review · Journal of Fish Diseases
Tilapia frequently suffer from co-infections, where two or more bacterial, viral, parasitic, or fungal pathogens infect the same host simultaneously or consecutively. These concurrent infections often interact synergistically, and more rarely antagonistically, increasing disease severity, raising host susceptibility, and heightening the likelihood of major outbreaks. Despite their prevalence across various tilapia species, knowledge of the exact pathogenic mechanisms and pathogen interactions remains limited. This gap exists partly because health management often focuses solely on a single dominant pathogen, leaving co-infecting organisms untreated. Raising awareness of co-infections, their clinical signs, and their distinct disease courses is critical for fish health specialists and tilapia producers seeking to establish consistent diagnostics and develop improved control strategies.
Tilapia farming is a crucial source of aquatic protein, but multi-pathogen infections complicate disease identification and treatment. When health specialists target only the most visible pathogen, neglected co-infectious agents can sustain disease outbreaks. Understanding these combined infections helps fish farmers and aquatic veterinarians improve diagnostic accuracy, reduce stock losses, and apply more effective health management strategies across aquaculture operations.
The insights are relevant to tilapia producers, aquaculture health managers, and diagnostic developers. The work is at an early review stage, outlining the need for comprehensive diagnostic protocols and holistic treatment regimens that target multiple pathogens simultaneously rather than isolated agents. Real-world application depends on translating these insights into field-ready multi-pathogen screening tools and tailored therapeutic strategies for fish farms.
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Co-infections commonly arise when two or multiple different pathogens infect the same host, either as simultaneous or as secondary concurrent infection. This potentiates their pathogenic effects and leads to serious negative consequences on the exposed host. Numerous studies on the occurrence of the bacterial, parasitic, fungal and viral co-infections were conducted in various tilapia species. Co-infections have been associated with serious negative impacts on susceptible fish because they increase the fish susceptibility to diseases and the likelihood of outbreaks in the affected fish. Co-infections can alter the disease course and increase the severity of disease through synergistic and, more rarely, antagonistic interactions. In this review, reports on the synergistic co-infections and their impacts on the affected tilapia species are highlighted. Additionally, their pathogenic mechanisms are briefly discussed. Tilapia producers should be aware of the possible occurrence of co-infections and their effects on the affected tilapia species and in particular of the clinical signs and course of the disease. To date, there is still limited information regarding the pathogenicity mechanisms and pathogen interactions during these co-infections. This is generally due to low awareness regarding co-infections, and in many cases, a dominant pathogen is perceived to be of vital importance and hence becomes the target of treatment while the treatment of the co-infectious agents is neglected. This review article aimed at raising awareness regarding co-infections and helping researchers and fish health specialists pay greater attention to these natural cases, leading to increased research and more consistent diagnosis of co-infectious outbreaks in order to improve control strategies to protect tilapia when infected with multiple pathogens.
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DOI: 10.1111/jfd.13164
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