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Made Agus Hendrayana


The pathogenesis of bacterial infection includes initiation of the infectious process and
the mechanisms that lead to the development of signs and symptoms of disease. Characteristics
of bacteria that are pathogens include transmissibility, adherence to host cells, invasion of host
cells and tissues, toxigenicity, and ability to evade the host's immune system. Many infections
caused by bacteria that are commonly considered to be pathogens are inapparent or
asymptomatic. Disease occurs if the bacteria or immunologic reactions to their presence cause
sufficient harm to the person.
Bacteria (and other microorganisms) adapt to the environment, including animals and
humans, where they normally reside and subsist. In doing so, the bacteria ensure their survival
and enhance the possibility of transmission. By producing asymptomatic infection or mild
disease, rather than death of the host, microorganisms that normally live in people enhance the
possibility of transmission from one person to another.
Some bacteria that commonly cause disease in humans exist primarily in animals and
incidentally infect humans. Other bacteria produce infection of humans that is inadvertent, a
mistake in the normal life cycle of the organism; the organisms have not adapted to humans, and
the disease they produce may be severe.
The clinical manifestations of diseases (eg, diarrhea, cough, genital discharge) produced
by microorganisms often promote transmission of the agents.
Many bacteria are transmitted from one person to another on hands. A person with S aureus
carriage in the anterior nares may rub his nose, pick up the staphylococci on the hands, and
spread the bacteria to other parts of the body or to another person, where infection results. Many
opportunistic pathogens that cause nosocomial infections are transmitted from one patient to
another on the hands of hospital personnel.
The most frequent portals of entry of pathogenic bacteria into the body are the sites
where mucous membranes meet with the skin: respiratory (upper and lower airways),
gastrointestinal (primarily mouth), genital, and urinary tracts. Abnormal areas of mucous
membranes and skin (eg, cuts, burns, and other injuries) are also frequent sites of entry. Normal
skin and mucous membranes provide the primary defense against infection. To cause disease,
pathogens must overcome these barriers.
Once in the body, bacteria must attach or adhere to host cells, usually epithelial cells. After the
bacteria have established a primary site of infection, they multiply and spread directly through
tissues or via the lymphatic system to the bloodstream. This infection (bacteremia) can be
transient or persistent. Bacteremia allows bacteria to spread widely in the body and permits them
to reach tissues particularly suitable for their multiplication and cause the diseases.
Learning Task
Case :
A 35 years old female, a secretary at private company come to general practician complained that
she has unreasonable pain when urinate since 5 days. She feels pain too at lower abdominal. The
urine color is dark yellow and little bit cloudy. Other physical examination results are normal.
The practician ask for laboratory examination for urine analysis and urine culture. After few
days, the urine analysis shown that she has urinary tract infection. The urine culture shown
colonies of Escherichia coli bacteria and significant as agent of infection.

Questions :
1. In this case, Escherichia coli as a pathogen bacteria. When is Escherichia coli called as
colonization bacteria?
2. Explain the differentiation between true pathogen and opportunistic pathogen!
3. Explain the pathogenesis how Escherichia coli can infect the urinary tract (from
transmission until infection and cause the disease) !
4. What are Escherichia colis virulence factors that can cause urinary tract infection?
5. Explain the microbial virulence factors that you know!
6. Explain the differentiation between exotoxins and endotoxin !
7. Describe how several pathogens are able to survive inside the macrophages !
8. Explain the routes of transmission that you know and give examples of each !

Self Assessment
1. Explain the meaning of this term above :
A. Contamination
B. Colonization
C. Invasion
D. Infection
E. Pathogen
F. Carrier
G. Nonpathogenic
H. Opportunistic pathogen:
I. Pathogenicity:
J. Toxigenicity:
K. Virulence:
L. Symbiosis
M. Commensalism
N. Parasitism
O. Zoonoses

2. Give examples of attachment mechanism !

Reff :
Jawetz, Melnick, Adelberg. 2010. Chapter 9. Pathogenesis of Bacterial Infection in Medical
Microbiology, 25th Edition by Vishal . The McGraw-Hill Companies. Lange Microbiology.