On Equilibrium & Balance in Your Microbial Universe

Two recent studies that shed light on the inner workings of our bacterial ecosystems, otherwise known as our microbiome, have me musing on the nature of disease and pathology, of harmony and balance.

The first study caused a stir in the media with its admittedly unorthodox solution to a brutal bacterial infection; I’m speaking of the infamous “fecal transplant” study conducted in the Netherlands that was used to treat chronic, untreatable C. difficile infections. Commonly referred to as “C. diff,” this infection is notoriously difficult to cure, not to mention a dreadful and painful nuisance in those afflicted. Many researchers know that the infection can be attributed to a bacterial imbalance in the gut, a “persistent disturbance with a reduced diversity of intestinal microbiota (1).” When a population of C. diff bacteria edge out existing gut flora beneficial to your intestinal ssytem, they establish a dominant presence that’s marked by severe abdominal pain, appetite loss and watery diarrhea that can lead an unfortunate individual to use the restroom up to 15 times each day. The ominously named fecal transplant in question is a radical method of restoring balance to the gut, infusing processed feces laden with good bacteria from a donor into the gut of a person afflicted with C. diff. The goal, and a successful one at that, is to replace C. diff with a more amenable population of fecal bacteria.

The second study that’s been on my mind concerns those wicked bacteria on your face that cause the dreaded “z word” – zits! Though you may not know it, your face is host to several strains of the skin-dwelling bacteria Propionibacterium acnes. Researchers at the University of California, Los Angeles and Washington University have found that people who suffer from acne have a greater preponderance of two particular strains of P. acnes, R4 and R5, than clear-skinned folk, who have a greater proportion of strain R6. Their study suggests that blemishes and pimples may be a result of an asymmetry or population imbalance between the good and malevolent strains of P. acnes. The force is within us and it is a battle for clear smooth skin.

A few of the microorganisms that comprise the body’s system of microbiomes. There is an interactive version at Scientific American that you can play with here. Image: Bryan Christie for Scientific American. Click for source.

Yes, I know the subject is gross – poop and pimples, great! – but these recent studies reinforce a compelling idea about our microbiomes that has been brewing for a few years: that some infectious diseases may be due in part to a disharmonious balance between pathogenic bad-guy bacteria and our resident commensal good-guy bacteria. The day-to-day working of our bodies – our gurgling gut, the relentless give-and-take of our lungs and even the zinging neurotransmitters in our brains – relies on equilibrium and balance in our ecosystems.

This may sound a little wishy-washy, maybe even a little New Age-y, but we’ve seen this phenomenon before on a macro-scale. We’ve seen it with the invasion of cane toads and rabbits in Australia and the ensuing devastation of the country’s ecology. Most of us see it everyday around 7 am and 5 pm on our highways. Heart attacks and arterial congestion, runaway climate change, and the United States subprime mortgage crisis and housing bubble.

At a time when we are plowing through our available stockpile of antibiotics to treat bacterial infections, giving some consideration to the exciting ideas unearthed by these studies might change the very way that we treat and think of microbial diseases. What other human diseases could be attributed to asymmetrical microbial warfare, to a disruption in the harmony of our microbial communities? What ailments could we treat by adding healthy bacteria to a bad situation? Wounds seething away with MRSA? Urinary tract infections in women? What of obesity and anxiety? The possibilities may not endless, but they may very well be within us.


“The infusion of donor feces is a potential therapeutic strategy against recurrent C. difficile infection (01).” Find out more about the “fecal transplant” procedure used to treat recurrent C. diff infections here.

For more on the battle between good and bad P. acnes strains, check out this write-up of the acne study here at Wired.

“Microbes defy a simple notion of individuality. They are essential to our biology, and they travel with us from birth to death. Yet they also flow between us, and can be found in water, food and soil.” A lovely article by Carl Zimmer, “Our Microbiomes, Ourselves” at the NYT.

Discover the organisms that comprise the body’s microbiome in this neat interaction here.


(1) E van Nood et al. (2013 ) Duodenal Infusion of Donor Feces for Recurrent Clostridium difficile. N Engl J Med 2013. 368: 407-415

(2) S Fitz-Gibbon et al. (2013) Propionibacterium acnes Strain Populations in the Human Skin Microbiome Associated with Acne. J Invest Dermatol. Epub ahead of print.

van Nood, E., Vrieze, A., Nieuwdorp, M., Fuentes, S., Zoetendal, E., de Vos, W., Visser, C., Kuijper, E., Bartelsman, J., Tijssen, J., Speelman, P., Dijkgraaf, M., & Keller, J. (2013). Duodenal Infusion of Donor Feces for Recurrent Clostridium difficile. New England Journal of Medicine, 368 (5), 407-415 DOI: 10.1056/NEJMoa1205037

A Nepalese Odysseus: XDR-TB is in South Texas

The Wall Street Journal has a superb write-up of a Nepalese man infected with extremely drug resistant tuberculosis (XDR-TB) who is currently detained at the US border in South Texas. XDR-TB is resistant to four of the major types of antibiotics that are used to treat and control TB infections and this man is the first person with this particularly dangerous strain of TB  to cross the border and be quarantined in this country (1).

Traveling in all of the modern ways known to man – by foot, car, boat and plane – the man ventured from his home in Nepal, traipsing through South Asia, flying to Brazil and hoofing it through Central America until reaching the southernmost tip of Texas.

From the WSJ,

His three-month odyssey through 13 countries – from his homeland of Nepal through South Asia, Brazil, Mexico, and finally into Texas – shows the way in which dangerous new strains of the disease can migrate across the world unchecked.

The Nepalese patient was taken into custody by the U.S. Border Patrol in late November as he tried to cross the border illegally near McAllen, Texas, according to Department of Homeland Security officials. The government declined to name him. He was transferred five days later to an Immigration and Customs Enforcement detention facility in Los Fresnos, Texas, and put into “medical isolation” with suspected tuberculosis.

 His XDR strain has been seen only once before in the U.S., in another patient of Nepalese origin, according to the government description.

A map of the U.S. Quarantine Stations. Staffed with quarantine medical and public health officers from CDC, they're located at 20 ports of entry and land-border crossings where international travelers arrive. Image: CDC. Click for source.

A map of the U.S. Quarantine Stations. Staffed with quarantine medical and public health officers from CDC, they’re located at 20 ports of entry and land-border crossings where international travelers arrive. Image: CDC. Click for source.

Our Nepalese man has innocently launched a global public health dilemma: of the potentially thousands of people that this man came across in his odyssey, who else has he infected? It will be a herculean and futile task for public health officers as many of the people that he may have passed on this pathogen are in a similar socioeconomic, nomadic situation – fellow tenacious migrants that quickly move from one place to another in their journey for economic sanctuary and personal salvation.

This case is a powerful reminder that globalization and innovations in travel have radically changed the rules of the game for dangerous and communicable infectious diseases. Of the 950,000 international travelers that arrive in the United States every single day, good public health institutions like the US quarantine stations scattered throughout the country are vital to monitoring hitch-hiking drug-resistant pathogens (2).

Please click here to read the WSJ’s article “Dangerous TB Patient Detained on U.S. Border.”

Note: To be specific, XDR-TB is resistant to the two first-line drugs, isoniazid and rifampin, used to treat TB initially, plus any fluoroquinolone and at least one of three injectable second-line drugs (i.e., amikacin, kanamycin, or capreomycin).


A fact sheet from the CDC on XDR-TB.


(1) B McKay (March 1, 2013) Dangerous TB Patient Detained on U.S. Border. Wall Street Journal. Accessed on March 7, 2013 here.

(2) CDC (August 3, 2012) Public Health Interventions Involving Travelers with Tuberculosis — U.S. Ports of Entry, 2007–2012. MMWR. 61(30); 570-573.

Centers for Disease Control and Prevention (CDC) (2012). Public health interventions involving travelers with tuberculosis–U.S. ports of entry, 2007-2012. MMWR. Morbidity and mortality weekly report, 61 (30), 570-3 PMID: 22854625

May the Vaccines Be With You!


The poster for the clever Star Wars Public Service Announcement featuring C-3PO and R2-D2 from the CDC and the Department of Health, Education, and Welfare encouraging parents to vaccinate their children against preventable infections. Click for source.

What is the best way to persuade parents to get their kids vaccinated against preventable diseases? Tug sentimentally at the heartstrings? Appeal to common sense and logic? Shame and blame?

Or how about going the pop culture route and using characters from one of the most popular movies in history as the CDC and the Department of Health, Education, & Welfare did in April 1978?

The poster on the right and the short commercial below feature the characters C-3PO and R2-D2 speaking directly to the “parents of Earth” on the necessity of vaccinating their children fully against polio, measles and whooping cough and the dangers of not doing so. As C-3PO admonishes a coughing R2-DC, “Droids don’t get diseases like whooping cough, or measles, or polio. But children do. All you need is a little rewiring but children need to be fully immunized but, alas, so many are not.”

I think it’s a particularly inspired moment in public health propaganda. If you’re going to convince wary parents to get their children vaccinated, why not use the Force?

– Rebecca Kreston


See more public health posters from the National Library of Medicine’s exhibition, “To Your Health: An Exhibition of Posters for Contemporary Public Health Issues.”

Washington state is the midst of a whooping cough epidemic – there were 4,815 cases of the disease last year – and certain types of vaccines may be to blame for a drop in efficiency and protection over time. Maryn McKenna goes into greater detail here.

The White House just quashed a petition for the country to “secure resources and funding, and begin construction of a Death Star by 2016.” Paul Shawcross, the Chief of the Science and Space Branch at the White House Office of Management and Budget, has a very inspiring and feel-good letter about why the Death Star will not be built but that the USA is on the right track for space exploration irregardless.


Wookieepdia: The Star Wars Wiki. (Unknown date of publishing) “Star Wars Immunization PSA.” Accessed January 15, 2013 here.

Boyle, Eric (September 23, 2003) “Infectious Disease: Immunization.” From the  Visual Culture & Public Health Posters Exhibit. National Institutes of Health [Online.] Accessed January 15, 2013 here.