Introduction
Infection is the invasion of the host by microorganisms, which then multiply in close association with the host’s tissues. Infection is distinguished from disease, a morbid process that does not necessarily involve infection (diabetes, for example, is a disease with no known causative agent). Bacteria can cause a multitude of different infections, ranging in severity from inapparent to fulminating. Table 7-1 lists these types of infections.
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The capacity of a bacterium to cause disease reflects its relative pathogenicity. On this basis, bacteria can be organized into three major groups. When isolated from a patient, frank or primary pathogens are considered to be probable agents of disease (e.g., when the cause of diarrheal disease is identified by the laboratory isolation of Salmonella spp. from feces). Opportunistic pathogens are those isolated from patients whose host defense mechanisms have been compromised. They may be the agents of disease (e.g., in patients who have been predisposed to urinary tract infections with Escherichia coli by catheterization). Finally, some bacteria, such as Lactobacillus acidophilus, are considered to be nonpathogens, because they rarely or never cause human disease. Their categorization as nonpathogens may change, however, because of the adaptability of bacteria and the detrimental effect of modern radiation therapy, chemotherapy, and immunotherapy on resistance mechanisms. In fact, some bacteria previously considered to be nonpathogens are now known to cause disease. Serratia marcescens, for example, is a common soil bacterium that causes pneumonia, urinary tract infections, and bacteremia in compromised hosts.
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Virulence is the measure of the pathogenicity of an organism. The degree of virulence is related directly to the ability of the organism to cause disease despite host resistance mechanisms; it is affected by numerous variables such as the number of infecting bacteria, route of entry into the body, specific and nonspecific host defense mechanisms, and virulence factors of the bacterium. Virulence can be measured experimentally by determining the number of bacteria required to cause animal death, illness, or lesions in a defined period after the bacteria are administered by a designated route. Consequently, calculations of a lethal dose affecting 50 percent of a population of animals (LD50) or an effective dose causing a disease symptom in 50 percent of a population of animals (ED50) are useful in comparing the relative virulence of different bacteria.
Pathogenesis refers both to the mechanism of infection and to the mechanism by which disease develops. The purpose of this chapter is to provide an overview of the many bacterial virulence factors and, where possible, to indicate how they interact with host defense mechanisms and to describe their role in the pathogenesis of disease. It should be understood that the pathogenic mechanisms of many bacterial diseases are poorly understood, while those of others have been probed at the molecular level. The relative importance of an infectious disease to the health of humans and animals does not always coincide with the depth of our understanding of its pathogenesis. This information is best acquired by reading each of the ensuing chapters on specific bacterial diseases, infectious disease texts, and public health bulletins.
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