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An asymptomatic carrier (healthy carrier or just carrier) is a person or other organism that has become infected with a pathogen, but who displays no symptoms. Although unaffected by the pathogen themselves, carriers can transmit it to others.[1]

Typhoid fever

History

Mary Mallon, known as "Typhoid Mary", was an asymptomatic carrier of Salmonella enterica serovar typhi, the causative agent of typhoid fever.[2] She worked as a cook for several families in New York City at the beginning of the twentieth century and she also cooked for the soldiers. Several cases of typhoid fever in members of those families were traced to her by the Health Department. It appeared that she "carried" the infectious agent without becoming sick. At the time, there was no way of eradicating the disease. Because typhoid is spread primarily through fecal-oral transmission, most of Mary Mallon's transmission risk was thought to arise from her continued involvement in occupations involving food preparation and handling. New York City's public health officials initially sought to merely restrict her from such employment rather than permanently quarantining her. When she continued to be non-compliant, the Health Commission ordered that she be quarantined on one of the islands surrounding Manhattan. She remained there until her death. Richard Gilbert was another prolific asymptomatic carrier.

Typhoid Mary appeared perfectly healthy, but infected about 50 people before she was quarantined. Scientists calculate that between 1% and 6% of individuals infected with Salmonella typhi become chronic, asymptomatic carriers like Mary.[3]

Dr. Denise Monack[4] and others set out to discover just how the bacterium that causes typhoid fever can remain dormant in humans after infection. To do this, she developed a mouse model. Unfortunately, S. typhi can only infect humans, but S. typhimurium, a closely related strand, can infect both mice and humans. It was discovered the infection can last in the system of mice for almost their entire lifetimes. The bacterium takes refuge in macrophages, which are inflammatory attack cells that digest invading pathogens. However, by examining the gut lymph nodes of the mice, 42 days after infecting them, it was determined the S. typhimurium actually changes the inflammatory response of the macrophages. Instead of eliciting an inflammatory response from the attack cells, the bacterium switches them into an anti-inflammatory mode, allowing it to survive within the macrophage.[3]

Cause

Typhoid fever is an ailment caused by bacterium Salmonella enterica ser. Typhi. An individual can acquire this infection from consuming risky foods or drinks, or by consuming foods or drinks prepared by an infected individual. (Hence, Typhoid Mary.) Those who recover from this infection can still carry the bacteria in their cells, and therefore be asymptomatic.[5]

HIV

HIV infection has a long period during which the person is asymptomatic.[6] Although the host may not be experiencing symptoms, the virus can still be passed on to others. It is also possible for the infection to become symptomatic after this latent period. Whether the host is showing symptoms or not, opportunistic infections can take advantage of the weakened immune system and cause further complications.[7]

Epstein-Barr Virus (EBV)

Many carriers are infected with persistent viruses such as Epstein-Barr Virus (EBV), which is a member of the herpes virus family. Studies show that about 95% of adults have antibodies against EBV, which means they were infected with the virus at some point in their life.[8]

Clostridium difficile

Clostridium difficile has also been shown to be spread by asymptomatic carriers, and poses significant problems in care home settings.[9]

Chlamydia

Chlamydia, an STI that affects both men and women, can also be asymptomatic in most individuals. Although the infection is not yielding any symptoms, it can still damage the reproductive system. If the infection goes unnoticed for a long time, the infected individual(s) are at risk of developing pelvic inflammatory disease (PID). Like Chlamydia, PID can also be asymptomatic. [10]

Poliomyelitis

A small number of asymptomatic carriers (referred to as chronic excretors) continue to produce active virus for years (or even decades) after their initial exposure to the oral Sabin vaccine.[11] Carriers of the attenuated virus unintentionally spread the attenuated virus, inoculating others, giving them contact immunity; however some adults with weak immune systems have contracted paralytic polio from contact with recently immunized children. Carriers of virulent strains spread polio, increasing the difficulty of poliomyelitis eradication.

References

  1. ^ "Dictionary Definition". Medical-dictionary.thefreedictionary.com. Retrieved 20 August 2013. 
  2. ^ "Scientists get a handle on what made Typhoid Mary's infectious microbes tick". Med.stanford.edu. Archived from the original on 18 August 2013. Retrieved 20 August 2013. 
  3. ^ a b "Scientists get a handle on what made Typhoid Mary's infectious microbes tick News Center Stanford Medicine". med.stanford.edu. 2013-08-14. Retrieved 2016-02-14. 
  4. ^ "Denise M. Monack". WikiGenes. Retrieved 2016-02-14. 
  5. ^ "CDC - Typhoid Fever: General Information - NCZVED". Cdc.gov. Retrieved 2016-02-14. 
  6. ^ Siliciano, Robert F. "HIV Latency". Cold Spring Harbor Laboratory Press. Retrieved 20 August 2013. 
  7. ^ "Asymptomatic HIV infection: MedlinePlus Medical Encyclopedia". Nlm.nih.gov. 2016-02-02. Retrieved 2016-02-14. 
  8. ^ "The Broad Spectrum of Epstein-Barr Virus (EBV) Disease on". Medicinenet.com. Retrieved 2016-02-14. 
  9. ^ Riggs, M. M.; Sethi, A. K.; Zabarsky, T. F.; Eckstein, E. C.; Jump, R. L. P.; Donskey, C. J. (2007). "Asymptomatic Carriers Are a Potential Source for Transmission of Epidemic and Nonepidemic Clostridium difficile Strains among Long-Term Care Facility Residents". Clinical Infectious Diseases. 45 (8): 992–998. doi:10.1086/521854. PMID 17879913. 
  10. ^ "STD Facts - Chlamydia". cdc.gov. Retrieved 2016-02-14. 
  11. ^ Ousmane M. Diop; Cara C. Burns; Roland W. Sutter; Steven G. Wassilak; Olen M. Kew. "Update on Vaccine-Derived Polioviruses — Worldwide, January 2014–March 2015". Morbidity and Mortality Weekly Report. 64: 640–646. 
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