For those of you who have an ear tuned to the media’s noise about germ this, bacteria that, this blog post may resonate with you. I was just reading this article recently published in Nature about B. pseudomallei, a bacteria that causes meliodosis. The authors found that the bacteria is more globally distributed than previously believed and that its infection rates are extremely underreported. Now does this come as a surprise to you?
With the exemption of the main culprits, it is extremely difficult to figure out which bacteria is the cause of an infection. The result? Underreported and unreliable geographical distribution of infection-causing bacteria. Not only can the symptoms of the same bacterial infection manifest themselves in different forms depending on the host, but also the symptoms for bacterial infections are all more or less the same. In other words, a bacterial infection is easy to identify, but the kind of bacteria is not. Doctors have tools they can use to make their ‘best guess’ as to what is causing the infection including current prevalence, geographic location, possible site of entry, common symptoms, response to treatment, etc. However, if the bacteria cannot be cultured and/or antibiotics have already killed off the bug, it is an even harder question to answer. We still have diagnostic tools to identify the bug at this point — that’s pretty cool – but financial restraints dampen this effort even for those persistent and curious enough. If the infection is cured with antibiotics — why bother?
Ah, great question. Let’s go back to the story of B. pseudomallei. This bacteria, being a soil microbe, is naturally resistant to many antibiotics. This results in extremely high fatality rates (the paper reports the figure of >70%), most likely due to not getting the correct treatment in time. The researchers made a model of where they expect to find B. pseudomallei, which not surprisingly overlapped with many countries that lack the advanced resources to identify the bug and therefore have unreported cases. In theory, if we can diagnosis the bacteria quickly and have reference to the best treatment model, we wouldn’t be dealing with fatality statistics at all. Welcome to the hamster wheel that prevents any profound progress in reducing fatalities due to bacterial infections.
We need molecular biologists to make quick diagnostic tools so we can identify the cause of bacterial infections in a timely manner. We need microbiologists to help them figure out how to do this, and to provide current information about antibiotic resistance. We need doctors to help these scientists, as they are responsible for treatment and patients come to them. We need policy to aid in the reporting and communication about any and all bacterial infections. Limits and restrictions come from every angle. Not one player can step up to the plate without help from the others. Combined with the dynamic characteristic of bacteria (for example, the acquisition of antibiotic resistance), it seems like we are faced with an impossible task. My rant comes not from frustration, but fright as we enter an era of unprecedented antibiotic resistant bacteria that can spread around the world at lightening speed. I predict that since we haven’t figured out a universal system for dealing with bacterial infection diagnosis and treatment by now, we’ll be hearing about dangerous germ this, deadly bacteria that for a long time.
I am a pathologist in a community hospital. One of the issues here is that my lab, and, most likely, most labs like it, do not have the ability to diagnose organisms that cannot be cultured unless serological tests are available. DNA sequencing is not available in laboratories like mine, and it will not be until there is greater demand and a willingness on the part of third party payers to reimburse for such testing. Hospitals in the US are operating on razor thin margins and cannot afford to absorb these costs.
Obviously, there are issues with providing even basic services in some parts of the world, and that needs to be addressed as well.