Current Diagnosis & Treatment in Infectious Diseases by Walter R. Wilson, W. Lawrence, MD Drew, Nancy K., Phd Henry,

By Walter R. Wilson, W. Lawrence, MD Drew, Nancy K., Phd Henry, Merle A., MD Sande, David A., MD Relman, James M., MD Steckelberg, Julie Louise, MD Gerberding

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The normal flora fill these body sites to the exclusion of other species. Thus, the presence of the normal flora provides a protective function. A relatively virulent species such as the fungus Candida albicans cannot occupy the vagina unless the normal flora are eliminated, for example, by use of broad-spectrum antibacterial agents used to treat urinary tract infections. Sometimes virulent microorganisms colonize a body site and coexist along with the normal flora. For example, Streptococcus pneumoniae is often found in the oropharynx of healthy individuals.

In this way, living microbes may remain dormant or latent within host tissues for years, or even decades. This scenario implies microbiostatic host-defense mechanisms. For example, the human tubercle bacillus (Mycobacterium tuberculosis) is inhaled into the lung. In the immunocompetent host, immunity is acquired, microbial replication ceases, and the mycobacteria become dormant, especially (but not exclusively) in the lung apices. A second way to thwart infectious disease is through a set of uniquely human prevention schemes that have resulted from brain development and intelligence.

Motility of neutrophils increases in response to environmental signals called chemotaxins, which include cytokines [IL-6, IL-8, granulocyte macrophage CSF, tumor necrosis factor a (TNFa), interferon-? )], leukotrienes, and chemical products from microorganisms themselves (eg, microbial oligopeptides such as formylmethionine-leucine-phenylalanine). When no concentration gradient is present, increased motility is random [chemokinesis (Figure 2-1E)]; however, in the presence of even weak gradients, neutrophil motility becomes directed toward an increased concentration of stimulus [chemotaxis (Figure 2-1F)].

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