1. Lecture One BIOL 5331 Host-Parasite Relationships Medical Microbiology

2. Lecture One Agents That Cause Disease. Pathogens VirusesBacteriaParasitesFungi

3. Lecture One BIOL 5333 Characteristics of Parasitism Encounter: agent meets host Entry: agent enters host Spread: agent spreads Multiplication: agent multiplies Damage: agent, host response, or both cause damage Outcome: agent or host wins, or coexist

4. Lecture One BIOL 5334 Encounter In utero –Do not normally come in contact with organisms Protection of fetal membranes Do not normally come in contact with organisms from mother –Normally only present sporadically –Exceptions: sexual diseases, virus causes, rubella

5. Lecture One BIOL 5335 Encounter At moment of birth –Come in contact with organisms present in vaginal canal and on skin Previously, antibodies passed from mother to fetus Defenses are good for a period of time, then they wane

6. Lecture One BIOL 5336 Encounter Challenge between man and microbe wages many times during lifetime –Most disappear rapidly –Some become part of normal flora –Only a few cause disease

7. Lecture One BIOL 5337 Later Encounters Exogenous: encountered in environment Endogenous: encountered in or on body –Organisms present on skin can cause disease when they go into deeper tissues

8. Lecture One BIOL 5338 Later Encounters Example: –Staphylococcus aureus enters cut and forms boil –In this case, encounter took place long before disease (at time skin was colonized) Encounter is not always sharply demarcated

9. Lecture One BIOL 5339 Normal Flora What constitutes normal flora? –Some people possess Streptococcus pyogenes in their throat for long periods, but rarely contract disease Opportunistic pathogen existence (carrier state) –95% of people never have this bacterium, and when they do, they get sick

10. Lecture One BIOL 53310 Normal Flora Defined Constitutes normal flora if definition is “any organism present that is not causing disease” Not normal flora if used to mean organisms present in majority of population

11. Lecture One BIOL 53311 Host-Parasite Interaction Exposure to virulent agents does not always lead to disease –Typhus and Black Plague epidemics: only half of population became sick, even though most likely exposed

12. Lecture One BIOL 53312 Host-Parasite Interaction Response of particular microbe to particular host –Depends on factors unique to each interaction –Within a single individual –Changes with: Age Nutritional state Other factors

13. Lecture One BIOL 53313 Entry Much of inside of body is connected to the outside; for example: –Lumen of intestine –Alveoli of lung –Tubules of kidney Almost all organs within thorax and abdomen are topologically connected to the outside

14. Lecture One BIOL 53314 Entry Mechanisms to keep out invaders –Sphincters and valves –With exception of digestive and genitourinary systems, these sites are normally sterile –Organism that resides on lumen side of intestine or lung alveoli has not penetrated body

15. Lecture One BIOL 53315 Entry Defined Ingress of microbes into body cavities contiguous with outside

16. Lecture One BIOL 53316 Digestive System Enter through eating –Numbers of organisms are reduced one million or more in stomach Bacillary dysentery can result from only a few hundred organisms –Not many survive in intestine because of digestive enzymes and strong force of peristalsis

17. Lecture One BIOL 53317 Digestive System More survive in ileum, but need mechanisms to prevent expulsion –Surface components serve as adhesins to allow adherence to epithelial cells Pili and surface polysaccharides –Diseases such as cholera and “traveler’s diarrhea” are caused without penetrating epithelium Toxins that affect epithelial cells

18. Lecture One BIOL 53318 Respiratory System Enter through being inhaled –Air containing microbes goes through air passages (nasal turbinates, oropharynx, larynx) –Microbes reaching lower respiratory system face powerful epithelium sweeping action –Colonization requires adhesion mechanisms

19. Lecture One BIOL 53319 Other No term for urinary or genital entry By bypassing epithelial tissue, microbes can cause disease without penetrating deep into tissues –Cholera, whooping cough, infection of urinary bladder

20. Lecture One BIOL 53320 Penetration into Deeper Tissues Very few organisms can penetrate unbroken skin (worms are an exception) Some organisms can penetrate epithelial tissue; for example: –S. pneumoniae, Treponema pallidum Normally after some injury to tissue (many times caused by a virus) –Viruses, by receptors

21. Lecture One BIOL 53321 Carried in by Macrophage Alveolar macrophage trap organisms in lung –Normally carry upward on ciliary epithelium –Some cases, can carry deeper into tissues Some organisms can live, grow in macrophage: –Legionella –Bordetella pertussis –HIV (via virus-laden macrophage from semen)

22. Lecture One BIOL 53322 Penetration by Other Means Insect bites: numerous viral and protozoan diseases Cuts and wounds: don’t normally lead to disease –Brushing teeth or defecating vigorously causes minute abrasions of epithelium Organisms quickly cleared from blood by reticuloendothelial system

23. Lecture One BIOL 53323 Penetration by Other Means –Injury to internal tissue disrupts defense mechanisms and serious disease can result; for example Subacute bacterial endocarditis –Devastating before antibiotics –Caused by oral streptococci that became implanted on heart valves damaged by rheumatic fever

24. Lecture One BIOL 53324 Penetration by Other Means Organ transplants or blood transfusions –Jakob-Cruetzfeldt disease from transplanted corneas –Cytomegalovirus from kidneys, probably in donor kidney Because immunosuppressive drugs are used, virus may be endogenous Hepatitis B, HIV transmitted by blood

25. Lecture One BIOL 53325 Disease Causation Why are organisms adapted to various locations? –Temperature optima; athletes foot yeast cannot grow at 37°C –Oxygen requirements –Specialized factors important for causing disease (i.e., virulence factors) –Virulence: degree of pathogenicity

26. Lecture One BIOL 53326 Virulence Factor Examples Exotoxins Endotoxins Capsules IgA proteases Adhesins (pili) Motility Invasive properties Ability to acquire iron Serum resistance Ability to survive inside phagocytes

27. Lecture One BIOL 53327 Inoculum Size Inoculum size can determine whether organisms cause disease Normally, high number needed to cause disease/overcome defenses; e.g. –Baths in contaminated hot tubs (veritable culture of bacteria—over one hundred million organisms per ml)

28. Lecture One BIOL 53328 Inoculum Size Normally harmless organisms can overcome defenses; e.g., –People get boils all over body If large number of organisms deposited in deeper tissues, infection usually results –Surgeon preps area to reduce numbers

29. Lecture One BIOL 53329 Spread of Disease General: spread only if overcome host defenses Sometimes precedes, sometimes follows microbial multiplication –Precede: parasite causes malaria disseminated before multiplication –Follow: S. aureus multiplies locally before being disseminated

30. Lecture One BIOL 53330 Spread of Disease Types: –Direct lateral propagation to contiguous tissues –Dissemination to distant sites Characteristics: –Anatomical factors (e.g., ear infections) –Active participation by pathogens— enzymes

31. Lecture One BIOL 53331 Multiplication Factors that affect –Microbial nutrition: body is very nutritious, but it also has antimicrobial substances –Body contains very little free iron Physical factors: temperature, etc. –Narrow temperature optima—prudence of lowering fever by “take two aspirin and call me in the morning”

32. Lecture One BIOL 53332 Damage General: type and intensity depend on specific organism and tissue Types: –Mechanical: mostly result of inflammation –Cell death: depends on: Which cells How many infected How fast infection proceeds

33. Lecture One BIOL 53333 Damage Types, continued: –Pharmacological: toxins alter metabolism –Damage due to host responses Inflammation can lead to destruction of neighboring cells Immune response

34. Lecture One Agents That Cause Disease. Pathogens VirusesBacteriaParasitesFungi

35. Lecture One Outcome: agent or host wins, or coexist BIOL 53335