Epidemiological trends and serological profiles of respiratory pathogens in Guangzhou: an 11-year retrospective study from 2013 to 2023

Background: Respiratory pathogens pose significant public health challenges globally, particularly in densely populated urban areas. This study aimed to analyze the epidemiological trends of multiple respiratory pathogens in Guangzhou, China, from 2013 to 2023, and investigate associated serological profiles to inform clinical management and public health interventions.

Methods: We conducted a retrospective analysis of 96,927 cases with suspected respiratory infections (SRIs) (defined by fever >37.5 ℃, cough, dyspnea, and/or chest pain) at The First Affiliated Hospital of Guangzhou Medical University. Clinical data were extracted from electronic medical records, and immunofluorescence assays were used to detect immunoglobulin M (IgM) antibodies against nine respiratory pathogens.

Results: Of the cases analyzed, 18.01% (17,454/96,927) tested serologically positive for at least one respiratory pathogen. Mycoplasma pneumoniae (MP) was the predominant pathogen (76.51% of serologically positive cases), followed by parainfluenza viruses (PIVS) (9.75%). The highest serologically positive rate was observed in the 5–14 age group (36.01%). Females exhibited a significantly higher overall serologically positive rate (21.30%) compared to males (15.97%, P<0.001). Serological analysis revealed profiles in confirmed infections, with significantly lower coagulation-related parameters (P<0.001) and some elevated inflammatory markers compared to suspected cases.

Conclusions: This comprehensive study provides crucial insights into the changing landscape of respiratory pathogen infections in Guangzhou over an 11-year period. The predominance of MP, particularly among school-age children and females, highlights the need for targeted interventions. The unexpected coagulation profiles in confirmed infections suggest complex pathophysiological mechanisms that warrant further investigation. These findings have important implications for clinical management, diagnostic approaches, and public health strategies in urban settings.

Keywords: Respiratory pathogens; epidemiology; serological profiles; Mycoplasma pneumoniae (MP); urban China

 

Highlight box

Key findings

• This 11-year retrospective study of 96,927 cases in Guangzhou revealed an 18.01% overall positive rate for respiratory pathogens, with Mycoplasma pneumoniae (MP) emerging as the predominant pathogen (76.51%). The study identified significant age and gender variations, with the highest infection rates observed in children aged 5–14 years (36.01%) and a notable female predominance in infection susceptibility (21.30% versus 15.97% in males). Serological analysis demonstrated distinct coagulation profiles in confirmed infections.

What is known and what is new?

• Prior research has established respiratory infections as significant public health concerns globally, with documented age-dependent distribution patterns and seasonal variations, particularly in urban settings.

• This study provides unprecedented insights through its comprehensive 11-year surveillance of multiple respiratory pathogens in southern China, revealing an exceptionally high prevalence of MP compared to other regions. The research uniquely identifies a significant gender disparity in infection rates and characterizes previously undocumented coagulation profiles in confirmed respiratory infections, suggesting complex underlying pathophysiological mechanisms.

What is the implication, and what should change now?

• These findings underscore the necessity for enhanced surveillance systems and targeted intervention strategies in urban settings, particularly in subtropical regions. The observed demographic patterns indicate the need for age- and gender-specific approaches to infection prevention and management. The distinctive coagulation profiles in confirmed infections suggest the importance of integrating coagulation monitoring into clinical protocols. These results should inform the development of more effective, population-specific public health strategies for respiratory infection control in rapidly urbanizing regions.