Deck-building games have emerged as competitive counterparts to collectible card games. The basic premise is to use cards as “currency” to buy and build a deck that is used in play. In Pathogenesis, a deck-building game released in 2017, players assemble microbial pathogens and add virulence factors and microbial defense mechanisms through play to attack human body barrier defenses in tissue, respiratory, and gastrointestinal tracts. As the attacks proceed and players breach the barrier defenses, the body fights back using adaptive and innate immune responses like inflammation, complement, and T cells represented in cards that players also accumulate. Players win when they defeat the tracts’ immune responses (pathogen, virulence, and microbial defense cards overwhelm barrier defense and immune cards) and lose if game play takes too long and physiologic immunity develops.
Pathogenesis is scientifically accurate and beautifully illustrated; finely drawn card details like bacterial pili and white blood cell granules are especially eye-catching. The game is ultimately more about immunology than about microbiology or clinical infectious disease, and just as learning the immune system is intricate and tricking it requires careful planning and strategy, learning to play Pathogenesis takes time, attention, and practice to master. Written game instructions are detailed and answer questions that come up during play, but they are dense and read like a biology textbook in places. Fortunately, a series of YouTube videos lay out the game’s basics.
Without question, the creation of Pathogenesis was inspired. The game is clearly a labor of love and recommended for avid deck builders looking to expand their repertoire and for immunology or science geeks who want to try deck building. Those who fall in between can marvel at the beauty of the illustrations (by Luk Cox and Idoya Lahortiga) and the sophisticated way the game’s developers (Jamie and Loren Cunningham) have transformed the perpetual battle between pathogen and host defense into competitive play.