{"doi":"10.1371/journal.pcbi.1011624","title":"Network analysis of patterns and relevance of enteric pathogen co-infections among infants in a diarrhea-endemic setting","abstract":"Despite significant progress in recent decades toward ameliorating the excess burden of diarrheal disease globally, childhood diarrhea remains a leading cause of morbidity and mortality in low-and-middle-income countries (LMICs). Recent large-scale studies of diarrhea etiology in these populations have revealed widespread co-infection with multiple enteric pathogens, in both acute and asymptomatic stool specimens. We applied methods from network science and ecology to better understand the underlying structure of enteric co-infection among infants in two large longitudinal birth cohorts in Bangladesh. We used a configuration model to establish distributions of expected random co-occurrence, based on individual pathogen prevalence alone, for every pathogen pair among 30 enteropathogens detected by qRT-PCR in both diarrheal and asymptomatic stool specimens. We found two pairs, Enterotoxigenic E. coli (ETEC) with Enteropathogenic E. coli (EPEC), and ETEC with Campylobacter spp., co-infected significantly more than expected at random (both pairs co-occurring almost 4 standard deviations above what one could expect due to chance alone). Furthermore, we found a general pattern that bacteria-bacteria pairs appear together more frequently than expected at random, while virus-bacteria pairs tend to appear less frequently than expected based on model predictions. Finally, infants co-infected with leading bacteria-bacteria pairs had more days of diarrhea in the first year of life compared to infants without co-infection (p-value <0.0001). Our methods and results help us understand the structure of enteric co-infection which can guide further work to identify and eliminate common sources of infection or determine biologic mechanisms that promote co-infection.","journal":"PLoS Computational Biology","year":2023,"id":361437,"datarank":0.3453877639491069,"base_score":2.302585092994046,"endowment":2.302585092994046,"self_citation_contribution":0.3453877639491069,"citation_network_contribution":0.0,"self_endowment_contribution":0.3453877639491069,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":9,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9578,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1113697,"name":"Connor Klopfer","orcid":"0000-0002-8558-9752","position":1,"is_corresponding":false},{"id":689720,"name":"Dorothy M. Dickson","orcid":"0000-0003-1705-7575","position":2,"is_corresponding":false},{"id":415592,"name":"Benjamin Lee","orcid":"0000-0001-7213-5631","position":3,"is_corresponding":false},{"id":486578,"name":"Matthew J. Wargo","orcid":"0000-0001-5659-749X","position":4,"is_corresponding":false},{"id":257475,"name":"Md Ashraful Alam","orcid":"0000-0003-1389-8510","position":5,"is_corresponding":false},{"id":246860,"name":"Beth D. Kirkpatrick","orcid":"0000-0002-7016-7338","position":6,"is_corresponding":false},{"id":236040,"name":"Laurent Hébert‐Dufresne","orcid":"0000-0002-0008-3673","position":7,"is_corresponding":false},{"id":761549,"name":"E. Ross Colgate","orcid":null,"position":0,"is_corresponding":true}],"reference_count":40,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-07-19T01:14:10.680991Z","pmid":"37992129","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}