume":"15","author":"Walch","year":"2024","journal-title":"Nat. Commun."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1016\/S0140-6736(13)60844-2","article-title":"Burden and Aetiology of Diarrhoeal Disease in Infants and Young Children in Developing Countries (the Global Enteric Multicenter Study, GEMS): A Prospective, Case-Control Study","volume":"382","author":"Kotloff","year":"2013","journal-title":"Lancet"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1384","DOI":"10.4269\/ajtmh.21-0881","article-title":"Clinical Course of Children with Campylobacter Gastroenteritis with and without Co-Infection in Lima, Peru","volume":"106","author":"Munoz","year":"2022","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"909","DOI":"10.1007\/s10096-013-1825-9","article-title":"Coinfection in Acute Gastroenteritis Predicts a More Severe Clinical Course in Children","volume":"32","author":"Valentini","year":"2013","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"606","DOI":"10.3201\/eid1704100939","article-title":"Diarrheagenic Pathogens in Polymicrobial Infections","volume":"17","author":"Lindsay","year":"2011","journal-title":"Emerg. Infect. Dis."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Parker, C.T., Schiaffino, F., Huynh, S., Paredes Olortegui, M., Pe\u00f1ataro Yori, P., Garcia Bardales, P.F., Pinedo Vasquez, T., Curico Huansi, G.E., Manzanares Villanueva, K., and Shapiama Lopez, W.V. (2022). Shotgun Metagenomics of Fecal Samples from Children in Peru Reveals Frequent Complex Co-Infections with Multiple Campylobacter Species. PLoS Negl. Trop. Dis., 16.","DOI":"10.1371\/journal.pntd.0010815"},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Muteeb, G., Rehman, M.T., Shahwan, M., and Aatif, M. (2023). Origin of Antibiotics and Antibiotic Resistance, and Their Impacts on Drug Development: A Narrative Review. Pharmaceuticals, 16.","DOI":"10.20944\/preprints202306.1921.v1"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1097\/QCO.0000000000000447","article-title":"When Do Co-Infections Matter?","volume":"31","author":"McArdle","year":"2018","journal-title":"Curr. Opin. Infect. Dis."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"e02313","DOI":"10.1016\/j.idcr.2025.e02313","article-title":"Wrong Diagnosis\u2014Wrong Antimicrobials: Rise in Antimicrobial Resistance in Developing Countries","volume":"41","author":"Panda","year":"2025","journal-title":"IDCases"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"117","DOI":"10.9734\/ijpr\/2024\/v13i6326","article-title":"The Impact of Antimicrobial Resistance on Co-INFECTIONS: Management Strategies for HIV, TB and Malaria","volume":"13","author":"Ayomide","year":"2024","journal-title":"Int. J. Pathog. Res."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1016\/j.tim.2015.05.002","article-title":"The Potential Impact of Coinfection on Antimicrobial Chemotherapy and Drug Resistance","volume":"23","author":"Birger","year":"2015","journal-title":"Trends Microbiol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1122","DOI":"10.1093\/trstmh\/trab048","article-title":"Key Considerations on the Potential Impacts of the COVID-19 Pandemic on Antimicrobial Resistance Research and Surveillance","volume":"115","author":"Rossolini","year":"2021","journal-title":"Trans. R. Soc. Trop. Med. 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