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The Magnitude and Diversity of Infectious Diseases

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The Magnitude and Diversity of Infectious Diseases Chapter 1 The Magnitude and Diversity of Infectious Diseases “All interest in disease and death is only another expression of interest in life.” Thomas Mann THE IMPORTANCE OF INFECTIOUS DISEASES IN TERMS OF HUMAN MORTALITY According to the U.S. Census Bureau, on July 20, 2011, the USA population was 311 806 379, and the world population was 6 950 195 831 [2]. The U.S. Central Intelligence agency estimates that the USA crude death rate is 8.36 per 1000 and the world crude death rate is 8.12 per 1000 [3]. This translates to 2.6 million people dying in 2011 in the USA, and 56.4 million people dying worldwide. These numbers, calculated from authoritative sources, correlate surprisingly well with the widely used rule of thumb that 1% of the human population dies each year. How many of the world’s 56.4 million deaths can be attributed to infectious diseases? According to World Health Organization, in 1996, when the global death toll was 52 million, “Infectious diseases remain the world’s leading cause of death, accounting for at least 17 million (about 33%) of the 52 million people who die each year” [4]. Of course, only a small fraction of infections result in death, and it is impossible to determine the total incidence of infec- tious diseases that occur each year, for all organisms combined. Still, it is useful to consider some of the damage inflicted by just a few of the organisms that infect humans. Malaria infects 500 million people. About 2 million people die each year from malaria [4]. About 2 billion people have been infected with Mycobacterium tuber- culosis. Tuberculosis kills about 3 million people each year [4]. Each year, about 4 million children die from lung infections, and about 3 million children die from infectious diarrheal diseases [4]. Rotaviruses are one of many causes of diarrheal disease (Group III Viruses, Chapter 41). J.J. Berman: Taxonomic Guide to Infectious Diseases. DOI: http://dx.doi.org/10.1016/B978-0-12-415895-5.00001-5 © 2012 Elsevier Inc. All rights reserved. 3 4 PART | I Principles of Taxonomy In 2004, rotaviruses were responsible for about half a million deaths, mostly in developing countries [5]. Worldwide, about 350 million people are chronic carriers of hepatitis B, and about 100 million people are chronic carriers of hepatitis C. In aggre- gate, about one quarter (25 million) of the hepatitis C chronic carriers will eventually die from ensuing liver diseases [4]. Infectious organisms can kill individuals through mechanisms other than through the direct pathologic effects of growth, invasion, and inflammation. Infectious organisms have been implicated in vascular disease. The organ- isms implicated in coronary artery disease and stroke include Chlamydia pneumoniae and Cytomegalovirus [6]. Infections caused by a wide variety of infectious organisms can result in cancer. About 7.2 million deaths occur each year from cancer, worldwide. About one-fifth of these cancer deaths are caused by infectious organisms [7]. In Europe, 60À70% of liver cancer cases are caused by hepatitis C virus; 10À15% of liver cancer is caused by hepatitis B infection [8]. Organisms contributing to cancer deaths include bacteria (Helicobacter pylori), animal parasites (schistosomes and liver flukes), and viruses (Herpesviruses, Papillomaviruses, Hepadnaviruses, Flaviviruses, Retroviruses, Polyomaviruses). Though fungal and plant organisms do not seem to cause cancer through human infection, they produce a multitude of biologically active secondary metabolites (i.e., synthesized molecules that are not directly involved in the growth of the organism), some of which are potent carcinogens. For example, aflatoxin produced by Aspergillus flavus, is possibly the most powerful carcinogen ever studied [9]. In summary, infectious diseases are the number one killer of humans worldwide, and they contribute to vascular disease and cancer, the two lead- ing causes of death in the most developed countries. These observations clearly indicate that every healthcare professional, not just infectious disease specialists, must understand the biology of infectious organisms. A listing of the number of occurrences of some common infectious diseases is provided in Appendix II. ONLY A SMALL PERCENTAGE OF TERRESTRIAL ORGANISMS ARE PATHOGENIC IN HUMANS Given all the suffering caused by infectious organisms, you might begin to wonder whether the majority of terrestrial life-forms are devoted to the annihilation of the human species. Not to worry. Only a tiny fraction of the life forms on earth are infectious to humans. The exact fraction is hard to estimate because nobody knows the total number of terrestrial species. Most taxonomists agree that the number is in the millions, but estimates range from a few million up to several hundred million. It is worth noting that species counts, even among the most closely scrutinized classes of organisms, are prone to underestimation. In the past, the Chapter | 1 The Magnitude and Diversity of Infectious Diseases 5 rational basis for splitting a group of organisms into differently named species required, at the very least, heritable functional or morphologic differences among the members of the group. Gene sequencing has changed the rules for assigning new species. For example, various organisms with subtle differences from Bacteroides fragilis have been elevated to the level of species based on DNA homology studies. These include Bacteroides distasonis, Bacteroides ovatus, Bacteroides thetaiotaomicron,andBacteroides vulgatus [10]. For the sake of discussion, let us accept that there are 50 million species of organisms on earth (a gross underestimate by some accounts). There have been about 1400 pathogenic organisms reported in the medical literature. This means that if you should stumble randomly upon a member of one of the species of life on earth, the probability that it is an infectious pathogen is about 0.000028. Of the approximately 1400 infectious organisms that have been recorded somewhere in the medical literature, the vast majority of these are “case report” items; instances of diseases that have, to the best of anyone’s knowledge, occurred once or a handful of times. They are important to epidemiologists because today’s object of medical curiosity may emerge as tomorrow’s global epidemic. Very few of these ultra-rare causes of human disease ever gain entry to a clinical microbiology textbook. Textbooks, even the most comprehensive, cover about three hundred organisms (excluding viruses) that are considered clinically important. In this book, we will cover about 350 living organisms and about 150 viruses within the main text. The Appendix lists about 1400 organisms (common, rare, and ultra-rare). This may seem like way too much to learn, but do not despair. Infectious agents fall into a scant 40 biological classes (32 classes of living organisms plus seven classes of viruses plus one class of prions). When you’ve learned the basic biology of the major taxonomic divisions that contain all the infec- tious organisms, you will understand the fundamental biological features that characterize every clinical organism. Almost everything else you need to learn can be acquired from web resources. Chapter 2 What is a Classification? “Deus creavit, Linnaeus disposuit,” Latin for “God Creates, Linnaeus organizes.” Carolus Linnaeus CLASSIFICATIONS DRIVE DOWN THE COMPLEXITY OF KNOWLEDGE DOMAINS The human brain is constantly processing visual and other sensory informa- tion collected from the environment. When we walk down the street, we see images of concrete and asphalt and grass and other persons and birds and so on. Every step we take conveys a new world of sensory input. How can we process it all? The mathematician and philosopher Karl Pearson (1857À1936) has likened the human mind to a “sorting machine” [11]. We take a stream of sensory information and sort it into objects, and then we collect the individual objects into general classes. The green stuff on the ground is classified as “grass”, and the grass is subclassified under some larger groups such as “plants”. Flat stretches of asphalt and concrete may be classified under “road” and the road might be subclassified under “man-made constructions”. If we did not have a culturally determined clas- sification of objects in the world, we would have no languages, no ability to communicate ideas, no way to remember what we see, and no way to draw general inferences about anything at all. Simply put, without classification, we would not be human. Every culture has some particular way to impose a uniform way of perceiving the environment. In English-speaking cultures, the term “hat” denotes a universally recognized object. Hats may be composed of many different types of materials, and they may vary greatly in size, weight, and shape. Nonetheless, we can almost always identify a hat when we see one, and we can distinguish a hat from all other types of objects. An object is not classified as a hat simply because it shares a few structural similarities with other hats. A hat is classified as a hat because it has a relationship to every other hat, as an item of clothing that fits over the head. Likewise, all biological classifications are built by relationships, not by similarities [12]. J.J. Berman: Taxonomic Guide to Infectious Diseases. DOI: http://dx.doi.org/10.1016/B978-0-12-415895-5.00002-7 © 2012 Elsevier Inc. All rights reserved. 7 8 PART | I Principles of Taxonomy GENERAL PRINCIPLES OF CLASSIFICATION Oddly enough, despite the importance of classification in our lives, few humans have a rational understanding of the process of classification; it’s all done for us on a subconscious level. Consequently, when we need to build and explain a formal classification, it can be difficult to know where to begin. As an example, how might we go about creating a classification of toys? Would we arrange the toys by color (red toys, blue toys, etc.), or by size (big toys, medium-sized toys), or composition (metal toys, plastic toys, cotton toys).
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