Le Bonheur Children's Hospital Pediatrician-in-Chief Jon McCullers, MD, was recently invited to submit a review in the April issue of Nature Reviews Microbiology, one of the world's foremost scientific publications. Dr. McCullers, an infectious disease specialist, and chair of the Department of Pediatrics at the University of Tennessee Health Science Center, analyzed the epidemiology and microbiology of co-infections during the 1918, 1957 and 1968 pandemics, as well as more recent 2009 novel H1N1 pandemic.
He reviewed the co-pathogenesis of influenza viruses with bacteria in the lung. Bacterial superinfection in the lungs of those suffering from influenza is a key element that promotes severe disease and mortality.
The co-pathogenesis McCullers reviewed is characterized by complex interactions between co-infecting pathogens and the host, leading to the disruption of physical barriers, dysregulation of immune responses and delays in a return to homeostasis.
The net effect of this cascade can be the outgrowth of the pathogens, immune-mediated pathology and increased morbidity.
McCullers calls for large-scale studies involving consortia or clinical networks to unlock the next unanswered questions about co-infections and viruses in order to prevent the loss of life of a pandemic similar to the one in 1918.
"There is increasing recognition that most pneumonia is caused by co-infections rather than a single pathogen, and the most severe disease seen in influenza pandemics is mediated by co-infecting bacteria working with the virus," said McCullers. "The scientific community must help the world prepare for the next pandemic by understanding a set of key, unanswered questions that are addressed in this review."
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