This article from the Departments of Microbiology and Immunology and Medicine at Albert Einstein College of Medicine is one of the best articles that I’ve read in a while as it addresses the idea and concept of pathogenicity very well. At the same time, I consider it to be an indictment on the poor state of medicine as it is currently practiced. Conversely, it vindicates the centuries old approach to healing as practiced by holistic doctors around the world – http://www.biomedcentral.com/1741-7007/10/6
Pathogen vs. Non-pathogen –
“…this takes us to an ongoing debate that dates back to the late 19th century when the [Pasteur] germ theory of disease was established. …even then it was obvious that neat classifications were problematic, for it was known that a microbe could be attenuated in the laboratory, but virulence could be restored by passage in a host, suggesting that the same microbe could exist in pathogenic and non-pathogenic states.”
Pasteur’s famous confession on is deathbed that he was wrong about his germ theory was in reference to this as he finally realized that the interaction between the host and the microbe was the determining factor for infection, not the microbe itself. Pasteur’s theory was openly opposed by scientists at the time, as they better understood the host-microbe interaction, however Pasteur held a government position allowing him to craft “official” policy (similar to what’s happening at the FDA today). The pharmaceutical industry has found it to be more profitable to market Pasteur’s germ theory, instead of his later understanding and now current science’s opinion, that the host-microbe interaction is the most important consideration.
“…properties conferring pathogenicity depend as much on the host as they do on the microorganism…it was developments in the 20th century that clearly obliterated the hope of ever drawing a clear and unequivocal line of distinction between pathogens and non-pathogens. Beginning in the 1950s the introduction of broad spectrum antimicrobial agents, immunosuppressive therapies, newer types of surgery, including organ transplantation and joint replacement, implantable devices and indwelling catheters, each of which alters host-microbe interactions, turned out to create conditions in which the host became vulnerable to microbes that were previously considered non-pathogenic. As a result, it became apparent that many microbes previously considered non-pathogenic, or rarely pathogenic, such as Staphylococcus epidermis and Candida albicans, could cause serious disease.”
I would correct the 3rd line to “Beginning in the late 1940s” as that was when antibiotics were introduced and there was a significant jump in fungal Candida albicans cases. The early 1950s saw an even more significant jump in candida albicans cases, along with a strong push in research around candida infections and resulting conditions, as antibiotic use continued to escalate. Of those therapies listed above, it was antibiotic use that created the most significant change. Here we start to see why the medical profession isn’t readily willing to look at systemic fungal Candida as a result of antibiotic use. The widespread use of antibiotics creates an even greater problem by altering the host’s ability to resist infections that are created by their use. Antibiotics empower the pathogen and weaken the host. Some antibiotics have been implicated as a direct trigger for then conversion of the normal yeast form of Candida to it’s pathogenic fungal form. Most research shows that it alters the host terrain, creating the conditions necessary to cause the yeast-fungal conversion.
“Antibiotics make people more vulnerable to microbe-mediated damage because they alter the microbiota, or the normal microbial flora, and the balanced relationships between the microbes that reside in the mucosal niches in the body and the host structures that support these communities. Surgery can have the same effect by removing or altering normal mucosal and cutaneous barriers to infection. So the effects of antibiotics and surgery enhance the pathogenicity of microbes that do not ordinarily cause damage or disease in normal microbial communities, or intact mucosal and cutaneous surfaces, by making the host more susceptible to damage or invasion.”
Is there any more that needs to be said? Thank you Albert Einstein College! You do your namesake great credit. I would like to say more, however. Antibiotic use is not only associated with these immediate effects, but they can permanently alter the make-up of the intestinal flora, and are being implicated in more serious diseases and conditions such as life-threatening colitis, diabetes, cancers, obesity, and a host of as yet other unknown diseases – http://www.plosbiology.org/article/info:doi/10.1371/journal.pbio.0060280
“many microbes that cause disease are already present in the individual and the individual is thus already ‘infected’. This is exemplified by microbes such as staphylococci and Candida spp., which are actually present in most individuals, but only cause disease in some. This also applies to many other microbes, including those to which an individual is immune, either through prior infection or through vaccination, as immune individuals are recognized as being resistant to the capacity of a microbe to cause disease.”
Health is a state of constant vigilance and maintenance. When you consider that most everyone already carries a heavy body burden of tens of thousands of chemicals and heavy metals from the environment, foods, and water from past exposures, and is constantly faced with even more, it becomes clearer how maintaining health has become an challenge.
“…when a host is immune, pathogenicity is not expressed. What is important to recognize is that pathogenicity and virulence are microbial properties that can only be expressed in a susceptible host.”
Health is a state of constant vigilance and maintenance. Worth repeating.
“…pathogenicity is an outcome of host-microbe interaction and is thus inextricably linked to characteristics of the host as well as those of the microbe. Rather than distinguishing commensals from pathogens/non-pathogens, the immune system of healthy hosts actually depends on these microbes. Commensals (also called the microbiota) are acquired by infection soon after birth, after which they establish residence in mucosal niches where they replicate, and there is increasing evidence that the microbiota play a crucial role in the development of the immune system and that the immune response to the bacteria in mucosal niches helps maintain barriers to invasion on surfaces exposed to potentially harmful microorganisms. The commensal bacteria themselves do no harm, provided that the immune system and mucosal barriers remain normal and intact. The immune system provides a large variety of tools – cells and molecules – that recognize, react to and control microbial growth and invasion, often in a manner that does not result in host damage or disease, and when this happens, there is no readout. In this instance, the immune system might be thought to have distinguished a pathogen from a non-pathogen, but in fact, it simply controls microbial growth and/or invasion in a manner that does not translate into microbial pathogenicity.”
The intestinal tract is an ecosystem composed of bacteria and other micro-organisms. As a whole, it doesn’t matter if some are pathogenic and some are commensal/friendly. They all exist in a harmonious state, as long as the host is healthy. Antibiotics disrupt this harmony.
“An interesting paradox occurs in the case of two bacteria that produce toxins generally regarded as factors increasing the virulence of the microbe: staphylococci that produce a so-called leukocidin, and pneumococci that produce a toxin called pneumolysin. Because these toxins also activate the innate immune response, bacteria that do not produce them can sometimes be more pathogenic than bacteria that do. Thus, when the immune response to a microbe is insufficient, microbial factors can cause damage, and when microbial factors fail to stimulate the immune system, the microbe can disseminate and cause disease.”
The standard medical approach is to see everything as bad and the body doesn’t know what its doing, regardless of what science continues to reveal. It’s not a black and white picture, it’s everything taken as a whole. These type of paradoxes in the human body are present everywhere. As I constantly point out to people when I lecture, we know about 1% of what goes on in the human body.
“At the other end of the spectrum, when the immune response to a microbe is too exuberant, it can be the immune response itself that is responsible for the pathology. When damage occurs in this setting, it is most commonly due to detrimental inflammation and can occur whether the microbe is controlled or contained or not.”
Crohn’s, IBS, IBD, and Colitis are good examples of this. Some authors have stated that most autoimmune diseases originate with imbalances in the intestinal tract.
“There is no difference between an opportunistic pathogen and any other kind of pathogen. Both are microbes and both have the potential to cause damage/disease in a host. The definition that is often used for opportunistic pathogens is that these microbes cause disease in people with impaired immunity but not in normal individuals. However, this definition is purely operational: the same microbe – consider Candida albicans and Staphylococcus epidermidis – can cause disease in one individual but live harmlessly in others, which means that the same microbe would be called an opportunist in one individual and a commensal in another. Indeed, the identification of certain microbes as a cause of disease in certain hosts can unmask or be a sentinel for an underlying immunodeficiency.”
Another way to look at this is, “if you have an infection, it’s diagnostic of a deficient or altered immune response.” One of the most consistent effects of antibiotic use is suppression of the immune system. It doesn’t make sense to suppress the immune system further, when it is already struggling. The reason that most doctors use it and most people continue to turn to its use is that it suppresses the normal immune response that causes the common symptoms of fevers, aches, and pains. It is the suppression of the normal inflammatory response that makes people “feel” better, but at the same time alters the natural healing process of the body. This process is necessary to promote ongoing immune function and improvement of health in the body. Pharmaceutical companies through advertising have raised a generation of doctors and consumers believing that we shouldn’t have to deal with that. We need to quit interfering with the body’s normal healing process by using drugs.
“…there are only microbes and hosts and the outcomes of their interactions, which include commensalism, colonization, latency and disease. Hence, attempts to classify microbes as pathogens, non-pathogens, opportunists, commensals and so forth are misguided because they attribute a property to the microbe that is instead a function of the host, the microbe, and their interaction.”
The entire approach of antibiotic use is severely questioned with the