CHAPTER 12
PATHOGENESIS OF
INFECTIOUS DISEASES
Burton's Microbiology
for the Health Sciences
CHAPTER 14 OUTLINE
• Symptoms of a Disease Versus Signs
• Introduction
of a Disease
• Infection Versus Infectious Disease
• Latent Infections
• Why Infection Does Not Always Occur
• Primary Versus Secondary
• Four Periods or Phases in the Course of an Infections
Infectious Disease • Steps in the Pathogenesis of
• Localized Versus Systemic Infections Infectious Diseases
• Acute, Subacute, and Chronic Diseases • Virulence
• Virulence Factors (Attributes That
Enable Pathogens to Attach, Escape
Destruction, and Cause Disease)
INTRODUCTION
• The prefix “path” refers to disease.
• Pathogenicity means the ability to cause disease.
• Pathogenesis refers to the steps or mechanisms involved in the
development of a disease.
INFECTION VERSUS
INFECTIOUS DISEASE
• An infectious disease is a disease caused by a microbe, and the microbes that
cause infectious diseases are collectively referred to as pathogens.
• Infection is commonly used as a synonym for infectious disease (e.g., an ear
infection is an infectious disease of the ear).
• Microbiologists reserve the word infection to mean colonization by a
pathogen; the pathogen may or may not go on to cause disease.
• A person can be infected with a pathogen, but not have an infectious disease.
WHY INFECTION DOES NOT
ALWAYS OCCUR
• The microbe may land at an anatomic • The indigenous microflora may
site where it is unable to multiply. produce antibacterial factors (i.e.,
bacteriocins) that destroy the
• Many pathogens must attach to specific pathogen.
receptor sites before they are able to
multiply and cause damage. • The individual’s nutritional and
overall health status often influences
• Antibacterial factors may be present at the outcome of the pathogen-host
the site where the pathogen lands. encounter.
• Indigenous microflora of that site may • The person may be immune to that
inhibit growth of the foreign microbe particular pathogen.
(i.e., microbial antagonism).
• Phagocytes present in the blood may
destroy the pathogen.
FOUR PERIODS OR PHASES IN
THE COURSE OF AN
INFECTIOUS DISEASE
• The incubation period
• The prodromal period
• The period of illness
• The convalescent period
LOCALIZED VERSUS
SYSTEMIC INFECTIONS
• Localized Infections
– Once an infectious process is initiated, the disease may remain localized
or it may spread; examples of localized infections are pimples, boils and
abscesses.
• Systemic Infections
– When the infection spreads throughout the body it is said to have become
a systemic or generalized infection; an example is miliary tuberculosis
caused by Mycobacterium tuberculosis.
ACUTE, SUBACUTE, AND
CHRONIC DISEASES
• An acute disease is one that has a rapid onset, and is usually followed by a
relatively rapid recovery; examples are measles, mumps, and influenza.
• A chronic disease has a slow onset and lasts a long time; examples are
tuberculosis, leprosy, and syphilis.
• A subacute disease is one that comes on more suddenly than a chronic
disease, but less suddenly than an acute disease; an example would be
bacterial endocarditis.
SYMPTOMS OF A DISEASE
VERSUS SIGNS OF A DISEASE
• A symptom of a disease is defined as some evidence of a disease that is
experienced by the patient; something that is subjective; for example, aches or
pains, ringing in the ears, blurred vision, nausea, dizziness, etc.
– There are symptomatic and asymptomatic diseases. In a symptomatic disease, the
patient is experiencing symptoms. In an asymptomatic disease, the patient is not
experiencing any symptoms.
• A sign of a disease is defined as some type of objective evidence of a disease;
for example, elevated blood pressure, abnormal heart sounds, abnormal pulse
rate, abnormal laboratory results, etc.
LATENT INFECTIONS
• Latent infections are infectious
diseases that go from being
symptomatic to asymptomatic, and
then, later, go back to being
symptomatic.
– Examples include syphilis and
herpes virus infections such as
cold sores, genital herpes, and
shingles.
PRIMARY VERSUS
SECONDARY INFECTIONS
• One infectious disease may commonly follow another; in such
cases, the first disease is referred to as a primary infection and the
second disease is referred to as a secondary infection.
– Example: serious cases of bacterial pneumonia frequently follow mild
viral respiratory infections.
• During the primary infection, the virus causes damage to the ciliated epithelial cells
of the respiratory tract; these cells are then unable to clear opportunistic bacterial
pathogens from the respiratory tract, leading to the secondary infection (pneumonia).
STEPS IN THE PATHOGENESIS
OF INFECTIOUS DISEASES
A common sequence of steps in the pathogenesis of
infectious diseases is:
1. Entry of the pathogen into the body.
2. Attachment of the pathogen to some tissue(s) within the body
3. Multiplication of the pathogen.
4. Invasion or spread of the pathogen.
5. Evasion of host defenses.
6. Damage to host tissue(s).
VIRULENCE
• The term “virulent” is sometimes used as a synonym for
pathogenic.
• There may be virulent (pathogenic) strains and avirulent
(nonpathogenic) strains of a particular species.
– Virulent strains are capable of causing disease; avirulent strains are not.
– For example, toxigenic (toxin-producing) strains of Corynebacterium
diphtheriae can cause diphtheria, but nontoxigenic strains of C.
diphtheriae cannot. Thus, the toxigenic strains are virulent, but the
nontoxigenic strains are not.
VIRULENCE
• Sometimes, the term virulence is used to express the measure or
degree of pathogenicity.
– Example: It only takes 10 Shigella cells to cause shigellosis, but it takes
between 100 and 1,000 Salmonella cells to cause salmonellosis. Thus,
Shigella is more virulent than Salmonella.
– Example: Some strains of Streptococcus pyogenes (e.g., the “flesh-
eating” strains) are more virulent than other strains of S. pyogenes.
– Example: Some strains of S. aureus produce toxic shock syndrome, but
other strains of S. aureus do not. Those that do are considered more
virulent.
VIRULENCE FACTORS
• Virulence factors are attributes that enable pathogens to attach, escape
destruction, and cause disease.
• Virulence factors are phenotypic characteristics that are dictated by the
organism’s genotype. Examples:
– Adhesins (ligands) - special molecules on the surface of pathogens – are considered to
be virulence factors because they enable pathogens to recognize and bind to particular
host cell receptors.
– Pili (bacterial fimbriae) are considered to be virulence factors because they enable
bacteria to attach to surfaces, such as tissues within the human body.
ADHESINS AND RECEPTORS
EXAMPLES OF VIRULENCE
FACTORS
OBLIGATE INTRACELLULAR
PATHOGENS
• Pathogens that must live within host cells in order to survive and
multiply are referred to as obligate intracellular pathogens
(examples: Rickettsia and Chlamydia spp.).
– Intraleukocytic pathogens (e.g., Ehrlichia spp. and Anaplasma
phagocytophilum) live within white blood cells, causing diseases known
as ehrlichiosis and anaplasmosis.
– Plasmodium spp. (which cause malaria) and Babesia spp. (which cause
babesiosis) are examples of intraerythrocytic pathogens; they live within
red blood cells.
FACULTATIVE
INTRACELLULAR PATHOGENS
• Facultative intracellular pathogens are capable of both an
intracellular and extracellular existence.
• Intracellular Survival Mechanisms
– Possess a cell wall composition that resists digestion (e.g.,
Mycobacterium tuberculosis)
– Fusion of lysosomes with phagosomes is prevented
– Production of phospholipases that destroy the phagosome membrane,
thereby preventing lysosome-phagosome fusion
– Other unknown mechanisms
CAPSULES AND FLAGELLA
• Capsules and flagella are considered to
be virulence factors.
• Examples of encapsulated bacteria:
Streptococcus pneumoniae, Klebsiella
pneumoniae, Haemophilus influenzae
and Neisseria meningitidis.
• Flagella are virulence factors because
they enable flagellated bacteria to
invade aqueous areas of the body; may Photomicrograph of stained Streptococcus
also help the bacterium to escape pneumoniae showing capsules (the
phagocytosis.c unstained halos that surround the bacteria).
EXOENZYMES
• The major mechanisms by which pathogens cause disease are the
exoenzymes or toxins that they produce.
• Exoenzymes released by bacteria include:
Necrotizing enzymes Coagulase
Kinases Hyaluronidase
Collagenase Hemolysins
Lecithinase
TOXINS
• Toxins are poisonous substances released by various pathogens. There are 2
general types:
– Endotoxins
• Part of the cell wall structure of Gram-negative bacteria
• Can cause serious, adverse physiologic effects such as fever and shock
• Exotoxins
• Poisonous proteins secreted by a variety of pathogens
• Examples: neurotoxins, enterotoxins, exfoliative toxin, erythrogenic
toxin, and leukocidins
MECHANISMS BY WHICH
PATHOGENS ESCAPE IMMUNE
RESPONSES
• Antigenic Variation
– Some pathogens evade the immune system by changing their surface
antigens – antigenic variation; examples, Neisseria gonorrhoeae and
Borrelia recurrentis.
• Camouflage and Molecular Mimicry
– Some organisms conceal their foreign nature by coating themselves with
host proteins – like camouflage (e.g., adult schistosomes).
• Destruction of Antibodies
– Some pathogens produce IgA protease, an enzyme that destroys some of
the host’s antibodies; example, Haemophilus influenzae.
