Early Release – Infectious: Pathogens and How We Fight Them – Volume 29, Number 4 – April 2023 – Emerging Infectious Diseases journal

John S Tregoning, PhD

Oneworld Publications, New York, New York, 2021 ISBN13: 9780861541225; Pages: 384; Price: $25.95 (hardcover), $30.62 (audiobook: Dreamscape Media, LLC; Mike Cooper, narrator; 9 hrs 35 mins)


Figure. Infectious: pathogens and how we fight them

Outbreaks of infectious diseases can have profound societal impacts (1), as underscored by the ongoing COVID-19 pandemic (2). Infectious: Pathogens and How We Fight Them, by John S. Tregoning, celebrates research dedicated to understanding and fighting harmful microbes (pictured). An immunologist at Imperial College, London, Tregoning writes an accessible, authoritative introduction that covers topics such as microbiology, epidemiology, and therapeutic solutions. He describes advances in pathogen identification techniques that have influenced scientific approaches to controlling, preventing, and even eliminating pathogens. He acknowledges pioneers such as Linnaeus and Gram and their work in categorizing organisms and distinguishing bacteria (3). He also sheds light on the topic of pathogen-host interactions and genetic changes: “Most mutations result in nonsense…a tiny number… [help] Pathogens escape the immune response and adapt to drugs.”

The book provides readers with a concise description of innate and adaptive immunity, including how specific immune memory emerges when adaptive cells recognize, for example, a viral SARS-CoV-2 spike protein. Tregoning provides an overview of how antibodies and T and B cells orchestrate immune responses and discusses how lifelong immunity can occur after recovery from certain diseases such as measles. He shares a moving tribute to Brigitte Askonas for her contributions to our understanding of immune memory after she was forced to leave her homeland in 1938 because of her Jewish heritage. Tregoning also emphasizes that science thrives on diversity and inclusion, and credits trailblazers like Alice Ball, an African American, for the first treatment for leprosy, and Tu Youyou, a Chinese scientist, for the discovery of artemisinin, an antimalarial drug.

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Tregoning convincingly explains why an accurate diagnosis is crucial for epidemiological investigations and therapeutic interventions. He provides examples of how causes of mysterious diseases have been determined, including Chlamydia psittaci-associated pneumonia among US seafarers in 1929 and more recent clusters of SARS-CoV-2 infections transmitted by asymptomatic individuals. His optimistic assumption that we will continue to prevail against pathogenic microbes is supported by descriptions of breakthroughs in research on antimicrobials, smallpox, malaria and COVID-19. It offers optimistic predictions about future advances, such as elucidating the host-specific response to infection and using artificial intelligence to detect outbreaks. However, the author’s good prospects are tempered by the realization of undesirable consequences of improper use of antimicrobial drugs.

Discussions about the threatening aspects of pathogens are countered with humorous observations and heartfelt vignettes. Tregoning at one moment jokingly describes Félix d’Hérelle’s “rather striking beard/mustache combination” and later describes how he cried uncontrollably after his son recovered from the respiratory syncytial virus. Referring to how Barry Marshall identified the cause of gastric ulcers, he notes: “[He] proved the connection by intentionally contracting Helicobacter pylori, which earned him an ulcer and a Nobel Prize.”

The book’s focus on “logics” and therapeutics does not fully address the social drivers of pathogens or address barriers to science-based interventions (5). Tregoning also missed an opportunity to emphasize the need to strengthen the global mechanism for reporting outbreaks and an improved integrated one-health approach to evolving threats (6,7).

Infectious will appeal to diverse audiences including biomedical trainees and policy makers as it transforms the discussion of harmful microbes into an engaging narrative. The book is an entertaining and insightful celebration of mankind’s achievements in the never-ending battle against pathogens. The audio version of the book comes with clarity and is rewarding.

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