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The meaning of microbial exposure, infection, colonisation, and disease in clinical practice
Liise-anne Pirofski1, Arturo Casadevall
1Department of Medicine, Division of Infectious Diseases, and Microbiology and Immunology, Albert Einstein College of Medicine and Montefiore Medical Center, New York 10461, USA. pirofski@aecom.yu.edu
Abstract:
The basic lexicon of infectious diseases includes the terms exposure, infection, colonisation, and disease, which are used to describe the clinical states in which the presence of a microbe in a host is suspected or discovered. Therefore, the lexicon is used to articulate an implied association between a host and a microbe. However, since it is often difficult to use the available clinical and diagnostic tools to discriminate the different ways in which microbes can exist in a host, the lexicon is often used in an ambiguous and imprecise manner. Another factor contributing to imprecise use of the lexicon is that microbial factors are often held responsible for disease pathogenesis. This relegates the part that the host plays in microbial pathogenesis to an exception, which leads to the need for qualification and modification of the terminology of infectious diseases. Recently, we proposed the "damage-response framework" to incorporate the contributions of both the host and the microbe in microbial pathogenesis in a synthesis whereby host damage was used as the common denominator to describe the outcome of the host-microbe relation. In this article, we illustrate how the application of the damage-response framework to clinical infectious diseases can clarify and make more precise the terminology used to convey the outcome of microbial infection in clinical practice.
Insights
The damage-response framework clarifies infectious disease terminology by focusing on host damage. This approach improves precision in describing host-microbe interactions and outcomes in clinical practice.
Area of Science:
- Microbiology
- Infectious Diseases
- Host-Pathogen Interactions
Background:
- Standard infectious disease lexicon (exposure, infection, colonization, disease) often lacks precision.
- Difficulty in distinguishing microbial presence states and overemphasis on microbial factors contribute to imprecise terminology.
- Existing terms inadequately capture the host's role in pathogenesis.
Purpose of the Study:
- To introduce and illustrate the application of the damage-response framework for infectious diseases.
- To enhance clarity and precision in the terminology used for host-microbe interactions.
- To provide a unified approach for describing the outcomes of microbial infections.
Main Methods:
- Proposal of the damage-response framework, emphasizing host damage as a common denominator.
- Application of the framework to clinical infectious disease scenarios.
- Analysis of how the framework clarifies existing terminology.
Main Results:
- The damage-response framework offers a more precise way to describe host-microbe relationships.
- It synthesizes the contributions of both host and microbe in pathogenesis.
- Clinical application demonstrates improved clarity in terminology.
Conclusions:
- The damage-response framework enhances the precision of infectious disease lexicon.
- It provides a valuable tool for clinicians and researchers to describe infection outcomes.
- This framework promotes a more accurate understanding of host-pathogen dynamics.