IMMUNOLOGY

Infection and Diseases

Infection is the process by which the microorganism enters into a relationship with the host.

Essential Steps
Entrance
GIT Genitourinary tract

Multiplicaton
Locally Spread to target organ

Propagation
Portal of exit Mode of transmission

Respiratory tract
Skin, mucous membrane

Outcome of Infections
Abortive Subclinical or silent Clinical Outcome depends on: 1- Microbial factors ( pathogenicity and virulence) 2- Host resistance ( natural and acquired)

Types of Microorganisms

Commensal or normal microbial flora

Opportunistic microorganisms

Pathogenic microorganisms

Opportunistic Microorganisms (potential pathogens)

They can cause disease under the following conditions:

1- Host defence mechanisms are lowered. 2- The natural habitat of the organism is changed. 3- Alteration in the host tissue occurs.

Pathogenic Microorganisms ( true pathogens)

They are pathogens capable of infecting the tissues of normal healthy subjects.

Properties of true pathogens

Infectivity Virulence Transmissibility

Infectivity
Pathogen portal of entry initiates infection. The capacity to initiate infection depends on: 1- Dose of pathogen. 2- Growth phase ( more infective in log phase) 3- Virulence.

Virulence
It is the degree of pathogenicity of the organism. Virulence Factors a- Adherence factors e.g. pili. b- Invasiveness ( ability to invade tissue, multiply and spread
rapidly).

c- Toxin production. ( endotoxins, exotoxins) d- Extracellular enzymes. ( help to establish infection e.g.
hyaluronidase, coagulase, fibrinolysin, collagenase).

Transmissibility
Organisms should have:
a)

b)

Portal of exit ( e.g. urine, stools, blood, body secretions). A mode of transmission to a new host ( e,g. hands,objects, insects, droplets).

Characteristics of Exotoxins and Endotoxins

Exotoxins
1- Excreted by living cells.

Endotoxins
1-Released upon bacterial death, part of Gram negative cell wall. 2- Only found in Gram ve bacteria. 3- LPS complex. 4- Relatively stable. 5- Weakly immunogenic.

2- Produced by Gram +ve and some Cram ve bacteria. 3- Polypeptides. 4- Relatively unstable. 5- Highly immunogenic.

Characteristics of Exotoxins and Endotoxins

Exotoxins
6 Converted to toxoids. 7- Highly toxic. 8- Binds to specific receptors on host cells, have selective effect on tissues e.g. leucocidins, haemolysins, necrotoxins. 9- Do not produce fever in host.

Endotoxins
6- Not converted to toxoids. 7- Less toxic. 8- No specific receptors on host cells, produce nonspecific effects as pyrexia, hypotention, shock. 9- Usually produce fever by release of IL-1 and other mediators.

Sources of Infection to Man

A) Exogenous:
1- Patients. 2- Healthy carriers. 3- Infected animals. 4- Soil.

B) Endogenous:
1- E. coli from gut UTI.

2- Staph aureus from nose skin boils. 3- Pneumococci from nasopharynx bronchopneumonia.

C) Hospital acquired infections:

Infections may be acquired in the hospital : 1- Endogenously- from patients own normal flora. 2- Exogenously- from other people (cross infection). - from inanimate objects in the hospital environment (environmental infection).

Modes of Infection
1- Respiratory infections. 2- Skin, wound and burn infections. 3- Venereal infections. 4- Alimentary tract infections ( faecal-oral route): a) Food-borne infection. b) Water-borne infection. 5- Percutaneous transmission. 6- Laboratory infection.