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Janeway CA Jr, Travers P, Walport M, et al. Immunobiology: The Immune device in Health and also Disease. Fifth edition. New York: Garland Science; 2001.

By agreement with the publisher, this publication is accessible by the find feature, but cannot it is in browsed.

Infectious an illness can it is in devastating, and sometimes fatal, come the host. In this partof the thing we will certainly briefly research the step of infection, and the varioustypes of transmittable agents.

10-1. The course of an infection can be divided into numerous distinctphases

The process of infection deserve to be broken down right into stages, every of which have the right to beblocked by different defense mechanisms. In the very first stage, a brand-new host isexposed to contagious particles shed by an infected individual. The number,route, mode of transmission, and also stability of an transmittable agent external thehost determines its infectivity. Some pathogens, such together anthrax, space spread byspores the are highly resistant come heat and also drying, when others, such as thehuman immunodeficiency virus (HIV), room spread only by the exchange that bodilyfluids or tissues due to the fact that they room unable to survive as infectious agentsoutside the body.

The very first contact v a new host occurs v an epithelial surface. This possibly the skin or the interior mucosal surfaces of the respiratory,gastro-intestinal, and urogenital tracts. ~ making contact, one infectiousagent must create a focus of infection. This entails adhering to theepithelial surface, and also then colonizing it, or penetrating it to replicate inthe tissues (Fig. 10.2, left-handpanels). Countless microorganisms room repelled at this phase by innate immunity. Wehave disputed the natural immune defense mediated through epithelia and also by phagocytesand complement in the underlying organization in thing 2. Chapter2 likewise discusses just how NK cells space activated in response tointracellular infections, and how a regional inflammatory solution and inducedcytokines and chemokines can bring much more effector cells and also molecules to the siteof an epidemic while preventing pathogen spread into the blood. This innateimmune responses usage a variety of germline-encoded receptors to discriminatebetween microbial and host cabinet surfaces, or infected and also normal cells. Lock arenot as efficient as adaptive immune responses, which have the right to afford to be morepowerful top top account of your antigen specificity. However, they deserve to prevent aninfection being established, or failing that, contain it while an adaptive immune an answer develops.


Figure 10.2

Infections and the responses to them can be split into a seriesof stages. This are shown here for an infectious virus enteringacross an epithelium, the commonest course of entry. The infectiousorganism must very first adhere to epithelial (more...)

Only when a microorganism has successfully developed a site of epidemic in thehost does condition occur, and small damage will certainly be resulted in unless the certified dealer isable to spread from the initial site of epidemic or have the right to secrete toxin thatcan spread out to various other parts that the body. Extracellular pathogens spread out by directextension of the focus of infection through the lymphatics or the bloodstream.Usually, spread by the bloodstream occurs just after the lymphatic device hasbeen overwhelmed by the load of infectious agent. Obligate intracellularpathogens have to spread from cell to cell; they carry out so one of two people by directtransmission native one cabinet to the next or through release right into the extracellularfluid and also reinfection that both adjacent and far-off cells. Many typical foodpoisoning organisms cause pathology there is no spreading right into the tissues. Theyestablish a website of infection on the epithelial surface ar in the lumen that the gutand reason no straight pathology themselves, however they secrete toxins that causedamage either in situ or after crossing the epithelial barrierand entering the circulation.

Most transmittable agents show a far-ranging degree of host specificity, causingdisease only in one or a few related species. What determines organize specificityfor every certified dealer is no known, yet the need for attachments to a particularcell-surface molecule is one crucial factor. As various other interactions through hostcells are also commonly required to assistance replication, many pathogens have actually alimited hold range. The molecule mechanisms of organize specificity consist of anarea the research known as molecule pathogenesis, which falls external the scopeof this book.

While many microorganisms space repelled by innate hold defenses, an initialinfection, once established, normally leads to perceptible disease followed byan effective host adaptive immune response. This is initiated in the locallymphoid tissue, in an answer to antigens presented by dendritic cells activatedduring the course of the natural immune an answer (Fig. 10.2, third and 4th panels). Antigen-specificeffector T cells and antibody-secreting B cells are produced by clonalexpansion and also differentiation over the food of number of days, during which timethe induced responses of natural immunity continue to function. Eventually,antigen-specific T cells and also then antibodies room released right into the blood andrecruited come the site of infection (Fig.10.2, last panel). A cure entails the clearance the extracellularinfectious particles by antibodies and also the clearance of intracellular residuesof infection v the plot of effector T cells.

After many species of infection there is little or no residual pathology followingan reliable primary response. In some cases, however, the epidemic or theresponse to it causes significant tissue damage. In various other cases, together asinfection through cytomegalovirus or Mycobacterium tuberculosis,the infection is contained yet not eliminated and also can persist in a latent form.If the adaptive immune response is later on weakened, together it is in got immune deficiency syndrome (AIDS), these diseases reappear together virulent systemicinfections. Us will focus on the strategies supplied by specific pathogens come evadeor subvert adaptive immunity and thereby create a persistent epidemic in thefirst part of thing 11.

In enhancement to clearing the transmittable agent, an effective adaptive immune an answer prevents reinfection. Because that some infectious agents, this security isessentially absolute, while because that others epidemic is reduced or attenuated uponreexposure.

10-2. Transmittable diseases are resulted in by diverse living agents that replicate intheir hosts

The agents the cause an illness fall into five groups: viruses, bacteria, fungi,protozoa, and also helminths (worms). Protozoa and worms space usually group togetheras parasites, and are the subject of the technique of parasitology, whereasviruses, bacteria, and fungi space the subject of microbiology. In Fig. 10.3, the classes of microorganismsand helminth that cause condition are listed, with usual examples that each. Theremarkable range of these pathogens has caused the natural an option of twocrucial attributes of adaptive immunity. First, the advantage of being able torecognize a wide range of various pathogens has actually driven the breakthrough ofreceptors top top B and T cells of same or better diversity. Second, the distincthabitats and life cycles that pathogens have to be countered by a variety ofdistinct effector mechanisms. The characteristic features of each pathogen areits mode of transmission, its system of replication, the pathogenesis or themeans through which it reasons disease, and also the solution it elicits. We will certainly focushere ~ above the immune responses to this pathogens.


Figure 10.3

A variety of microorganisms can cause disease. Pathogenic organisms room of 5 main types: viruses, bacteria,fungi, protozoa, and worms. Some usual pathogens in each group arelisted in the tower on the right.

Infectious agents can grow in various body compartments, as presented schematicallyin Fig. 10.4. Us have currently seen thattwo significant compartments deserve to be defined—intracellular and extracellular.Intracellular pathogens have to invade hold cells in order come replicate, and also somust one of two people be prevented native entering cells or it is in detected and eliminated oncethey have actually done so. Together pathogens deserve to be subdivided further into those thatreplicate easily in the cell, such as viruses and particular bacteria (species ofChlamydia and Rickettsia also asListeria), and those, such together the mycobacteria, thatreplicate in cellular vesicles. Viruses can be prevented native entering cell byneutralizing antitoxin whose manufacturing relies ~ above TH2 cells (seeSection 9-14), while once withincells castle are dealt with by virus-specific cytotoxic T cells, which recognizeand kill the infected cell (see Section8-21). Intravesicular pathogens, ~ above the other hand, greatly infectmacrophages and also can be got rid of with the assist of pathogen-specificTH1 cells, i beg your pardon activate infected macrophages to damage thepathogen (see section 8-26).


Figure 10.4

Pathogens can be uncovered in miscellaneous compartments of the body, wherethey have to be dealt with by different host defense mechanisms. Virtually all pathogens have actually an extracellular phase where they arevulnerable to antibody-mediated effector mechanisms. However,intracellular (more...)

Many microbe replicate in extracellular spaces, either within the human body oron the surface of epithelia. Extracellular bacteria space usually susceptible tokilling by phagocytes and also thus pathogenic species have developed method ofresisting engulfment. The encapsulated gram-positive cocci, because that instance, growin extracellular spaces and also resist phagocytosis by way of their polysaccharidecapsule. This means they are not immediately eliminated by organization phagocytes oninfecting a formerly unexposed host. However, if this device of resistanceis conquer by opsonization by complement and particular antibody, lock arereadily killed after sloop down by phagocytes. Thus, this extracellular bacteriaare clearing by means of the humoral immune an answer (see chapter 9).

Different transmittable agents reason markedly various diseases, showing thediverse processes whereby they damage tissues (Fig. 10.5). Countless extracellular pathogens cause an illness by releasingspecific toxic commodities or protein toxins (see Fig. 9.23), which have the right to induce the manufacturing of neutralizingantibodies (see section 9-14).Intracellular contagious agents typically cause an illness by damaging the cellsthat house them. The particular killing of virus-infected cell by cytotoxic T cells hence not only avoids virus spread however removes damaged cells. The immune response to the transmittable agent can itself it is in a major cause of pathology inseveral illness (see Fig. 10.5). Thepathology led to by a particular infectious agent additionally depends on the site inwhich the grows; Streptococcus pneumoniae in the lung causespneumonia, vice versa, in the blood it reasons a quickly fatal systemic illness.


Figure 10.5

Pathogens can damage tissues in a variety of differentways. The instrument of damage, representative infectious agents, and also thecommon surname of the diseases associated with each space shown.Exotoxins space released by microorganisms and also act in ~ the surface ar (more...)

As us learned in thing 2, because that apathogen to invade the body, that must very first bind to or overcome the surface ar of anepithelium. As soon as the infection is as result of intestinal pathogens such asSalmonella typhi, the causal agent of typhoid fever, orVibrio cholerae, which reasons cholera, the adaptive immune solution occurs in the dedicated mucosal immune system linked with thegastrointestinal tract, as described later in this chapter. Part intestinalpathogens also target the M cell of the gut mucosal immune system, i m sorry arespecialized to transfer antigens throughout the epithelium, as a means ofentry.

Many pathogens cannot be entirely eliminated by the immune response. However neitherare most pathogens universally lethal. Those pathogens that have persisted formany hundreds of years in the human population are highly developed to exploittheir human being hosts, and cannot alter their pathogenicity there is no upsetting thecompromise they have accomplished with the human immune system. Quickly killingevery organize it infects is no far better for the long-term survival the a virus thanbeing wiped out by the immune an answer before that has had time to infect anotherindividual. In short, we have learned to live v our enemies, and they withus. However, we have to be on the alarm at all times for new pathogens and newthreats come health. The human being immunodeficiency virus that causes AIDS serves together awarning come mankind that we stay constantly delicate to the appearance of newinfectious agents.

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The mammalian body is prone to epidemic by countless pathogens, i m sorry mustfirst make contact with the host and also then develop a emphasis of epidemic inorder to cause infectious disease. To create an infection, the pathogen mustfirst colonize the skin or the inner mucosal surface of the respiratory,gastrointestinal, or urogenital tracts and then get over or bypass the innateimmune defenses linked with the epithelia and also underlying tissues. If itsucceeds in doing this, it will provoke an adaptive immune response that willtake effect after numerous days and will typically clear the infection. Pathogensdiffer significantly in their lifestyles and method of pathogenesis, requiring anequally diverse collection of protective responses from the host immune system.