McCance/Huether: Pathophysiology: The Biologic Basis of Disease in Adults

and Children, 8th Edition

Chapter 10: Infection

Chapter Summary Review

Emerging Infections

1. Emergence of previously unknown infections, reemergence of old infections thought to

be controlled, and the development of infections resistant to multiple antibiotics or
vaccination are significant causes of death and morbidity.

Microorganisms and Humans: A Dynamic Relationship

1. The human body is a hospitable site for microorganisms to grow and flourish. These
microorganisms make up the normal microbiome of the body.
2. The beneficial homeostasis between humans and microorganisms is maintained through
the physical integrity of the gut and other mechanisms that sequester these
microorganisms on the mucosal surface.
3. The symbiotic relationship with the normal microbiome can be altered by injury,
compromising protective barriers including the skin and mucous membranes.

Microorganisms and Infections

1. Clinical infectious disease occurs in four distinct stages: (1) incubation period, (2)
prodromal state, (3) invasion period, and (4) convalescence.
2. The hallmark of most infectious diseases is fever. Body temperature is regulated at a
higher than normal level.
3. Several factors influence the capacity of a pathogen to cause disease, including
communicability, immunogenicity, infectivity, mechanisms of action, pathogenicity,
entry portal, toxigenicity, and virulence.
4. Infectious diseases also are classified by their prevalence and spread as endemic,
epidemic, and pandemic.
5. The process of infection includes colonization, invasion, multiplication, and
dissemination.
6. When an individual’s immune system is deficient, the person can become infected with
opportunistic infections.
7. True pathogens in adequate numbers can circumvent an individual’s defenses and
directly cause infection.
8. Infectious microorganisms usually exist in reservoirs (e.g., contaminated soil,
contaminated water or food, breast milk), animals, or another human.
9. Direct transmission of pathogens can occur by direct physical contact, ingestion or
inhalation, or placental transfer.
10. Indirect transmission occurs from contact with contaminated materials, which can range
from towels to food or through a vector.

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11. As part of colonization, the microorganism stabilizes the adherence to tissue through
surface receptors and can then invade surrounding tissue.
12. Because tissue is warm and nutrient rich, most microorganisms undergo rapid
multiplication. Viral pathogens replicate within infected cells, and some bacteria are
intracellular pathogens and replicate in macrophages and other cells.
13. Successful spreading requires a variety of virulence factors, including adhesion
molecules, toxins, and the ability to evade immunity.
14. Mixed species of microorganisms can come together and form slimy biofilms and anchor
themselves to various surfaces and resist immune defenses.
15. Stable colonization of bacteria requires adhesion. Many bacteria attach through pili
(fimbriae), surface glycoproteins, or complement-related receptors.
16. Invasion results in direct confrontation with an individual’s defense mechanisms,
including complement, antibodies, and phagocytes (neutrophils, macrophages). Evasion
of these defenses can result in bacteremia or viremia or fungemia and sepsis.
17. Bacteria can protect against phagocytosis by producing toxins that destroy phagocytic
cells and extracellular enzymes that digest complement, clotting factors,
immunoglobulins, cytokines, and antimicrobial peptides and promote extracellular
spreading.
18. Classes of infectious microorganisms include bacterial, fungal, parasitic, protozoal, and
viral.
19. Bacteria are divided into several groups—“true bacteria,” filamentous, spirochetes,
mycoplasma, rickettsia, and chlamydia—and can be categorized as gram negative or
gram positive.
20. Many bacteria have specialized surface structures such as pili and flagella that promote
adhesion and tissue invasion.
21. Bacteria can produce a variety of toxic molecules that may kill the individual’s cells,
disrupt tissue, and protect the individual against inflammation.
22. Exotoxins are released by bacteria during bacterial growth and can damage cell
membranes, activate second messengers, and inhibit protein synthesis.
23. Endotoxins are contained in the cell walls of gram-negative bacteria and released during
lysis of the bacteria. Bacteria that produce endotoxins are called pyrogenic bacteria
because they activate inflammation and produce fever. They also can activate the
coagulation cascade and release cachectin (TNF).
24. Inflammatory and immune responses to infection can cause tissue damage through
excessive production of inflammatory cytokines, excessive activation of antibodies, and
infiltration of T cells, macrophages, and neutrophils.
25. Other self-protective mechanisms for bacteria and other pathogens include degradation of
immune molecules, neutralization of immune molecules, complement evasion, immune
suppression, and escape from the phagosome.
26. Some bacteria (and viruses) proliferate more rapidly than the development of immune
defenses causing severe clinical disease.
27. Some bacteria (like viruses) evade immune defenses by surviving inside immune cells.
28. Some bacteria can coat the Fc portion of an individual’s antibody, preventing
complement activation or phagocytosis.
29. Antigenic variation allows pathogens to alter surface molecules that express antigens that
are the targets of protective immune responses. The pathogen thus becomes resistant.

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Chapter Summary Review 10-3

30. Some bacteria can release molecules that bind to and neutralize antibody or form immune
complexes that deposit in tissue, causing damage.
31. Some bacteria can degrade immunoglobulins or components of the complement system.
32. Some bacteria can suppress immune responses that block T cells or impair the signals in
the inflammatory response or interfere with antigen processing and presentation.
33. S. aureus has numerous virulence factors that promote invasive infection. It has become a
major cause of hospital-acquired (nosocomial) infections and antibiotic resistance.
34. Fungal infection is called mycosis. Most pathologic fungi are from the environment and
transmitted by human-to-human contact, inhalation, or contamination of wounds.
35. Fungi have polysaccharide surface molecules that promote adhesion to epithelial tissue.
36. Fungi can produce toxins that promote infection, evade immune responses, or cause
cancer (aflatoxins).
37. Some fungi secrete enzymes that damage tissue and initiate pathogenic inflammatory
responses including hypersensitivity reactions.
38. Some fungi can survive in phagocytes and resist lysosomal destruction.
39. C. albicans is the most common cause of fungal infections in humans. It resides in the
skin, gastrointestinal tract, mouth, and vagina. Local defense mechanisms, including
members of the bacterial microbiome, produce antifungal agents. The infection remains
localized in individuals with an intact immune system.
40. Parasitic organisms establish a symbiosis with another species, whereby the parasite
benefits. They range from unicellular protozoa to large worms.
41. Parasites adhere to and breakdown connective tissue and basement membranes allowing
penetration and entry to the circulatory system.
42. Some parasites only reproduce within host cells (obligatory intracellular parasites).
43. Some parasites evade immune defenses by secreting cytotoxic molecules or by antigenic
variation.
44. Malaria is one of the most common infections worldwide. It is transmitted through the
bite of an infected Anopheles mosquito. The parasite (Plasmodium) enters the
bloodstream, survives in the liver, and invades parenchymal cells. After several rounds of
division, the liver cell ruptures and thousands of parasites enter the blood, infecting red
blood cells.
45. Viruses are intracellular microorganisms. The viral life cycle is completely intracellular
and involves several stages: attachment, penetration, uncoating, replication, assembly,
and release of new virions.
46. Viruses are classified by the format of nucleic acid in the virion (RNA or DNA and either
single-stranded [ss] or double-stranded [ds]) and by whether the virus uses the enzyme
reverse transcriptase (RT) for replication.
47. Successful viruses use a variety of mechanisms for bypassing immune rejection,
including rapid division, intracellular survival, coating with self-proteins, antigenic
variation, neutralization, complement evasion, and immune suppression.
48. Viruses inside the infected cell have several harmful effects, including inhibition of
DNA, RNA, or protein synthesis; disruption of lysosomal membranes, resulting in lytic
enzyme release; promotion of cell apoptosis; fusion of adjacent cells (i.e., giant cells);
transformation into a neoplastic cell; and alteration of antigenic properties (i.e.,
decreasing immune effectiveness).

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Chapter Summary Review 10-4

49. An example of viral infection is influenza, an ssRNA virus transmitted through aerosol
and body fluids, and there are several variant forms. Influenza viruses undergo antigen
shifts allowing them to evade protection from vaccines.

Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome

1. AIDS is a viral disease caused by HIV.

2. HIV infects and depletes a portion of the immune system (Th cells), making individuals
susceptible to life-threatening infections and malignancies.
3. HIV/AIDS remains a major cause of death worldwide.
4. Aggressive antiretroviral therapy and public health campaigns have stabilized the number
of new cases and deaths in the United States from HIV/AIDS and other parts of the world
where there is access to therapy.
5. HIV is a blood-borne pathogen present in body fluids with typical routes of transmission:
blood or blood products, intravenous drug abuse, heterosexual and homosexual activity,
and maternal-child transmission before or during birth.
6. The primary surface receptor on HIV is the envelope glycoprotein gp120, which binds to
the CD4 molecule found mostly on the surface of T-helper cells. Several other important
co-receptors have been identified.
7. HIV is a member of the retrovirus family, which carries genetic information in the form
of RNA. An enzyme, reverse transcriptase (RT), converts RNA into a double-stranded
DNA. Another enzyme, an integrase, inserts the new DNA into the infected cell’s genetic
material. On activation, translation of the viral information may be initiated, forming new
virions, resulting in lysis and death of the infected cell, and shedding infectious HIV
particles.
8. The major immunologic finding in AIDS is the striking decrease in the number of CD4+
Th cells.
9. The presence of circulating antibody against HIV indicates infection by the virus,
although many individuals are asymptomatic.
10. The current treatment for HIV infection is a combination of drugs called antiretroviral
therapy (ART) that attacks different portions of the viral replication pathway.
11. Mother-to-child transmission has been reduced to 1% with prenatal treatment of HIV
infection.
12. Neonates become HIV infected by placental transmission or through breast-feeding.
13. Children with HIV are at increased risk of coronary artery disease.

Countermeasures Against Pathogens

1. Effective means of countering infectious microorganisms are rigorous use of

environmental infection control measures, including control of insect vector populations,
establishment of modern sanitation facilities, and provision of clean water and
uncontaminated food supplies. Prophylactic or interventive procedures include vaccines
and antimicrobials.
2. Passive immunotherapy has been effective using previously formed human
immunoglobulin for diseases such as hepatitides A and B, rabies, and ebola.

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3. With antibiotic-resistant pathogens, a greater emphasis is placed on the development of

new vaccines.

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