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Subclinical infection

subclinical infection, subclinical infection definition
A subclinical infection sometimes called a preinfection is an infection that, being subclinical, is nearly or completely asymptomatic no signs or symptoms A subclinically infected person is thus an asymptomatic carrier of a microbe, intestinal parasite, or virus that usually is a pathogen causing illness, at least in some individuals Many pathogens spread by being silently carried in this way by some of their host population Such infections occur both in humans and nonhuman animals An example of an asymptomatic infection is a mild common cold that is not noticed by the infected individual Since subclinical infections often occur without eventual overt sign, their existence is only identified by microbiological culture or DNA techniques such as polymerase chain reaction


  • 1 Infection transmission/signs
  • 2 Types of subclinical infections
  • 3 Host tolerance
  • 4 See also
  • 5 References
  • 6 Further reading

Infection transmission/signs

An individual may only develop signs of an infection after a period of subclinical infection, a duration that is called the incubation period This is the case, for example, for subclinical sexually transmitted diseases such as AIDS and genital warts Individuals with such subclinical infections, and those that never develop overt illness, creates a reserve of individuals that can transmit an infectious agent to infect other individuals Because such cases of infections do not come to clinical attention, health statistics can often fail to measure the true prevalence of an infection in a population, and this prevents the accurate modeling of its infectious transmission

Types of subclinical infections

The following pathogens together with their symptomatic illnesses are known to be carried asymptomatically, often in a large percentage of the potential host population:

  • Bordetella pertussis Pertussis or whooping cough
  • Chlamydia pneumoniae
  • Chlamydia trachomatis Chlamydia
  • Clostridium difficile
  • Cyclospora cayetanensis
  • Dengue virus
  • Dientamoeba fragilis
  • Entamoeba histolytica
  • enterotoxigenic Escherichia coli
  • Epstein-Barr virus
  • Group A streptococcal infection
  • Helicobacter pylori
  • Herpes simplex oral herpes, genital herpes, etc
  • HIV-1 AIDS
  • Legionella pneumophila Legionnaires' disease
  • measles viruses
  • Mycobacterium leprae leprosy
  • Mycobacterium tuberculosis tuberculosis
  • Neisseria gonorrhoeae gonorrhoea
  • Neisseria meningitidis Meningitis
  • nontyphoidal Salmonella
  • noroviruses
  • Poliovirus Poliomyelitis
  • Plasmodium Malaria
  • rhinoviruses Common cold
  • Salmonella enterica serovar Typhi Typhoid fever
  • Staphylococcus aureus
  • Streptococcus pneumoniae Bacterial pneumonia
  • Treponema pallidum syphilis

Host tolerance

Fever and sickness behavior and other signs of infection are often taken to be due to them However, they are evolved physiological and behavioral responses of the host to clear itself of the infection Instead of incurring the costs of deploying these evolved responses to infections, the body opts to tolerate an infection as an alternative to seeking to control or remove the infecting pathogen

Subclinical infections are important since they allow infections to spread from a reserve of carriers They also can cause clinical problems unrelated to the direct issue of infection For example, in the case of urinary tract infections in women, this infection may cause preterm delivery if the person becomes pregnant without proper treatment

See also

  • Asymptomatic
  • Asymptomatic carrier
  • Evolutionary medicine
  • Latent tuberculosis
  • Natural reservoir


  1. ^ Klement E, Grotto I, Srugo I, Orr N, Gilad J, Cohent D March 2005 "Pertussis in soldiers, Israel" Emerging Infect Dis 11 3: 506–8 doi:103201/eid1103040672 PMID 15789494 
  2. ^ Müller J, Møller DS, Kjaer M, Nyvad O, Larsen NA, Pedersen EB 2003 "Chlamydia pneumoniae DNA in peripheral blood mononuclear cells in healthy control subjects and patients with diabetes mellitus, acute coronary syndrome, stroke, and arterial hypertension" Scand J Infect Dis 35 10: 704–12 doi:101080/00365540310016538 PMID 14606608 
  3. ^ a b Cecil JA, Howell MR, Tawes JJ, et al November 2001 "Features of Chlamydia trachomatis and Neisseria gonorrhoeae infection in male Army recruits" J Infect Dis 184 9: 1216–9 doi:101086/323662 PMID 11598849 
  4. ^ a b Korenromp EL, Sudaryo MK, de Vlas SJ, et al February 2002 "What proportion of episodes of gonorrhoea and chlamydia becomes symptomatic" Int J STD AIDS 13 2: 91–101 doi:101258/0956462021924712 PMID 11839163 
  5. ^ Sutton TL, Martinko T, Hale S, Fairchok MP December 2003 "Prevalence and high rate of asymptomatic infection of Chlamydia trachomatis in male college Reserve Officer Training Corps cadets" Sex Transm Dis 30 12: 901–4 doi:101097/01OLQ0000091136149328B PMID 14646638 
  6. ^ Rivera EV, Woods S 2003 "Prevalence of asymptomatic Clostridium difficile colonization in a nursing home population: a cross-sectional study" J Gend Specif Med 6 2: 27–30 PMID 12813999 
  7. ^ Chacin-Bonilla L, Mejia de Young M, Estevez J March 2003 "Prevalence and pathogenic role of Cyclospora cayetanensis in a Venezuelan community" Am J Trop Med Hyg 68 3: 304–6 PMID 12685635 
  8. ^ Burke DS, Nisalak A, Johnson DE, Scott RM January 1988 "A prospective study of dengue infections in Bangkok" Am J Trop Med Hyg 38 1: 172–80 PMID 3341519 
  9. ^ Peek R, Reedeker FR, van Gool T February 2004 "Direct Amplification and Genotyping of Dientamoeba fragilis from Human Stool Specimens" J Clin Microbiol 42 2: 631–5 doi:101128/JCM422631-6352004 PMC 344490  PMID 14766828 
  10. ^ Blessmann J, Ali IK, Nu PA, et al October 2003 "Longitudinal Study of Intestinal Entamoeba histolytica Infections in Asymptomatic Adult Carriers" J Clin Microbiol 41 10: 4745–50 doi:101128/JCM41104745-47502003 PMC 294961  PMID 14532214 
  11. ^ Wennerås C, Erling V December 2004 "Prevalence of enterotoxigenic Escherichia coli-associated diarrhoea and carrier state in the developing world" J Health Popul Nutr 22 4: 370–82 PMID 15663170 
  12. ^ Pegtel DM, Middeldorp J, Thorley-Lawson DA November 2004 "Epstein-Barr Virus Infection in Ex Vivo Tonsil Epithelial Cell Cultures of Asymptomatic Carriers" J Virol 78 22: 12613–24 doi:101128/JVI782212613-126242004 PMC 525079  PMID 15507648 
  13. ^ Ozturk CE, Yavuz T, Kaya D, Yucel M December 2004 "The rate of asymptomatic throat carriage of group A Streptococcus in school children and associated ASO titers in Duzce, Turkey" Jpn J Infect Dis 57 6: 271–2 PMID 15623954 
  14. ^ Kul S, Sert B, Sari A, et al September 2008 "Effect of subclinical Helicobacter pylori infection on gastric wall thickness: multislice CT evaluation" Diagn Interv Radiol 14 3: 138–42 PMID 18814135 
  15. ^ Wald A, Zeh J, Selke S, Ashley RL, Corey L September 1995 "Virologic characteristics of subclinical and symptomatic genital herpes infections" N Engl J Med 333 12: 770–5 doi:101056/NEJM199509213331205 PMID 7643884 
  16. ^ Mummidi S, Ahuja SS, Gonzalez E, et al July 1998 "Genealogy of the CCR5 locus and chemokine system gene variants associated with altered rates of HIV-1 disease progression" Nat Med 4 7: 786–93 doi:101038/nm0798-786 PMID 9662369 
  17. ^ Flournoy DJ, Guthrie PJ, Lawrence CH, Silberg SL, Beaver S January 1990 "Incidence of Legionella pneumophila infections among Oklahoma pulmonary disease patients" J Natl Med Assoc 82 1: 25–9 PMC 2625929  PMID 2304095 
  18. ^ Anlar B, Ayhan A, Hotta H, et al August 2002 "Measles virus RNA in tonsils of asymptomatic children" J Paediatr Child Health 38 4: 424–5 doi:101046/j1440-17542002t01-1-00029x PMID 12174013 
  19. ^ Beyene D, Aseffa A, Harboe M, et al October 2003 "Nasal carriage of Mycobacterium leprae DNA in healthy individuals in Lega Robi village, Ethiopia" Epidemiol Infect 131 2: 841–8 doi:101017/S0950268803001079 PMC 2870027  PMID 14596524 
  20. ^ Dye C, Scheele S, Dolin P, Pathania V, Raviglione MC August 1999 "Consensus statement Global burden of tuberculosis: estimated incidence, prevalence, and mortality by country WHO Global Surveillance and Monitoring Project" JAMA 282 7: 677–86 doi:101001/jama2827677 PMID 10517722 
  21. ^ Yazdankhah SP, Caugant DA September 2004 "Neisseria meningitidis: an overview of the carriage state" J Med Microbiol 53 Pt 9: 821–32 doi:101099/jmm045529-0 PMID 15314188 
  22. ^ Sirinavin S, Pokawattana L, Bangtrakulnondh A June 2004 "Duration of nontyphoidal Salmonella carriage in asymptomatic adults" Clin Infect Dis 38 11: 1644–5 doi:101086/421027 PMID 15156460 
  23. ^ Gallimore CI, Cubitt D, du Plessis N, Gray JJ May 2004 "Asymptomatic and Symptomatic Excretion of Noroviruses during a Hospital Outbreak of Gastroenteritis" J Clin Microbiol 42 5: 2271–4 doi:101128/JCM4252271-22742004 PMC 404621  PMID 15131210 
  24. ^ van Benten I, Koopman L, Niesters B, et al October 2003 "Predominance of rhinovirus in the nose of symptomatic and asymptomatic infants" Pediatr Allergy Immunol 14 5: 363–70 doi:101034/j1399-3038200300064x PMID 14641606 
  25. ^ Parry CM, Hien TT, Dougan G, White NJ, Farrar JJ November 2002 "Typhoid fever" N Engl J Med 347 22: 1770–82 doi:101056/NEJMra020201 PMID 12456854 
  26. ^ Kenner J, O'Connor T, Piantanida N, et al June 2003 "Rates of carriage of methicillin-resistant and methicillin-susceptible Staphylococcus aureus in an outpatient population" Infect Control Hosp Epidemiol 24 6: 439–44 doi:101086/502229 PMID 12828322 
  27. ^ Malfroot A, Verhaegen J, Dubru JM, Van Kerschaver E, Leyman S September 2004 "A cross-sectional survey of the prevalence of Streptococcus pneumoniae nasopharyngeal carriage in Belgian infants attending day care centres" Clin Microbiol Infect 10 9: 797–803 doi:101111/j1198-743X200400926x PMID 15355410 
  28. ^ Singh AE, Romanowski B April 1999 "Syphilis: Review with Emphasis on Clinical, Epidemiologic, and Some Biologic Features" Clin Microbiol Rev 12 2: 187–209 PMC 88914  PMID 10194456 
  29. ^ Miller MR, White A, Boots M September 2005 "The evolution of host resistance: tolerance and control as distinct strategies" J Theor Biol 236 2: 198–207 doi:101016/jjtbi200503005 PMID 16005309 
  30. ^ Boots M, Bowers RG April 2004 "The evolution of resistance through costly acquired immunity" Proc Biol Sci 271 1540: 715–23 doi:101098/rspb20032655 PMC 1691655  PMID 15209105 
  31. ^ Romero R, Espinoza J, Chaiworapongsa T, Kalache K August 2002 "Infection and prematurity and the role of preventive strategies" Semin Neonatol 7 4: 259–74 doi:101053/siny20020121 PMID 12401296 

Further reading

  • Endara, Pablo; Trueba, Gabriel; Solberg, Owen D; Bates, Sarah J; Ponce, Karina; Cevallos, William; Matthijnssens, Jelle; Eisenberg, Joseph NS 2007-04-01 "Symptomatic and Subclinical Infection with Rotavirus PG9, Rural Ecuador" Emerging Infectious Diseases 13 4: 574–580 doi:103201/eid1304061285 ISSN 1080-6040 PMC 2391297  PMID 17553272 

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