The co-pathogenesis of influenza viruses with bacteria in the lung

Nat Rev Microbiol. 2014 Apr;12(4):252-62. doi: 10.1038/nrmicro3231. Epub 2014 Mar 3.


Concern that a highly pathogenic virus might cause the next influenza pandemic has spurred recent research into influenza and its complications. Bacterial superinfection in the lungs of people suffering from influenza is a key element that promotes severe disease and mortality. This co-pathogenesis is characterized by complex interactions between co-infecting pathogens and the host, leading to the disruption of physical barriers, dysregulation of immune responses and delays in a return to homeostasis. The net effect of this cascade can be the outgrowth of the pathogens, immune-mediated pathology and increased morbidity. In this Review, advances in our understanding of the underlying mechanisms are discussed, and the key questions that will drive the field forwards are articulated.

Publication types

  • Review

MeSH terms

  • Bacterial Infections / etiology*
  • Bacterial Infections / microbiology
  • Bacterial Infections / virology
  • Coinfection / microbiology*
  • Coinfection / virology*
  • Humans
  • Influenza, Human / complications*
  • Influenza, Human / microbiology
  • Influenza, Human / virology
  • Lung / microbiology
  • Lung / pathology
  • Lung / virology
  • Pneumonia, Bacterial / etiology*
  • Pneumonia, Bacterial / microbiology
  • Pneumonia, Bacterial / virology
  • Pneumonia, Viral / complications*
  • Pneumonia, Viral / microbiology
  • Pneumonia, Viral / virology
  • Superinfection / microbiology
  • Superinfection / virology