 Virulent vs Virulence

o Virulent is used as a synonym for pathogenic

o Virulent (pathogenic) Strains are capable of causing disease whereas Avirulent
(nonpathogenic) Strains are not.
o Virulence is used to express a measure or degree of pathogenicity or used in
reference to the severity of the infectious diseases that are caused by the
pathogens.

 Virulence Factors
o The physical attributes or properties of pathogens that enable them to escape
various host defense mechanism and cause disease.
o Are phenotypic characteristics that enable microbes to be virulent (to cause
disease).
o Toxins are obvious virulence factors but other virulence factors are not so
obvious.
o Figure 14-6

1. Attachment – type or types of cells to which the pathogen is able to attach.

To cause disease, some pathogens must be able to anchor themselves to
cells after they have gained access to the body.

a. Receptors and Adhesins

The general terms receptor and integrin are used to describe the
molecule on the surface of a host cell that a particular
pathogen is able to recognize and attach to (Fig 14-7).

A particular pathogen can only attach to cells bearing the appropriate

receptor. Thus, certain viruses cause respiratory infections because
they are able to recognize and attach to certain receptors that are
present on cells that line the respiratory tract. Because those
particular receptors are not present on cells lining the gastrointestinal
tract, the virus is unable to cause gastrointestinal infections. Similarly,
certain viruses cause infections in dogs, but not in humans, because
dog cells possess a receptor that human cells lack.
 The general terms adhesin and ligand are used to describe the molecule on
the surface of a pathogen that is able to recognize and bind to a particular
receptor (Fig. 14-7).

In some cases, antibodies directed against such adhesins prevent the

pathogen from attaching and, thus, prevent infection by that pathogen

b. Bacterial Fimbriae(Pili)

are long, thin, hairlike, flexible projections composed primarily of an

array of proteins called pilin. Fimbriae are considered to be virulence
factors because they enable bacteria to attach to surfaces, including
various tissues within the human body.

Fimbriated (piliated) strains of N. gonorrhoeae are able to anchor

themselves to the inner walls of the urethra and cause urethritis.
Should nonfimbriated (nonpiliated) strains of N. gonorrhoeae gain
access to the urethra, they are flushed out by urination and are thus
unable to cause urethritis. Therefore, with respect to urethritis,
fimbriated strains of N.gonorrhoeae are virulent and non- fimbriated
strains are avirulent.

Other bacterial pathogens possessing fimbriae are Vibrio cholerae,

Salmonella spp., Shigella spp., Pseudomonas aeruginosa, and
Neisseria meningitidis. Because bacterial fimbriae enable bacteria to
colonize surfaces, they are sometimes referred to as colonization
factors.

2. Obligate intracellular Pathogens or Obligate Intracellular Parasites

Certain pathogens must live within host cells to survive and multiply;

Example: Rickettsias invade and live within endothelial cells and vascular
smooth muscle cells. Rickettsias are capable of synthesizing proteins, nucleic
acids, and adenosine triphosphate (ATP), but are thought to require an intra-
cellular environment because they possess an unusual membrane transport
system; they are said to have leaky membranes.
3. Facultative Intracellular Pathogens or facultative intracellular parasites

are capable of both an intracellular and extracellular existence or pathogens

that can live both within and outside of host cells.

Many facultative intracellular pathogens that can be grown in the laboratory

on artificial culture media are also able to survive within phagocytes.

4. Intracellular Survival Mechanisms

The two most important categories of phagocytes in the human body

(referred to as “professional phagocytes”) are macrophages and neutrophils.
Once phagocytized, most pathogens are destroyed within the phagocytes by
hydrolytic enzymes, hydrogen peroxide, superoxide anions and other
mechanisms. However, certain pathogens are able to survive and multiply
within phagocytes after being ingested.

5. Capsules

are considered to be virulence factors because they serve an antiphagocytic

function (i.e., they protect encapsulated bacteria from being phagocytized by
phagocytic white blood cells). Phagocytes are unable to attach to
encapsulated bacteria because they lack surface receptors for the
polysaccharide material of which the capsule is made. If they cannot adhere
to the bacteria, they cannot ingest them. Because encapsulated bacteria that
gain access to the bloodstream or tissues are protected from phagocytosis,
they are able to multiply, invade, and cause disease. Nonencapsulated
bacteria, on the other hand, are phagocytized and killed.

6. Flagella-

are considered virulence factors because flagella enable flagellated (motile)

bacteria to invade aqueous areas of the body that nonflagellated (nonmotile)
bacteria are unable to reach.
7. Exoenzymes-
The major mechanisms by which pathogens cause disease are certain
exoenzymes or toxins that they produce. Some pathogens release enzymes
(called exoenzymes) that enable them to evade host defense mechanisms,
invade, or cause damage to body tissues. These exoenzymes include:

a. Necrotizing Enzymes – are exoenzymes that cause destruction of cells

and tissues.
Notorious examples are the flesh-eating strains of S. pyogenes, which
produce proteases and other enzymes that cause very rapid
destruction of soft tissue, leading to a disease called necrotizing
fasciitis (Fig. 14-8).