lack of predictability, there is a certainty: dangerous “new” diseases will occur.
Living Off Others
The “germs” that caused SARS, Legionnaires’ disease, and TSS are parasites. To appreciate more fully the nature of these diseases as well as others and how they may be controlled, it helps to know a little more about parasites. No one likes to be called a parasite. The word suggests, at least to some, a repugnant alien creature that insinuates itself into us and cannot be shaken loose. Nothing could be further from the truth. Within the range of all that lives, some are unable to survive on their own, and they require another living being for their nourishment. These life-dependent entities are called parasites, from the Greek parasitos, meaning “one who eats at the table of another. “The business they practice, parasitism, is neither disgusting nor unusual. It is simply a means to an end: obtaining the resources needed for their growth and reproduction. We do the same—eating and breathing—in order to survive.
Parasitism is the intimate association of two different kinds of organisms (species) in which one benefits (the parasite) at the expense of the other (the host), and as a consequence of this, parasites often harm their hosts. The harm inflicted, with observable consequences, such as those seen in Commander Peter Turner and Mary Benton and those patients afflicted with SARS and Zika virus, is called “disease,” literally “without comfort.” Though parasites can be described by the one thing they are best known for—causing harm—they come in many different guises. Some may be composed of a fragment of genetic material wrapped in protein (virus).* Others consist of a single cell* (bacteria, fungi, and protozoa), and some are made up of many cells (roundworms, flatworms, mosquitoes, flies, and ticks). Some parasites, such as tapeworms, hookworms, malaria, and HIV, as well as the Zika and Ebola virus, live inside the body, whereas others (ticks and chiggers) live on the surface. Parasites are invariably smaller in mass than their host. Consider the size of malaria, a microparasite, and hookworm, a macroparasite. Both produce anemia, or, as one advertisement for an iron supplement called the condition, “tired blood.”
Figure 1.2 The Plague of Ashod by Nicolas Poussin (1594-1665).
The painting probably represents bubonic plague since rats are shown on the plinth
A malaria parasite lives within a red blood cell that is 1/5,000 of an inch in diameter. If only 10% of your blood cells were infected, the total mass of the malaria parasites would not occupy a thimble, and yet in a few days they could destroy enough of your red blood cells that the acute effects of blood loss could lead to death. In effect, you could die from an internal hemorrhage. Although the “vampire of the American South,” the bloodsucking, thread-like hookworm, is only 0.5 in. in length and 0.05 in. in girth, if your intestine harbored 50 worms, you would lose a cupful of blood a day. Yet the entire mass of worms would weigh less than 5 hairs on your head.
Some parasites have complex life cycles and may have several hosts. In malaria the hosts are mosquitoes and humans; in blood fluke disease, the “curse of the pharaohs,” the hosts are humans and snails; and in sleeping sickness the hosts are tsetse flies, game animals, and humans. All parasites—whether they are large or small—cause harm to their host, though not all kill their host outright. This is because resistance may develop in any population of hosts and not every potential host will be infected—some individuals may be immune or not susceptible due to a genetic abnormality or the absence of some critical dietary factor (vitamin deficiency).
To succeed in a hostile world where individual hosts are distinct and separate from one another, parasites need to disperse their offspring or infective stages to reach new hosts. To meet this requirement they produce lots of offspring, thereby increasing the odds that some of these will reach new hosts. It is a matter of numbers: more offspring will have a greater probability of reaching a host and setting up an infection. In this way the parasite enhances its chances for survival. Three cases will illustrate this: the red blood cell-destroying hookworms, malaria, and the white blood cell killer HIV.
When a malaria-infected mosquito feeds, it injects with its saliva perhaps a dozen of the thousands of parasites that are present in its salivary glands. Each malaria parasite invades a liver cell, and after a week each produces up to 10,000 offspring; in turn, every one of these infects a red blood cell. Within the infected red blood cell, a malaria parasite produces 10 to 20 additional infective forms to continue the destructive process. In little more than 2 weeks a person infected by a single malaria parasite will have produced >100,000 parasites, and 2 days later the blood will contain millions of malaria parasites.
Hookworms live attached to the lining of the small intestine, which they pierce with their razor-sharp teeth, allowing them to suck blood, as would a leech. Each female hookworm—no bigger than an eyelash—can live within the intestine for >10 years, producing each day >10,000 eggs. In her lifetime, this “Countess Dracula” can produce >36 million microscopic eggs.
The AIDS-causing virus, HIV, is a spherical particle so small that if 250,000 were lined up they would hardly be 1 in. in length. Each virus, however, has an incredible capacity to reproduce itself. After it invades a specific kind of white blood cell (the T-helper lymphocyte), where it replicates, a million viruses will be produced in a few short days. To gain some appreciation of the high reproductive capacity of this virus, we might think of the infecting HIV as a person standing on a barren stretch of beach; if we were to return to this beach a few days later, we would find it jammed and overcrowded with millions—a population explosion.
Any environment other than a living host is inimical to the health and welfare of the parasite. Some parasites have gotten around this with resistant stages such as spores, eggs, or cysts that enable them to move from one host to another in a fashion akin to “island hopping.” Hookworms, tapeworms, blood flukes, and pinworms have eggs that are able to survive outside the body; the microscopic cysts of the roundworm Trichinella are able to resist the ordinarily lethal effects of the acids in our stomach to cause trichinosis, and now we are all too familiar with the possibility of a bioterrorist attack from anthrax (p. 416), which has resistant spores that allow it to spread by inhalation of “anthrax dust.” The movement of a parasite from host to host—whether by direct or indirect means—is called transmission. When the transmission of parasites involves a living organism such as a fly, mosquito, tick, flea, louse, or snail, these “animate intermediaries” are called vectors. Transmission by a vector may be mechanical (e.g., the bite wound of a mosquito or fly) or developmental (e.g., parasites that grow and reproduce in snails in blood fluke disease, or in mosquitoes, as in malaria and yellow fever). Transmission of a parasite may also occur through contamination of eating utensils, drinking cups, food, needles, bedclothes, towels, or clothing, or in droplet secretions. In the 1976 outbreak of Legionnaires’ disease in Philadelphia, transmission was not from person to person but through a fine mist of water in the air conditioning system, whereas in the case of SARS (and influenza), transmission is from person to person via droplet secretions from the nose and mouth.
Parasites and their free-living relatives come in a variety of sizes, shapes, and kinds (species). Bacteria, 1 to 5 micrometers (µm) in size, are prokaryotes* that can be free-living or parasitic. They may assume several body forms: rods (bacilli), spheres (cocci), or spiral. Protozoa, 5 to 15 µm in size, are one-celled eukaryotes* that can lead an independent existence (such as the freshwater Amoeba sp.) or be parasitic (such as the Entamoeba sp. that causes amebic dysentery or the corkscrew-shaped trypanosomes that cause African sleeping sickness). Bacteria
