Latent coinfection and the maintenance of strain diversity

Bull Math Biol. 2009 Jan;71(1):247-63. doi: 10.1007/s11538-008-9361-y. Epub 2008 Dec 10.

Abstract

Technologies for strain differentiation and typing have made it possible to detect genetic diversity of pathogens, both within individual hosts and within communities. Coinfection of a host by more than one pathogen strain may affect the relative frequency of these strains at the population level through complex within- and between-host interactions; in infectious diseases that have a long latent period, interstrain competition during latency is likely to play an important role in disease dynamics. We show that SEIR models that include a class of latently coinfected individuals can have markedly different long-term dynamics than models without coinfection, and that coinfection can greatly facilitate the stable coexistence of strains. We demonstrate these dynamics using a model relevant to tuberculosis in which people may experience latent coinfection with both drug sensitive and drug resistant strains. Using this model, we show that the existence of a latent coinfected state allows the possibility that disease control interventions that target latency may facilitate the emergence of drug resistance.

MeSH terms

  • Basic Reproduction Number
  • Biodiversity*
  • Communicable Diseases / drug therapy
  • Communicable Diseases / microbiology*
  • Drug Resistance, Bacterial / genetics
  • Host-Pathogen Interactions* / drug effects
  • Host-Pathogen Interactions* / immunology
  • Humans
  • Incidence
  • Infectious Disease Incubation Period
  • Models, Biological*
  • Mycobacterium / drug effects
  • Mycobacterium / genetics
  • Mycobacterium / immunology
  • Nonlinear Dynamics
  • Selection, Genetic
  • Species Specificity
  • Tuberculosis / drug therapy
  • Tuberculosis / immunology
  • Tuberculosis / microbiology
  • Virus Latency* / physiology