The Four Horsemen of the Microbocalypse

Also known as Sidin's third cousins

Interacting Intimately With The Local Amoeba

So this story begins a few days after I (i.e. Sidin) got back home after a rather illuminating road trip with some friends through parts of central and western Europe. This was… let me think… nine years ago. So, our car full of boisterous boys bantered our way through Lithuania, Estonia, Czechia, Poland, and Switzerland (not in that order because that would be weird) before dispersing to our respective homes. We did many cool things such as drink, eat, walking tour, listen to jazz music, tourist attractions and so on. It was extremely memorable.

And then a few days after I got back home my back began to ache. Constantly. And severely. And none of the usual remedies seemed to work. Painkillers. New pillows. Changed posture. Massages. Yoga. NOTHING. So far, so bad. And then things got worse. I got a fever. And, just like the backache, it was un-fucking-relenting. Hot, exhausting, relentless.

What followed was a series of medical institutions each finding absolutely no cause for my pain and fever. It was all proving to be very idiopathic. Blood test after blood test suggested some sort of severe infection and yet there was nothing on my body except lean muscle and chiselled abs. Meanwhile, the doctors began to ask the most indecent questions. And sometimes in front of my family. “Sidin”, the doctor would ask, “when you went on your road trip with these male friends of yours, did you interact with any locals?” “Yes of course,” I said, “is not interaction the point of perambulation?” And then the doctor said, “Yes ok but did you interact overly intimately with any of the locals?”

Illustration of Sidin interacting intimately with the local Amoeba

The outrage. Of course not, I said. The closest I got to intimate interaction was when I made a droll joke to the Prague tourist guide about whether she accepted payments in cash or… Czech(!) and she playfully ran over my feet with her Segway and then kept going and going and I had to find another tourist guide.

Then after that my father-in-law, who was visiting, pulled me aside and started: “Sidin… sometimes men make mistakes…"

I ended up being admitted into a hospital, hooked up to saline and painkillers. For a couple of days, I was poked and prodded randomly until eventually, one doctor decided to p&p me in the liver area. I yelped in pain. Proper yelp.

Eureka Forbes! They found it. A table tennis ball-shaped amoebic abscess in my liver. A little lump of… pus basically. Due to infection by amoeba. Over the next few days, I was scanned repeatedly, medicated with something called Metronidazole, and further poked and prodded but this time with much greater purpose and precision. And then one extremely eccentric radiologist took me to a scanner of some sort and over an hour or so rapidly, and painfully, drained my liver. All the while high-fiving me, singing songs, and generally displaying excessive tomfoolery.

I am perfectly fine now my friend. However, this kind of thing apparently can come back. Amoeba, it seems, can hang around one’s body indefinitely and then suddenly strike without warning.

But instead what happened was Krish intervened with a story about… beer and fungi.

Yeast or West, Candida is the best

Thank you Sidin. And that tale of amoebic abscess and chiselled abs brings us to beer, a drink that Sidin should have consumed instead of tap water in Warsaw which resulted in him becoming the world’s first person to suffer from a third-world disease in a first-world setting. So, let me ask you, the reader, a simple question.

What connects beer, crocodiles basking in the sun, a dangerous fungal infection, 98.6 Fahrenheit, and an apocalyptic asteroid collision?

If the answer is - “Lots of beer”, that would technically be right. With enough beer, all things will seem connected, but I assure you, these items are soberly connected in quite the most astonishing fashion.

Beer, despite being one of mankind’s oldest alcoholic beverages, was always an artisanal endeavour till the Industrial revolution. The idea is to invite a friendly fungus named Saccharomyces to come and feast upon the starchy goodness of cereal grains such as wheat, barley, maize, rice, and oats and in that process, convert those starches to alcohol and ceremonially fart out carbon dioxide that ultimately makes a fizzy and pleasantly sour drink.

The key to making consistent tasting beer is to control the brewing temperature very precisely. Yeast operates at its maximum efficiency at certain temperatures and any variation tends to produce wildly off-flavours.

The best beer in Europe used to (and still is) made in Trappist monasteries in Belgium where monks would produce small batches every year, and it was only when a certain Michael Combrune figured out that using a newfangled device in the 18th century known as the thermometer, invented by one Daniel Gabriel Fahrenheit, made large-scale beer production precise and consistent. Now, where did he learn about the thermometer? It was from the papers of a certain Dr Hermann Boerhaave who pioneered the use of thermometers in medicine.

This brings us to 98.6 Fahrenheit, the temperature we consider to be, on average, "normal" body temperature. The use of thermometers in hospitals saved millions of lives because, for the first time, it let doctors detect illnesses ahead of time and precisely. But we shall ask a more interesting question - why 98.4F? Why is our body temperature not higher or lower than that? In fact, all mammals have an internal temperature in this range, so it begs the question - why? Would a slightly lower temperature not save us a ton of energy? Even one degree less would require us to eat a lot less food daily. Maintaining our body temperature takes most of the energy we consume as food, so why didn’t evolution prefer, well, slightly chilled-out mammals?

To answer this question, we first have to take a detour and head back to our friendly beer-brewing microbe, the Saccharomyces yeast. Yeast is a single-celled fungus that has been around for hundreds of millions of years and we know about 1,500 varieties of them. Some of them, like the Candida family of yeasts, are opportunistic pathogens who, instead of helping us turn grains into beer, like colonizing our bodies and making us rather unwell. In the early 2010s, there was a mysterious outbreak of a surprisingly lethal yeast infection in multiple places in the developed world at around the same time, thus ruling out transmission by human travel. Medical forensics ultimately revealed the culprit to be Candida auris and to understand why this microbe was suddenly causing some rather nasty yeast infections in kids in the 2010s, we need to take our biggest detour to date - both in terms of time and place - to the Yucatan peninsula 66 million years ago.

One day, 66 million years ago, an asteroid collided with our planet in the Yucatan peninsula and wiped out three-quarters of all life on the planet. In fact, it’s estimated that no animal over 25 kgs survived. This is the event that caused the extinction of dinosaurs. Among the animals that survived this apocalypse were these tiny, shrew-like underground things that were some of the earliest known mammals. One of these female shrews was the great great great ….(N)…great great grandmother of every human on the planet today.

So this brings us to our next question (and I know, I seem to be asking questions rather than giving answers, but bear with me, it will all come together like an elaborate Sidin joke) - while that collision killed off the large dinosaurs, clearly, some reptiles survived - turtles, tortoises & crocodiles, for instance. But why don’t reptiles dominate the planet today? Think about it. Where such a collision happens, dust from the earth tends to be dispersed in the sky blocking out the sun for many years and thus causing what’s usually called a nuclear winter. This tends to lower the earth’s surface temperature by many degrees and one might also imagine that food might not be easy to come by. So, in such conditions, who has better survival chances? A cold-blooded reptile that only needs to eat once in a few days and does not have to waste energy keeping itself warm or a mammal that needs to constantly feed itself and also deal with the cold temperatures?

You’d be tempted to think - the surviving reptiles should have still have steamrolled over those tiny shrews in the post-apocalyptic world of 66 million years ago, except it’s time to ask our last question - Guess what other living thing likes low temperatures? Yep, fungi! Now, one of the reasons reptiles tend to bask in the sun is to heat up their bodies enough to keep fungal infections at bay. Mammals don’t have that problem because they maintain an unholy 98.6F internal temperature. In fact, the 2 places where humans tend to suffer from yeast infections are all places that are wet and cold - sweaty feet and vaginas. And guess what is in short supply after a massive asteroid impact? Sunlight! So, the hypothesis by scientists is that the post-collision world was a veritable reptile-featured buffet for fungi, and that is what gave mammals the head-start they badly needed.

So mammals slowly started dominating the planet and here we are. Sipping craft beer brewed with precision thermometers originally used by doctors to measure 98.6F, the temperature that keeps yeast infections at bay. But of course, that’s not the end of the story. It turns out that, at least in the west, average body temperatures are going down. In many places, kids now have as low as 97.5F as body temperatures, and there are many reasons for this - Lower metabolic rates, an overall reduction in instances of inflammation due to better medical care etc. If we don’t get infected as often as used to in the past, we don’t need to maintain a high internal temperature, it turns out.

But what this means is that a Candida auris yeast, with the genetic memory of 66 million years is now realizing that, like reptiles in the post-apocalyptic world back then, humans with a lowered body temperature are, to put it mildly, fair game. One realizes that this is not the kind of scaremongering one needs in the middle of a viral pandemic with multicoloured fungi sidekicks but relax. Our body temperatures aren’t falling that fast, and unlike viruses, we know how to cure fungal infections.

Hotel Havoc

Sidin here again. And this is where I came back in to briefly talk about an outbreak of Legionnaire’s disease that, as a listener told us afterwards, is considered one of the textbook cases of epidemiological studies. I won't bore you with the very exciting details. But in 1976 around 2000 members of something called the American Legion attended a three-day convention at the Bellevue-Stratford Hotel in Philadelphia. A few weeks later almost 150 of these “Legionnaires" and another three dozen people all fell with a mysterious illness that no one could immediately identify. Later 29 of these patients died. 

It took six months for the CDC to even identify the disease and its cause—a bacterium later named Legionella Pneumophila. And it turned out that the bacteria was hiding away in the hotel’s ventilation system.

What makes this outbreak so important in the annals of epidemiology is that it led to the development of many of the protocols that outfits like the CDC use today to spot, identify and then react to outbreaks of various kinds. Before Legionnaire’s, for instance, there were no standard protocols for field scientists and laboratory researchers to communicate and cooperate on outbreak response. Legionnaire’s and the bacterium behind it changed all that.

It is a great, and sadly all-too resonant, story.

The 15-million year Pandemic

Ashok again. If you are thinking, when on earth the covid pandemic will end and life will get back to normal, I’d like to remind everyone that during the late Oligocene, there was a viral pandemic that lasted 15 million years. How do we know? Well, it’s literally in our genes! Retroviruses (of which the most infamous modern example is HIV) use their RNA to reverse engineer their DNA using a host cell and this particular virus, rather anticlimactically named ERV-Fc (because virologists have no imagination) jumped across species so many times that it has left behind its viral DNA in most mammalian species surviving today! One thing we have that those mammals in the Oligocene didn’t have - VACCINES!. Please get vaccinated and help as many people get vaccinated as soon as possible to beat Covid-19.

Parting Thoughts

• This week’s Salem junction is in support of Railway Children of India, who are on the front line of the Covid19 crisis in India, helping over 18,000 street children with life-saving supplies. One of the railway stations they work with is - Salem Junction. Kindly do the needful and donate generously.

• Do listen to this fantastic Radiolab episode - Fungus Amungus that covers the connection between Candida fungal infections in 2010 with the asteroid collision 66 million years ago

• Sidin has written a military-medium-paced, right-arm-over-the-wicket thriller set in India about a deadly disease and the heroic efforts to contain the plague before it’s too late