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\begin{document}

\title{Is it the flu? Is it a virus? No, it's Superbugs!}



\author[1]{Miriam Rivera}%
\author[2]{Lauren Nelson}%
\author[2]{Ernesto Llamas }%
\affil[1]{Affiliation not available}%
\affil[2]{Journal of Sketching Science}%


\vspace{-1em}



  
  \date{May 27, 2024}


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\sloppy


\section*{The good, the bad and the ugly
(bacteria)}

{\label{713176}}\par\null\selectlanguage{english}
\begin{figure}[h!]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/Virus-and-Bact/Viruses-and-Bacteria}
\caption{{Spot the difference between a virus and a bacterial cell.
{\label{798282}}%
}}
\end{center}
\end{figure}

It is imperative that we first identify the difference between bacteria
and viruses. Bacteria are single-celled microorganisms which can be
beneficial or detrimental to our health. Bacteria can live in hosts
(such as humans) but are also found in many environments across the
planet. A virus, however, has no cell structure and requires a host in
order to survive. Infections can be caused by viruses or bacteria
(\emph{e.g.,}~chest infections, UTIs (urinary tract infections), etc.),
but the way we treat them differs hugely. Mammalian hosts can have
vaccinations against numerous viruses in order to prevent their
infection, but viruses such as the common cold are not curable in this
way, and usually they just need time to pass before recovery. Bacteria,
however, are combated using antibiotics. Later we'll discuss how
antibiotics do this but it is important to note this key point: Viruses
cannot be killed by antibiotics.~

\subsection*{}

{\label{806637}}

\subsection*{The Good~}

{\label{210446}}

\begin{quote}
`Good' bacteria are found on our skin, in our airways and digestive
systems. These bacteria are the first line of defence, like frontline
soldiers, preventing viruses and other potentially detrimental things
(such as pathogens) from getting further into our systems and making us
unwell. The bacteria found naturally in each of us differs from person
to person and is called our~\textbf{microbiome~}\citep{Eckburg_2005}. The
microbiome helps to enhance our immune system.~
\end{quote}

\subsection*{The Bad~}

{\label{239410}}

\begin{quote}
These are the disease-causing bacteria and usually become prevalent when
our microbiomes are disrupted, meaning the `bad' bacteria has more room
to grow and are no longer regulated by the `good' bacteria. Examples of
disease-causing bacteria are ~\emph{Staphylococcus aureus} (causing
infections such as pneumonia and ear infections ),~\emph{Neisseria
meningitidis} (causing bacterial meningitis),~\emph{Clostridium tetani}
(causing tetanus),~\emph{etc}.~ ~ ~~
\end{quote}

\subsection*{The Ugly~}

{\label{194592}}

\begin{quote}
The overuse of antibiotics has led to a very ugly situation. By removing
good bacteria from our bodies, we've opened up an opportunity for bad
bacteria to infiltrate, multiply and spread.~
\end{quote}

\par\null

\section*{How antibiotics work}

{\label{688579}}

The first antibiotic to be discovered/developed was penicillin (1920),
helping countless people since then to overcome bacterial infections.

\begin{itemize}
\tightlist
\item
  \textbf{Beta-lactams:} Beta-lactam antibiotics prevent the bacterial
  cell wall from forming and as a result, the bacterial cell cannot
  support itself and will eventually burst. Mammalian cells do not have
  a cell wall like bacteria, meaning that only bacterial cells are
  specifically targeted by this type of antibiotic. ~\emph{Penicillin}
  is an example of a beta-lactam antibiotic.
\item
  \textbf{Macrolides:} These antibiotics target ribosomes, which are
  responsible for aiding protein building within bacterial cells.
  Ribosomes also perform this function in mammalian cells, but there are
  sufficient differences between bacterial and mammalian ribosomes which
  allow for the bacterial ribosomes to be targeted specifically.
  Macrolides are able to block the process of ribosomes and thus,
  prevent bacterial proteins from being made, which in turn stops
  cellular functions. \emph{Erythromycin} is an example of a macrolide
  antibiotic.~
\item
  \textbf{Quinolones:~}As a bacteria begins to copy its DNA, quinolones
  act to break the DNA strands apart, preventing the bacterial cells
  from multiplying. Eventually, the remaining bacterial cells won't be
  able to survive in the hostile environment. \emph{Levofloxacin} is an
  example of a quinolone antibiotic.~
\end{itemize}

\par\null

\section*{Pesky Bacteria: Antibiotic
Resistance}

{\label{477885}}

It should be stated that it is the bacteria itself which becomes
resistant, NOT us as individuals. For instance, gonorrhea is developing
resistance to antibiotics used to treat it and is the 2nd most commonly
reported infectious disease.~\citet{cdc}

\par\null

\textbf{How do bacteria develop resistance?~}Unlike mammalian cells,
bacterial cells divide and multiply rapidly. As a result, mutations will
arise because the bacterial DNA is copied too quickly and thus, errors
in the DNA sequence will occur. ~

Bacteria also have this `nifty' way of making non-resistant cells,
resistant! As if they weren't annoying enough already. The process is
called~\emph{\textbf{horizontal~gene transfer}}.\selectlanguage{english}
\begin{figure}[h!]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/Pokemon-Bacteria-English/Pokemon-Bacteria-English}
\caption{{Gotta catch 'em all.all.
{\label{825868}}%
}}
\end{center}
\end{figure}

Here, resistant bacterial cells will~\emph{conjugate}~to (\emph{i.e.}
make a link with) a non-resistant bacterial cell. This enables a path to
form between the two cells and they can transfer genetic data
(\emph{i.e.~}share their resistant genes). Overall, more bacterial cells
will now possess this mutation and thus be resistant to the antibiotic,
making it harder to eradicate the infection.

\par\null

Other methods of resistant gene transfer
include:~\textbf{\emph{transduction}}~and~\textbf{\emph{transformation}}.
Using transduction, bacteria can share resistant DNA, transferring
genetic information from one bacterium to another using a virus
(\emph{phages}). There is no physical contact between the bacterial
cells using this method. Transformation describes the direct uptake and
incorporation of an external genetic material of a bacterial cell from
its surroundings; this can be a natural or artificial process. Lastly,
bacteria can also achieve resistance through~\emph{\textbf{enzyme
production}}~(\emph{i.e.} nature's catalyst which enables a reaction to
occur). The bacteria learn what the antibiotic looks like and will
produce enzymes which can break down the antibiotic when they make
contact with it. After all, bacteria are living things and have the
ability to learn as we do.~

\par\null

\section*{The Rise of the Superbug}

{\label{726592}}

According to~\emph{\textbf{WHO}}~(World Health
Organisation)~\citep{organisation2017}, global increase in antibiotic
resistance is one of the most significant threats to human health today.
During winter many people experience colds and cases of flu, with the
occasional stomach bug thrown in for good measure too. It's at this time
of year that many people go to their doctors in search of a quick remedy
to what can sometimes feel like a never-ending~cough or a runny nose.
However, when you go in search of such miracles in the form of
antibiotics, could you be doing more harm than good?\selectlanguage{english}
\begin{figure}[h!]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/AntbioticsEnglish/AntibioticsEnglish2}
\caption{{And we would have got away with it too, if it weren't for you pesky
bacteria.
{\label{675876}}%
}}
\end{center}
\end{figure}

When an antibiotic is taken to combat a bacterial infection, some
bacterial cells may possess mutations which make them resistant to the
drug. As with natural selection, those bacterial cells which are
resistant to the drug will survive even after a full course of
antibiotics. You are likely to feel better, and not notice the infection
anymore as the number of resistant cells would be negligible. However,
these cells will remain, divide and reproduce. Therefore, the next time
you get this infection, there are more of the resistant cell type
present, and as a result, the symptoms you experience may not clear as
the antibiotic will not have the desired effect,~ (\emph{i.e.}
destroying the bacterial cell wall).~Eventually, your doctor will give
you another antibiotic which appears to combat the infection, and you
continue as usual. However, new mutations in the bacteria may have
arisen as the infection grew, and so the resistance continues. Overall,
you are left with resistant bacteria which are much harder to target as
fewer and fewer antibiotics can destroy the bacterial cell walls. To
make matters worse, antibiotics may not affect human cells but they do
kill the `good' bacteria which help to prevent infection and regulate
our microbiomes. Therefore, alongside more resistant bacteria, our
immune systems are less able to cope with future infections. ~

\par\null

Antibiotic-resistant bacteria also work their way into our systems from
the ingestion of livestock. Many farmers use antibiotics to deter
disease and promote growth in their stock. However, these animals are
not immune to antibiotic resistance. As a result, there has been a rise
in the number of resistant bacteria seen in livestock and thus, through
ingestion of this stock, we have yet more antibiotic-resistant bacteria.
Not only do humans need to stop taking antibiotics unnecessarily, so do
animals! In 2017, WHO published new guidelines for the use of
antimicrobials in food-producing livestock in a bid to educate those
administering them but also, in an attempt to reduce the instances of
unnecessary antibacterial resistance.~\citep{resistance}

\par\null

\section*{How can we Overcome
Resistance?~}

{\label{694000}}

To overcome resistance research is underway into developing new
antibiotics which aim to address different bacterial processes than
those currently targeted. A novel approach, however, is looking to go
back to basics and utilise something that has shown antibacterial
properties for thousands of years:~\textbf{metals}. Silver is regularly
used in plasters to prevent bacterial infections in cuts (etc.), so now,
scientists are investigating the use of silver in antibiotics. The exact
mechanism is not known, but it is thought that as metals are not
naturally found in a bacteria's environment,~bacterial cells are not
able to form resistance towards them (yet!) and thus, silver can protect
against bacterial infections~\citep{Owens_2013}. Other research into the
use of phages which naturally target bacteria, is also currently
underway. Georgia uses phages widely for bacterial infections, but the
more rigorous standards in countries such as the UK and USA, mean a much
longer time frame until such research could be administered to the
general public.~~\selectlanguage{english}
\begin{figure}[h!]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/d4b6f8a5-d6f6-4018-8e09-a883fdb4e7cf/Metal-VS-Bact}
\caption{{Our antibiotic knight in silver armour.~
{\label{908733}}%
}}
\end{center}
\end{figure}

To summarise, antibacterial resistance is one of the most significant
problems the World has to currently tackle. With the rise of resistant
infections such as MRSA, super gonorrhea, and bacterial
meningitis~\citep{Malcolm_2011}, it is of the utmost importance for new
antibiotic drugs to be founded, addressing different mechanisms than
they already do. However more urgently needed, is the education of the
public to ensure we all understand what resistance is, why it happens
and thus, why it is so vital that we only use antibiotics when
absolutely necessary~and~use them correctly.

\par\null

\section*{Contributions}

{\label{911760}}

-Miriam Rivera made the illustrations. She is specialized in comics
about biology subjects, which she calls Biomiics. She has a Human
Biology Degree and a Master in Scientific, Medical and Environmental
Communication. She has cooperated
with~\href{http://illustraciencia.info/}{Illustraciencia} (International
Award of Scientific Illustration)
and~\href{http://http://scenio.es/}{Scenio}, a scientific divulgation
platform.
(Twitter\href{https://twitter.com/miriamriig?lang=es}{@miriamriig};
webpage~\href{http://http://miriamriig.com/}{miriamriig.com})

-Lauren Nelson wrote the text.~Lauren is a Ph.D. student at Newcastle
University (UK), researching computational drug design alongside the
Northern Institute for Cancer Research. Lauren also writes a scientific
blog aiming to stop science from seeming so boring.
(Twitter~\href{http://twitter.com/ashortscientist}{@ashortscientist};
Instagram~\href{http://www.instagram.com/ashortscientist}{@ashortscientist};
Blog:~\href{http://ashortscientist.wordpress.com/}{ashortscientist.wordpress.com})

-Ernesto Llamas edited the text. Creator of Sketching Science.~
(Instagram~\href{https://www.instagram.com/eellamas/}{@eellamas})

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