Space & Innovation

Superbug Named 'Phantom Menace': Here's Why

Make a disease name 'clickable' and it gets eradicated more quickly, say health experts.

Which would you click on: a story about a threatening bacteria called carbapenem-resistant Enterobacteriaceae (CRE) producing OXA-48-like carbapenemases or one about a scary germ headlined the Phantom Menace?

Unless you're a microbiologist, we're guessing you chose the Star Wars-inspired term. In fact, they refer to the same bacteria: a potentially devastating superbug that is resistant to antibiotics - and spreading in the United States.

The name of the germ plays a huge role in how the public perceives it (and that, in turn, can affect everything from how research gets funded to how successfully it is curtailed).

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"I think naming has a real function," said Lance Price, director of the Antibiotic Resistance Action Center at George Washington University's Milken Institute of Public Health. "People don't want us to use terms like carbapenem-resistant Enterobacteriaceae producing OXA-48-like carbapenemases, and we need people to pay attention."

He calls the news that a superbug gene recently found in China that has already infected someone in Denmark the worst he's heard in a long time.

The term "Phantom Menace" conveys the way "this bug and others of its ilk spread around the world unnoticed until they reach a critical mass," Price said.

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It's an ideal term by almost every measure: it's accurate, it's a reference almost everyone gets, and the timing couldn't be better, with Star Wars Episode VII opening next week. In other words, it's clickable.

"If you go with a very dry, dense, opaque scientific term, it turns into that Charlie Brown teacher voice or white noise, and it's really unlikely most readers will key into it," said Mike Bell, deputy director of the Center for Disease Control and Prevention's Division of Healthcare Quality Promotion.

"Having an easily acquired handle for topics like this can be helpful to shine a light on them among all the other things" in the 24-hour news cycle. "It's very clever; I wish I'd thought of it," he added.

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That credit goes to French scientists who coined it in a 2012 study and the Washington Post for reviving it last week when the CDC reported the rise of the bug in the U.S.

Compare it to nontuberculous mycobacterial infections: "That's a bad name," Bell said. "Whenever you're telling us what it's not," it's not a good choice.

Another way to tell if a name isn't working: it's followed by a colon and a short phrase. "Ebola is highly recognizable," Bell said. "You don't need to say ‘Ebola: the deadly virus.'"

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Of course, Phantom Menace is not the actual name of the bug, Price points out. And, the concept applies to more than one bacteria.

"My only reservation is that the same description really applies to all these bugs that spread asymptomatically, but when they get a hold of somebody, they kick you when you're down," Price said. "So when your immune system is down, or for people in the ICU or a group of elderly people - that's when they really do their thing."

Diseases are named with an eye to new guidelines from the World Health Organization, which discourages associations with places, groups of people and animal species (think Middle East Respiratory Syndrome, Spanish Flu, swine flu).

It also discourages "terms that incite undue fear," such as "fatal." But more subtle references to fear can be helpful in making people pay attention, Bell said. Anthrax, for example, invokes a sense of foreboding simply based on its sound.

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"The letter X is uncommon," Bell pointed out, although he's not sure "what it is that makes it a threatening name."

"X" is also used in XDR TB, for extensively drug-resistant TB.

When a name doesn't escape from the "white noise" of scientific speak, it's often dubbed something else. Remember the bovine spongiform encephalopathy scare of the 1990s? Hint: It's nickname is mad cow disease. How about E. coli O157:H7? It's better known as Jack-in-the-Box E. coli.

The color black, as in black plague, can also give a subtle indication of fear.

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At a minimum, a name should be pronounceable or have a pronounceable acronym, Price said. MRSA (shorthand for Methicillin-resistant Staphylococcus aureus), for example, may mean very little to most, but it helps to be able to say "mer-sah," rather than M.R.S.A. Same goes for SARS, short for severe acute respiratory syndrome, and MERS, despite its reference to a location.

Even H1N1 and E. coli are OK because they're easy to say, Bell said.

As a runner-up to Phantom Menace, Price likes H30-Rx, a train of antibiotic-resistant E. coli bacteria.

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"When we discovered a new strain of E. coli that kills a lot of people in the U.S. and is really resistant to antibiotics, we thought about the name quite a bit and coined the name H30-Rx," he said. "It's still a little wonky, but it has that T. Rex sound to it, plus the Rx for treatment. It didn't take off in the media but our scientists colleagues picked up on it."

The bottom line: The reason scientists need the public to recognize things like carbapenem-resistant Enterobacteriaceae (CRE) producing OXA-48-like carbapenemases is so they ask legislators to fund research, Price said. "I don't try to heighten these things to get funding, but we need to pay attention," he said. "This and global climate change are the two biggest things we face today."

When the carbapenem-resistant enterobacteriaceae (CRE) gets into a patients bloodstream, it is fatal 40 to 50 per cent of the time.

Rarely has anyone looked at a potentially fatal infectious disease and exclaimed, "Now, that is a thing of beauty." One sculptor, however, has taken bacteria and viruses from their invisible world and placed them in ours.

Artist Luke Jerram has created a collection of glass artwork in the shape microorganisms -- bacteria and viruses no less that have the potential to infect or even kill human beings. By bringing these microscopic marauders to the light, Jerram demystifies these otherwise unknowable microorganisms. And using glass as a medium reinforces not only the fragility of the work, but also our own in the face of these diseases.

In this slide show, take a closer look at some of the highlights from Jerram's glass microbiology collection.

Turning HIV into a work of art is a seemingly impossible task. The virus is responsible for the deaths of an estimated 34 million people worldwide since the epidemic was first reported in 1981, according to UNAIDS, the joint United Nations Programme on HIV/AIDS.

The HIV virus sculpture was the first Jerram built for his collection.

If there's one disease that has plagued humankind throughout its history, it's malaria. In 2010, the World Health Organization estimated that more than 200 million people were infected with the disease, mostly in poverty-stricken regions of sub-Saharan Africa, but also parts of South America and Southeast Asia.

Malaria is transmitted through mosquito bites. Mosquito nets, insect repellant and pesticides are all effective means of prevention, but only for those with the available resources and access to afford them.

Looking at this spindly sculpture might make you the slightest bit queasy, and for good reason. E. coli is represented by this glass artwork. Although most E. coli strains are in fact harmless to humans, the strains we're most acquainted with are the ones that cause food poisoning.

This alien-looking sculpture is actually T4 Bacteriophage, a virus that targets E. coli bacteria.

Bacteriophages are small viruses that attach to the cell membrane of bacteria. The virus injects its DNA into the bacteria, which then produces replicas of the virus, filling the bacterium until it bursts.

If this model is giving you that nostalgic feeling of plagues past, you might not be surprised to find out that this work represents Severe acute respiratory syndrome, or SARS.

SARS made global headlines in 2003 when people in 37 countries and nearly reached pandemic levels. Although coverage of the illness was widely criticized for overstating the threat, nearly 9,000 were infected with the disease, with had a nearly 10 percent fatality rate.

Swine flu, shown here, was another contagious disease that drew global attention that Jerram selected for his exhibition, but this time it was personal. According to his website, Jerram came down with swine flu and constructed the sculpture "with a fever whilst swallowing my Tamiflu tablets every few hours."

Swine flu, or H1N1 strain of the influenza virus, made global headlines in 2009 as the next potential major flu epidemic. Though common among pigs, swine flu is rarely transmitted among humans. When it does infect a human, however, the symptoms associated with the virus, typical of other flu strains, are particularly acute.

Given just how common the Human Papilloma Virus (HPV) is among humans, you'd think this virus, pictured here, wouldn't be so controversial. In fact, it isn't, but the use of a vaccine to prevent the infection, which can lead to certain kinds of cancers in women.

Because the virus can be transmitted sexually, however, the idea of vaccinations, particularly compulsory ones for children -- the vaccine is in fact intended only for people 25 and younger -- generated a considerable pushback, despite the obvious benefits of the treatment.

Hand, foot and mouth disease might not get a lot of press, but these disease outbreaks are in fact fairly common, particularly among infants and children. Occasionally, they can be fatal. Symptoms are similar to the flu, with the exception of sores that can appear all over the body, but particularly the hands, feet and mouth of the carrier.

This final entry is an unrealized future mutation for a disease that doesn't exist yet. Look for it in a contaminated water main, food source or loving pet near you. (But seriously, don't.)