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

d b

:itoxi ;a

rapositive And

9 The, viru ence o an organism can be measure y its es

toxigenic potential, and invasivVness a
se
a *6
ids pr ly, so'gehid

gr4 i i

id

Jrike~ 4iiii -_
, I ', r- I
n cdons are either endogenous or exogenous
de e di on wh the th pathog6n is deri b
p n , ng
e r, e ved from th
patient's own flora or from an external source P-c u, e fever,
Transmission ofa pathogen to an infective focus can occur via h: otelm
rcascade disseininated
C
inhalation, ingestion or inoculation
phagocytic activio of
. . . I I , , ma
0"

intiavascu

...........

1 cre

The ability of an organism to adhere to host surfaces is

c , rop
vi
a prc~equisite for initiating infection,
0 Attin i s o actersaare
called M oids -'they
he.
are n~ i

re antigenic and

ce use', in protective

- bacterial infection leads to pyogenic and granulomatous

inflammation
17U
am,entry, 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,_
:0 Encloto,xins are the lipopolysaccharide (LPS)

iem

components of cell walls of Gram-negative bacteria and Vlrus~entry i .

nto a,'host cell inay ~esult in aho~rl . ve, cytocidal,
hence, by definition, Gram-positive bacteria do not have
'r
latenzi, chronic oncoge c-(traiufbming) or',low infection
endotoxins