Age.

Some viruses (such as mumps, polio, EBV or hepatitis) tend to produce less
severe infection in infants, whereas others (such as respiratory syncytial virus
and rotavirus) are more severe in children. The basis for this type of age depe
ndence of viral infection is not clear.
Miscellaneous factors. Hormonal and nutritional status may influence the outcome
of viral infections, as shown by the fact that a number of viral infections (e.
g. polio, hepatitis A and B) are often more severe during pregnancy, and protein
malnutrition dramatically exacerbates the severity of measles infection. Person
al habits (e.g. cigarette smoking) may influence the outcome of viral infections
such as influenza - possibly due to impaired mucociliary clearance in the respi
ratory tract. Further, it is known that preceding vigorous exercise may accentua
te the severity of a subsequent bout of poliomyelitis.
PATHOGENESIS OF FUNGAL DISEASE
See Chapter 22.
KOCH'S POSTULATES
A wide spectrum of microbes inhabit the human body. Some are permanent residents
living as commensals, others
are transient organisms and still others are commensals that behave as pathogens
under suitable conditions (opportunistic pathogens). Hence when infection super
venes it is important to differentiate a commensal from a pathogen in order to i
dentify and eliminate the latter. This problem was encountered by Robert Koch, a
German general practitioner, in 1877 when he tried to determine the cause of an
infection called anthrax in cattle and tuberculosis in humans. Koch defined the
criteria for attributing an organism as the cause of specific disease. These cr
iteria, called Koch's postulates, are as follows:
1.
The organism must be isolated from every patient with the disease and it
s distribution in the body correspond to that of the lesions observed.
2.

The organism must be isolated and cultured outside the
body (in vitro) in pure culture.

3.

The pure organism must cause the disease in healthy, susceptible animals.

4.

The organism must be recovered from the inoculated
animal.

Currently these four postulates are complemented with another:
5.

The antibody to the organism should be detected in the
patient's serum.

Clearly, these are ideal criteria and are not always attainable in practice (e.g
. M. leprae, the leprosy bacillus, cannot be cultured in vitro), but they provid
e a framework for establishing an actiological role of organisms in infectious d
iseases.

KEY FACTS

I n cdons are either endogenous or exogenous de e di on wh the th pathog6n is deri b p n . I I .. e ved from th patient's own flora or from an external source P-c u. by definition. 0 Attin i s o actersaare called M oids -'they he.bacterial infection leads to pyogenic and granulomatous inflammation 17U am.entry.. I '..... are n~ i c re antigenic and ce use'. chronic oncoge c-(traiufbming) or'. e fever. and invasivVness a se a *6 ids pr ly. ingestion or inoculation phagocytic activio of . rop vi a prc~equisite for initiating infection.'host cell inay ~esult in aho~rl . .a rapositive And 9 The. hence. r. ve. .. in protective ._ :0 Encloto. ma 0" intiavascu .low infection endotoxins . . 1 cre The ability of an organism to adhere to host surfaces is c . ng e r. Gram-positive bacteria do not have 'r latenzi.xins are the lipopolysaccharide (LPS) iem components of cell walls of Gram-negative bacteria and Vlrus~entry i .. nto a. rprea Toxins of bacteria are classified as enclotoxins or o d ifiiiiiighout tfie~ Vi 6 ' body by direct I cal spreadjyruphatics blood exotoxins -a N~iaemiit nd peripheral nervous.. viru ence o an organism can be measure y its es toxigenic potential. so'gehid gr4 i i id Jrike~ 4iiii -_ .I f d b :itoxi . cytocidal.. Transmission ofa pathogen to an infective focus can occur via h: otelm rcascade disseininated C inhalation.