Clinical and ecological significance of bacterial dormancy in human pathogens

SUMMARY Bacteria can enter a transient state of reduced metabolic activity to survive temporary unfavorable conditions. This phenomenon, sometimes referred to as dormancy, growth arrest, or quiescence, enables pathogen survival inside and outside of their host, with major clinical consequences for the management of infections. From spores to persister cells, these states associated with bacterial dormancy share molecular mechanisms for controlling cellular activity and for responding to related environmental signals. In this review, we provide a synthesis of the diversity of dormant states in human pathogenic bacteria and their pathophysiology within a unifying framework of a dormant-to-active spectrum. We highlight recent developments in therapeutic strategies targeting growth-arrested bacteria and shed light on the role of dormancy in pathogen dissemination and transmission across compartments under a global health perspective. Finally, we discuss the role of dormancy as a microbial trait that shapes virulence and infection dynamics over the course of evolution. Overall, this work seeks to provide new insights into the links between bacterial dormancy and latency in microbial pathogenesis while alleviating the semantic boundaries of the field.