Microbial Pathogenicity

Eiman Mokaddas MD, FRCPath

Associate Professor
Microbiology Department
Faculty of Medicine
 Quiz
A patient with known blood borne pathogen
was operated in the operating theatre, which
involved the use of a flexible endoscope
What is usually done to the reusable items
in the theatre?
Clean and place in CSSD bin
 Quiz
Endoscopes are heat-sensitive equipments.
How would you make it fit to be used for
the next patient?
Wear gloves, clean carefully and then rinse
with detergent and water. Flush through and
then soak with 2% gluteraldehyde for 3
hours. Rinse in sterile water before use
 Quiz
There was spillage of blood and body secretions
on the theatre floor during operation.
How would you take care of the spillage?
Answer:
• Wear disposable gloves and plastic apron. Pour 1%
hypoclorite solution (10,000 ppm) on the spilage
• Clean the floor with detergent and hot water
 Quiz
To what group of disinfectants does
gluteraldehyde belong?
Answer:
Gluteraldehyde is a chemical disinfectant an
alkylating agent like formaldehyde and
ethylene oxide and it belongs to the group
of aldehyde disinfactants
 Quiz
What is the advantage and disadvantage of gluteraldehyde?
Answer:
Advantage:
• Good activity against spores as well as vegetative bacteria, viruses
and fungi
Disadvantage:
• Moderate activity against Mycobacterium tuberculosis.
• Need exposure for 3 hours to kill all microbes 9 new
concentration)
• Affected by PH
• Toxic and may cause sensitivity reaction to skin, eyes or lungs
 Quiz
What type of disinfectant is hypochlorite?
Answer:
• Halogen
• Oxidizing agent like hydrogen peroxide and
chlorine gas
 Quiz
What are the advantages and disadvantages of
hypochlorite?
Answer:
Advantage:
• Active against viruses
• Very usefull against HIV and Hepatitis B virus
Disadvantage:
• Easily inactivated by organic matter
• Surface must be cleaned thoroughly before application
• Corrosive to metals
• Activity deteriorate rapidly When diluted
 Quiz
What are its uses?
Extra strong solution (10.000 ppm)
• Blood spliage from HBs Ag positive patient
Strong solution (2.500ppm)
• General blood spilage
• Laboratory pipette jar
• Antiseptic in infected pressure sores
0.1% solution (1000ppm)
• General environmental disinfectant
Weak solution (125ppm) MILTON
• Cleaning infant feeding utensils
 Definitions
Pathogenicity
• Capability to cause disease
Infectivity:
• Ability to breach the new host’s defenses
Virulence:
• Capacity of the pathogen to harm the host
 Types of Pathogens
Primary Pathogens: capable of establishing
disease in a previously healthy individual with
intact immunological defenses
• Conventional
• Conditional
Opportunistic pathogens: rarely cause disease in
individuals with intact immunological and
anatomical defenses
• Cause infection only when such defenses are impaired
by disease or treatment e.g. Coagulase negative
staphylococci, candida spp etc…
 Virulent Determinants
Both primary and opportunistic pathogens
have virulence determinants or aggresins
that facilitate pathogenesis. Usually bacteria
posses many of those virulence
determinants to be able to cause disease
Not all strains of a particular bacterial
species are equally pathogenic e.g.
Haemophilus influenzae
 Establishment of Infection
Potential pathogens may enter the body by various
routs:
• Respiratory
• Gastrointestinal
• Urinary
• Genital
• Skin: bites, inoculation, trauma
Opportunistic pathogens are carried in the body
and can enter readily in the compromised host
 Source of infection
Individuals with clinical disease ( patient)
Carrier: symptoms are either absent or mild
due to the early stage of the disease or due
to the establishment of partial immunity to
the pathogen
Environmental: food, water, fomites,
equipments ( act as reservoir and source for
environmental contamination)
 Colonization
The establishment of a stable population of
bacteria or other microbes in the host
Normally requires adhesion to the mucosal surface
This allows the establishment of focus of infection
that remains localized without causing much harm
However it may subsequently spread anytime to
other tissues
 Adhesion
Adhesion is very important to allow resisting host
defense, flushing action of mucous and saliva)
Involves surface interaction between specific
receptors on the mammalian cell membrane
( usually carbohydrates) and the bacterial ligands
( usually proteins) on the bacterial surface
Specific receptors on the mammalian cell are
responsible for the tissue specificity of infection
 Types of adhesins
Fimbrial: on the surface of many Gram-positive
and Gram-negative bacteria
Fimbriae: Thin, rigid rod-like structures
Mediate attachment to mammalian cells
Can carry various antigenic determinants
Association with infection may differ according to
the type of fimbrial antigens
Non-fimbrial adhesins: haemagglutinins, outer
membrane proteins, polysaccharides
 Invasion
Once attached to mucosal surfaces, some
pathogens exert their pathogenic effect without
penetrating the host tissues ( through
toxins)
Other pathogens, adhesion is the first step of tissue
invasion
Examples: Mycobacteria, salmonella, Shigella,
E.coli etc…
Cell invasion confer ability to escape humeral host
defense mechanisms
 Avoidance of host defense
mechanism
Available host defenses:
• Humeral-mediated immune system
• Cell-mediated immune system
• Complement components
• Lysosyme
• Phagocytes
 Avoidance of host defense
mechanism
1. Capsules: The most common mechanism to avoid
phagocytosis by bacteria
All pathogens associated with meningitis and pneumonia
have capsules e.g. Haemophilua influenzae, Streptococcus
pneumoniae, E.coli, Neisseria meningitidis
Non-capsulated variants are usually less pathogenic
Capsules are polysaccharides that reduce efficiency of
phagocytosis as they are less immunogenic and prevent
opsonization of the bacterium by complements
 Avoidance of host defense
mechanism
2. M-protein of Streptococcus pyogenes
3. Resistance to killing by phagocytic cells:
intracellar multiplication ( resistance of
intracellular killing)
4. Antigenic variation: Variation of surface antigen
composition during the course of infection
provides a mechanism of avoidance of specific
immune response directed at those antigens
(bacteria, viruses)
 Toxins
In many bacterial infections the characteristic pathology of the disease
is caused by toxins
Types of toxins:
Endotoxins:
• Called lipopolysaccharides (LPS)
• Is a component of the outer membrane of Gram-negative bacteria
• Released from the bacterial surface upon lysis of the bacteria
• Responsible for endotoxic shock and septic shock
Exotoxins:
• In contrast to endotoxins are diffusable proteins secreted into external
medium by the pathogen
• Toxoids: denatured toxins which lack toxic effect but still immunogenic
• Examples: enterotoxins( GI)