bioRxiv2019
Confronted with the challenge of understanding population-level processes, disease ecologists and epidemiologists often simplify quantitative data into distinct physiological states (e.g. susceptible, exposed, infected, recovered). However, data defining these states often fall along a spectrum rather than into clear categories. Hence, the host-pathogen relationship is more accurately defined using quantitative data, often integrating multiple diagnostic measures, just as clinicians do to assess their patients. We use quantitative data on a bacterial infection (Leptospira interrogans) in California sea lions (Zalophus californianus) to improve both our individual-level and population-level understanding of this host-pathogen system. We create a \"host-pathogen space\" by mapping multiple biomarkers of infection (e.g. serum antibodies, pathogen DNA) and disease state (e.g. serum chemistry values) from 13 longitudinally sampled, severely ill individuals to visualize and characterize changes in these values through time. We describe a clear, unidirectional trajectory of disease and recovery within this host-pathogen space. Remarkably, this trajectory also captures the broad patterns in larger cross-sectional datasets of 1456 wild sea lions in all states of health. This mapping framework enables us to determine an individuals location in their time-course since initial infection, and to visualize the full range of clinical states and antibody responses induced by pathogen exposure, including severe acute disease, chronic subclinical infection, and recovery. We identify predictive relationships between biomarkers and outcomes such as survival and pathogen shedding, and in certain cases we can impute values for missing data, thus increasing the size of the useable dataset. Mapping the host-pathogen space and using quantitative biomarker data provides more nuanced approaches for understanding and modeling disease dynamics in a system, yielding benefits for the clinician who needs to triage patients and prevent transmission, and for the disease ecologist or epidemiologist wishing to develop appropriate risk management strategies and assess health impacts on a population scale.\n\nAuthor SummaryA pathogen can cause a range of disease severity across different host individuals, and these presentations change over the time-course from infection to recovery. These facts complicate the work of epidemiologists and disease ecologists seeking to understand the factors governing disease spread, often working with cross-sectional data. Recognizing these facts also highlights the shortcomings of classical approaches to modeling infectious disease, which typically rely on discrete and well-defined disease states. Here we show that by analyzing multiple biomarkers of health and infection simultaneously, treating these values as quantitative rather than binary indicators, and including a modest amount of longitudinal sampling of hosts, we can create a map of the host-pathogen interaction that shows the full spectrum of disease presentations and opens doors for new insights and predictions. By accounting for individual variation and capturing changes through time since infection, this mapping framework enables more robust interpretation of cross-sectional data; e.g., to detect predictive relationships between biomarkers and key outcomes such as survival, or to assess whether observed disease is associated with the pathogen of interest. This approach can help epidemiologists, ecologists and clinicians to better study and manage the many infectious diseases that exhibit complex relationships with their hosts.