Latent Infections: Dormant Pathogens, Reactivation Risks, and Public Health Impact

A latent infection is a state where a pathogen persists in the host without active replication or symptoms, yet retains potential to reactivate and transmit.

Key Features

• Pathogen genome persists (integrated or episomal).
• Host immune control maintains dormancy.
• Reactivation triggered by immunosuppression, stress, aging, comorbidities.
• Carrier can transmit during reactivation (sometimes asymptomatically).

Major Examples

Public Health Implications

• Asymptomatic shedding → transmission.
• Screening: LTBI (IGRA/TST), HIV, HSV in pregnancy.
• Preventive therapy: INH/rifapentine for LTBI; ART for HIV; valganciclovir for CMV in transplant.
• Vaccines: VZV (shingles), future HSV/TB/HIV.

Understanding latency is crucial for eradication strategies and managing immunocompromised patients.

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Pathogen	Latent Reservoir	Reactivation Disease
HSV-1/2	Sensory ganglia (trigeminal/sacral)	Cold sores, genital herpes
VZV	Dorsal root ganglia	Shingles (herpes zoster)
EBV	B lymphocytes	Mono, lymphomas, NPC
HIV	CD4+ T cells (integrated provirus)	AIDS (if ART fails); reservoir barrier to cure
M. tuberculosis	Granulomas (lung)	Active TB (5–10% lifetime risk)
CMV	Myeloid progenitors	Retinitis, colitis (immunocompromised)