COMMENTARY

An Infectious Disease Specialist Watches Dune

Armelle Pérez-Cortés Villalobos, MD, MSc

November 11, 2021

One of the most anticipated releases of 2021 is the science fiction film Dune, directed by Denis Villeneuve and based on Frank Herbert's novel of the same name. The film tells the story of Paul Atreides, a brilliant young man who must travel to one of the galaxy's most inhospitable planets: Arrakis, also known as Dune. This planet is characterized by its desert-like climate and is inhabited by colossal sandworms. These extremely dangerous creatures produce "the spice," a narcotic that makes interstellar travel possible, prolongs life, and brings about superhuman levels of thought and energy.

The concept of sandworms is not alien to those of us in infectious diseases. Sand is often home to a multitude of microorganisms, such as fungi, bacteria, and parasites. Beach sand, in particular, is known to harbor various larvae, such as Strongyloides stercoralis, and hookworms, such as Necator americanus and Ancylostoma duodenale, which are nematodes. These larvae penetrate people's skin and are carried by the bloodstream to the lungs. When the larvae reach the trachea, they are swallowed and end up in the small intestine, where they mature and reproduce.

Individuals infected with this type of intestinal parasitic disease often show no symptoms; nevertheless, such diseases can be associated with iron deficiency anemia and malnutrition. To prevent this disease, people should wear shoes and use a physical barrier when sitting on sand.

In the film, the gigantic sandworms appear when they sense any rhythmic sound in the dunes. As they move, they displace large quantities of sand. Sandstorms are a constant on Arrakis, so the Fremen (the people who live in this desert) need to use masks and nose plugs nearly all the time.

These storms immediately made me think about the risk of acquiring an endemic mycoses infection, such as coccidioidomycosis, or Valley fever. This infection is caused by the fungus Coccidioides, which is often found in desert-like regions, such as those in the southern United States and northern Mexico. People usually get coccidioidomycosis by breathing in microscopic fungal spores. It should be noted that the majority of people who inhale these spores never get sick, even if they inhale large amounts of dust and spores. Adults older than 60 years, pregnant women, and people with weakened immune systems are at elevated risk for coccidioidomycosis. If people at high risk have to travel to an area where this fungus is common, they should avoid places with a lot of dust, use a mask, and stay in an enclosed space with the windows closed in the event of a sandstorm. Preventive antifungal medication can be considered for certain immunocompromised patients if Coccidioides is endemic to the area where they live or are travelling to.

Life on Arrakis is hard. Water is incredibly scarce in the desert, so the Fremen have to wear special suits that recycle water from sweat and urine just to survive. They also reclaim water from the bodies of their fallen tribesmen. Not having access to water increases the risk for infection because it limits the ability of people to practice good hygiene and wash their hands. And it heightens the risk that people will ingest contaminated water, facilitating the transmission of diseases, such as dysentery, cholera, and typhoid fever, to mention just a few.

Waterborne infectious diseases claim up to 3.2 million lives annually, according to the World Health Organization (WHO), which accounts for 6% of total deaths worldwide. Far from being science fiction, the scarcity of water is a problem in real life. Any intervention to ensure sanitation and the supply of potable water will improve every aspect of health for human beings here on Earth.

The movie shows magnificent scenes of life in the desert, and in several shots you can see one of the desert's famous inhabitants: the long-tailed colilargo (Oligoryzomys longicaudatus). These desert-dwelling wild rodents have been identified as being natural reservoirs of hantavirus.

Hantavirus can infect humans, causing fever, headache, muscle pain, and abdominal pain that lasts 3 to 5 days, followed by the onset of respiratory and cardiac issues. It can be a very severe disease, and approximately 40% of infected patients die.

This virus is contracted by breathing air contaminated with the droppings, urine, or saliva of wild rodents. To prevent infection, people should practice good hygiene and keep food in sealed containers. In addition, they should air out any spaces that have been closed up for a while before they enter. And if you see any evidence of long-tailed colilargo, disinfect the area with water and bleach or soap.

Life on Dune poses a challenge to the prevention of infectious diseases, especially because of the scarcity of water. Nonetheless, this film does an extraordinary job in showing a world where humans are aware of their role in change and are constantly working to create optimal surroundings, all with a clear understanding of the danger and harm that come with living in the desert.

Armelle Pérez-Cortés Villalobos, MD, M.Sc. is a member of the Editorial Board for Medscape Spain. No conflicts of interest.

This article originally appeared in the Spanish edition of Medscape.

Follow Armelle Pérez-Cortés Villalobos on Twitter @ArmelleID.

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