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ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd
Edition) © Garland Science
CHAPTER 5
REQUIREMENTS FOR INFECTION
ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd
Edition) © Garland Science
WHY IS THIS IMPORTANT?
 This chapter introduces you to the mechanisms
involved in the infectious disease process
 Understanding the requirements necessary for
infection is critical to understanding treatment
 Four of the five requirements for infection will
be discussed in this chapter
ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd
Edition) © Garland Science
OVERVIEW
ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd
Edition) © Garland Science
REQUIREMENTS FOR A
SUCCESSFUL INFECTION
 Entry–getting in
 Establishment–staying in
 Defeat the host defenses
 Damage the host
 Exit the host and be transmitted to another host
ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd
Edition) © Garland Science
VIRULENCE FACTORS
 Pathogens use virulence factors for the
infection process
 They allow pathogens to survive and thrive in the
host
 They make harmless organisms dangerous and
make dangerous organisms more dangerous
ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd
Edition) © Garland Science
PORTALS OF ENTRY
(GETTING IN)
 Any point at which pathogens can enter is
called a portal of entry
 There are three categories of portals of entry:
 Mucous membranes
 Skin
 Parenteral routes
ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd
Edition) © Garland Science
PORTALS OF ENTRY
(GETTING IN)
ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd
Edition) © Garland Science
MUCOUS MEMBRANES
 Mucous membranes are in direct contact with
the external environment
 They allow pathogens to gain access into the
body
 They are found in the:
 Respiratory tract
 Gastrointestinal tract
 Genitourinary tract
ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd
Edition) © Garland Science
THE RESPIRATORY TRACT
 This is the most favorable portal of entry to
pathogens because we have to breathe
continuously
 Pathogens can be found on droplets of
moisture as well as on dust particles
ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd
Edition) © Garland Science
THE RESPIRATORY TRACT
 Pathogens using the respiratory tract include:
 Viruses that cause common cold
 Bacteria and viruses that cause pneumonia
 Mycobacterium tuberculosis
 Influenza virus
 Measles virus
 Smallpox virus
ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd
Edition) © Garland Science
THE GASTROINTESTINAL
TRACT
 This is the second most favorable portal of
entry for pathogens since we have to eat and
drink regularly
 It has many barriers to infection but is still the
entry point for many pathogens
ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd
Edition) © Garland Science
THE GASTROINTESTINAL TRACT
 Pathogens using the gastrointestinal tract
include:
 Salmonella species
 Shigella species
 Escherichia coli
 Vibrio cholerae
 Hepatitis A virus
 Giardia
ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd
Edition) © Garland Science
THE GASTROINTESTINAL TRACT
 The gastrointestinal tract is also an important
portal of exit
 Pathogens can be found in fecal material after
leaving the body
 The fecal-oral route of contamination is very
important in the infection process
ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd
Edition) © Garland Science
THE GASTROINTESTINAL TRACT
 Helicobacter pylori infects the stomach and
duodenum of the small intestine
 It survives the acidic environment of the
stomach by producing an alkaline halo around
itself
 It takes up residence in the mucus that lines
the stomach and duodenum
 Infection with H. pylori is a known risk factor
for stomach and duodenal ulcers
ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd
Edition) © Garland Science
THE GENITOURINARY TRACT
 This portal of entry is more complicated than
the ones previously discussed
 Urinary tract infections (UTIs) are more
common in women than in men
 These types of infections cause major
problems in hospitals and clinical settings
 Diseases of the reproductive tract are usually
sexually transmitted and are also part of this
portal of entry
ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd
Edition) © Garland Science
THE GENITOURINARY TRACT
 Pathogens using the genitourinary tract
include:
 Proteus mirabilis
 Chlamydia trachomatis
 Herpes simplex virus
 HIV
ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd
Edition) © Garland Science
SKIN
 The skin is the largest organ in the body
 The large surface area of the skin provides a
vast area through which microorganisms may
enter the body
 Many microorganisms reside on the skin
 Skin provides an impermeable barrier to most
microbes and must be broken to allow entry
ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd
Edition) © Garland Science
THE PARENTERAL ROUTE
 The term parenteral route refers to breaks in
the skin which permit entry of microorganisms
 The parenteral route depends on injections,
cuts, or wounds, and surgical procedures to
provide an entry point
 Insect bites can also allow entry of microbial
organisms
 Insect transfer is referred to as vector
transmission
ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd
Edition) © Garland Science
ESTABLISHMENT
(STAYING IN)
 After entry into the host, pathogens must find
a way to stay in the body
 Pathogens use structures, such as capsules or
fimbriae to attach to the surface of cells or
tissues
ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd
Edition) © Garland Science
ESTABLISHMENT
(STAYING IN)
© Professors P. Motta & F. Carpino / University "La Sapienza", Rome / Science Photo Library
ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd
Edition) © Garland Science
ESTABLISHMENT
(STAYING IN)
© Professor P.M. Motta / University "La Sapienza", Rome / Science Photo Library
ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd
Edition) © Garland Science
ESTABLISHMENT
(STAYING IN)
© Professor P.M. Motta Et Al / Science Photo Library
ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd
Edition) © Garland Science
ESTABLISHMENT
(STAYING IN)
 Pathogens can use adhesins (surface proteins)
to adhere to tissue
 An example of adherence is the plaque found
on teeth
 Plaque forms when a pellicle coats the tooth and
bacteria subsequently adhere to it
 As many as 300 to 400 different types of bacteria
will adhere to each other building a biofilm on the
tooth. This is the plaque
ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd
Edition) © Garland Science
ESTABLISHMENT
(STAYING IN)
Spirochetes like
Treponema
pallidum (the
causative agent of
syphilis)
corkscrew into
tissues.
© CDC/ Dr. David Cox
ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd
Edition) © Garland Science
INCREASING THE NUMBERS
 Increasing the number of pathogens can
establish the infection in the host
 Rapid growth and increased numbers of
pathogens can happen very quickly
 Some pathogens can double their numbers in as
short a period as twenty minutes
 An organism that doubles every twenty minutes
will become 1 x 1021
organisms in just 24 hours
ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd
Edition) © Garland Science
INCREASING THE NUMBERS
 Some pathogens are more virulent than others
– fewer pathogens are needed for a successful
infection
 We use the terms ID50 and LD50 to characterize
these differences between pathogens
ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd
Edition) © Garland Science
INCREASING THE NUMBERS
 ID50 = infectious dose 50%
 The number of organisms required for 50% of the
host population to show signs of infection
 LD50 = lethal dose 50%
 The number of organisms required to kill 50% of a
host population
ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd
Edition) © Garland Science
INCREASING THE NUMBERS
 Binary fission is the form of reproduction seen
in most bacteria
 One cell divides to yield two
 Two divide to become four and so on
 The number of bacteria can increase very quickly
ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd
Edition) © Garland Science
INCREASING THE NUMBERS
 In viral infections, the number of viruses
increases even more dramatically
 Virally infected cells will lyse and this releases
millions of viral particles
 Each particle can infect a new cell
 Each newly infected cell will produce millions of
viral particles
ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd
Edition) © Garland Science
DEFEATING THE HOST’S
DEFENSES
 The body possesses powerful defense
mechanisms
 Pathogens must avoid, evade, or compromise
these defenses in order to survive and thrive
 Pathogens can defeat host defenses in two
ways:
 Passive defense – using built-in structures found
on the pathogen cell
 Active defense – attacking the host defenses
ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd
Edition) © Garland Science
PASSIVE PROTECTION
STRATEGIES: Capsules
The main passive protection strategy is the bacterial
capsule which inhibits phagocytosis by host cells.
ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd
Edition) © Garland Science
PASSIVE PROTECTION
STRATEGIES: Cell Walls
 Another passive protection strategy is through
components of the bacterial cell wall
 M proteins are found in the cell wall of
streptococcal organisms

They increase virulence by increasing adherence to host
cells

They can also inhibit phagocytosis
ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd
Edition) © Garland Science
PASSIVE PROTECTION
STRATEGIES: Cell Walls
 Another passive protection strategy is through
components of the bacterial cell wall
 Mycolic acid is a waxy material found in the cell
walls of Mycobacterium species

It can inhibit phagocytosis and the entry of antibiotics
ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd
Edition) © Garland Science
ACTIVE PROTECTION
STRATEGIES: Enzymes
 Active bacterial protection strategies involve
the production of extracellular enzymes which
can:
 Increase protection against host defenses
 Enable the spread of infection by attacking and
killing host defensive cells
ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd
Edition) © Garland Science
EXAMPLES OF BACTERIAL
PROTECTIVE ENZYMES
 Leukocidins – destroy white blood cells
 Hemolysins – attack red and white blood cells
 Coagulase – causes the formation of fibrin clots
 Kinases – break down fibrin and destroy clots
 Hyaluronidase and collagenase – break down
connective tissue and collagen
ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd
Edition) © Garland Science
EXAMPLES OF BACTERIAL
PROTECTIVE ENZYMES
ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd
Edition) © Garland Science
HIDING FROM THE HOST
DEFENSE
 Pathogens can also hide in order to defend
themselves
 Getting inside a host cell can protect the pathogen
from the host immune defense:
 Viruses are obligate intracellular parasites and can
easily enter host cells
 Bacteria have to use the host cell cytoskeleton
(microtubules and microfilaments) to get into and
move around a host cell
 Bacteria can also use the molecule cadherin to move
into adjacent cells
ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd
Edition) © Garland Science
DAMAGING THE HOST
 Most of the damage to a host can be divided
into two causes:
 Damage that occurs because pathogens are present
and active
 Damage that occurs because of host defense
mechanisms
ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd
Edition) © Garland Science
DAMAGING THE HOST
 Damage to the host committed by the
pathogen can be direct or indirect
 Direct damage

Is obvious and includes the destruction of host cells or
tissues

Is usually controlled by the host immune response
 Indirect damage

Involves systemic infection as a result of toxin
production by the pathogen
ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd
Edition) © Garland Science
BACTERIAL TOXINS
 Bacterial toxins are:
 Very poisonous
 Soluble in aqueous solutions
 Easily diffusible into blood and lymph which
causes distal pathology
ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd
Edition) © Garland Science
BACTERIAL TOXINS
 Bacterial toxins can produce fatal outcomes in
patients
 They produce common symptoms such as
fever, shock, diarrhea, cardiac and
neurological trauma, and the destruction of
blood vessels
 There are two types of toxins:
 Exotoxins
 Endotoxins
ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd
Edition) © Garland Science
EXOTOXINS
 Exotoxins are are specific to a certain
pathogen and secreted by the pathogen and can
then even enter host cells
 They are among the most lethal substances
known
 They are usually an enzymatic protein soluble
in the blood and lymphatic system
ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd
Edition) © Garland Science
EXOTOXINS
 Exotoxins rapidly diffuse into tissues where
they inhibit metabolic function
 They are usually produced as pro-enzymes
 Many genes that code for toxins are carried on
prophages or plasmids
ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd
Edition) © Garland Science
EXOTOXINS
ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd
Edition) © Garland Science
EXOTOXINS
 There are three types of exotoxins:
 Cytotoxins – kill cells
 Neurotoxins – interfere with neurological signaling
 Enterotoxins – affect the lining of the digestive
system
ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd
Edition) © Garland Science
EXOTOXINS
ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd
Edition) © Garland Science
EXOTOXINS:
Anthrax Toxin
 Anthrax toxin is a cytotoxin
 It is produced by Bacillus anthracis (a Gram-
positive rod commonly found in soil of pastures)
 It is made up of three parts which are:
 Produced separately within the pathogen
 Assembled outside the anthrax organism cell wall
 It interrupts signaling capability of host
macrophages and dendritic cells
ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd
Edition) © Garland Science
EXOTOXINS:
Diphtheria Toxin
 Diphtheria toxin is a cytotoxin
 It is produced by Corynebacterium diphtheriae
 It is first produced in an inactive form
 It inhibits protein synthesis in the host
 A single molecule can kill a host cell
ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd
Edition) © Garland Science
EXOTOXINS:
Diphtheria Toxin
 The structure of diphtheria toxin is well
studied and composed of two chains called
A and B
 The B chain binds to the target cell and
facilitates the entry of the A chain
 The A chain causes inhibition of protein
synthesis
ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd
Edition) © Garland Science
EXOTOXINS:
Botulinum Toxin
 Botulinum toxin is a neurotoxin
 It is produced by Clostridium botulinum
 There are seven forms of this toxin, all of
which inhibit the release of the
neurotransmitter acetylcholine
 This disrupts neurological signaling of the skeletal
muscle
 This disruption causes paralysis
ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd
Edition) © Garland Science
EXOTOXINS:
Tetanus Toxin
 Tetanus toxin is a neurotoxin
 It is produced by Clostridium tetani
 It causes loss of skeletal muscle control
 Prevents muscle relaxation
 Causes uncontrollable convulsive muscle
contractions
 Lockjaw is an early symptom
ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd
Edition) © Garland Science
EXOTOXINS:
Cholera Toxin
 Cholera toxin is an enterotoxin
 It is produced by Vibrio cholerae
 It has a two chain polypeptide structure
 The B chain binds to the target cell
 The A chain causes cells to release large amounts
of electrolytes
 The release of large amounts of electrolytes
causes potentially lethal diarrhea and vomiting
ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd
Edition) © Garland Science
EXOTOXINS:
S. aureus Toxin
 Toxic shock syndrome is caused by the
enterotoxin from Staphylococcus aureus
 This condition causes excessive loss of
electrolyte fluids
 The loss of the fluids leads to hypotensive
shock
ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd
Edition) © Garland Science
ENDOTOXINS
 The damage to the host caused by endotoxins
is very different from the damage caused by
exotoxins
 Endotoxins are part of Gram-negative cell
walls and are released on the death of the
bacterium
 Lipopolysaccharides contain a particular lipid
called lipid A, which has endotoxin properties
ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd
Edition) © Garland Science
ENDOTOXINS
ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd
Edition) © Garland Science
EXOTOXINS AND ENDOTOXINS
ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd
Edition) © Garland Science
ENDOTOXINS
 Endotoxins cause the following symptoms:
 Chills
 Fever
 Aches
 Muscle weakness
 Large amounts of endotoxins can cause
disseminated intravascular coagulation (DIC)
ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd
Edition) © Garland Science
ENDOTOXINS
 Exotoxins can elicit an immune response
 Endotoxins do not elicit an immune response
 Endotoxins can contaminate materials and
equipment
 There are tests for endotoxin contamination
ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd
Edition) © Garland Science
VIRAL PATHOGENIC EFFECTS
 Viral host cell damage is referred to as a
cytopathogenic effect (CPE)
 The cytopathogenic effect of viruses occurs in
three ways:
 From viral overload
 From cytocidal effects (killing of host cells)
 From non-cytocidal effects (damage caused by
host defense)
ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd
Edition) © Garland Science
VIRAL PATHOGENIC EFFECTS
 Viral cytopathology can be seen
microscopically
 Viral inclusions such as Negri bodies can be seen
in rabies infections
 Syncytia (giant cells) can be present
ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd
Edition) © Garland Science
VIRAL PATHOGENIC EFFECTS
© CDC/ Dr. Edwin P. Ewing, Jr.

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Lecture chapter 05

  • 1. ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd Edition) © Garland Science CHAPTER 5 REQUIREMENTS FOR INFECTION
  • 2. ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd Edition) © Garland Science WHY IS THIS IMPORTANT?  This chapter introduces you to the mechanisms involved in the infectious disease process  Understanding the requirements necessary for infection is critical to understanding treatment  Four of the five requirements for infection will be discussed in this chapter
  • 3. ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd Edition) © Garland Science OVERVIEW
  • 4. ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd Edition) © Garland Science REQUIREMENTS FOR A SUCCESSFUL INFECTION  Entry–getting in  Establishment–staying in  Defeat the host defenses  Damage the host  Exit the host and be transmitted to another host
  • 5. ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd Edition) © Garland Science VIRULENCE FACTORS  Pathogens use virulence factors for the infection process  They allow pathogens to survive and thrive in the host  They make harmless organisms dangerous and make dangerous organisms more dangerous
  • 6. ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd Edition) © Garland Science PORTALS OF ENTRY (GETTING IN)  Any point at which pathogens can enter is called a portal of entry  There are three categories of portals of entry:  Mucous membranes  Skin  Parenteral routes
  • 7. ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd Edition) © Garland Science PORTALS OF ENTRY (GETTING IN)
  • 8. ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd Edition) © Garland Science MUCOUS MEMBRANES  Mucous membranes are in direct contact with the external environment  They allow pathogens to gain access into the body  They are found in the:  Respiratory tract  Gastrointestinal tract  Genitourinary tract
  • 9. ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd Edition) © Garland Science THE RESPIRATORY TRACT  This is the most favorable portal of entry to pathogens because we have to breathe continuously  Pathogens can be found on droplets of moisture as well as on dust particles
  • 10. ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd Edition) © Garland Science THE RESPIRATORY TRACT  Pathogens using the respiratory tract include:  Viruses that cause common cold  Bacteria and viruses that cause pneumonia  Mycobacterium tuberculosis  Influenza virus  Measles virus  Smallpox virus
  • 11. ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd Edition) © Garland Science THE GASTROINTESTINAL TRACT  This is the second most favorable portal of entry for pathogens since we have to eat and drink regularly  It has many barriers to infection but is still the entry point for many pathogens
  • 12. ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd Edition) © Garland Science THE GASTROINTESTINAL TRACT  Pathogens using the gastrointestinal tract include:  Salmonella species  Shigella species  Escherichia coli  Vibrio cholerae  Hepatitis A virus  Giardia
  • 13. ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd Edition) © Garland Science THE GASTROINTESTINAL TRACT  The gastrointestinal tract is also an important portal of exit  Pathogens can be found in fecal material after leaving the body  The fecal-oral route of contamination is very important in the infection process
  • 14. ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd Edition) © Garland Science THE GASTROINTESTINAL TRACT  Helicobacter pylori infects the stomach and duodenum of the small intestine  It survives the acidic environment of the stomach by producing an alkaline halo around itself  It takes up residence in the mucus that lines the stomach and duodenum  Infection with H. pylori is a known risk factor for stomach and duodenal ulcers
  • 15. ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd Edition) © Garland Science THE GENITOURINARY TRACT  This portal of entry is more complicated than the ones previously discussed  Urinary tract infections (UTIs) are more common in women than in men  These types of infections cause major problems in hospitals and clinical settings  Diseases of the reproductive tract are usually sexually transmitted and are also part of this portal of entry
  • 16. ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd Edition) © Garland Science THE GENITOURINARY TRACT  Pathogens using the genitourinary tract include:  Proteus mirabilis  Chlamydia trachomatis  Herpes simplex virus  HIV
  • 17. ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd Edition) © Garland Science SKIN  The skin is the largest organ in the body  The large surface area of the skin provides a vast area through which microorganisms may enter the body  Many microorganisms reside on the skin  Skin provides an impermeable barrier to most microbes and must be broken to allow entry
  • 18. ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd Edition) © Garland Science THE PARENTERAL ROUTE  The term parenteral route refers to breaks in the skin which permit entry of microorganisms  The parenteral route depends on injections, cuts, or wounds, and surgical procedures to provide an entry point  Insect bites can also allow entry of microbial organisms  Insect transfer is referred to as vector transmission
  • 19. ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd Edition) © Garland Science ESTABLISHMENT (STAYING IN)  After entry into the host, pathogens must find a way to stay in the body  Pathogens use structures, such as capsules or fimbriae to attach to the surface of cells or tissues
  • 20. ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd Edition) © Garland Science ESTABLISHMENT (STAYING IN) © Professors P. Motta & F. Carpino / University "La Sapienza", Rome / Science Photo Library
  • 21. ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd Edition) © Garland Science ESTABLISHMENT (STAYING IN) © Professor P.M. Motta / University "La Sapienza", Rome / Science Photo Library
  • 22. ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd Edition) © Garland Science ESTABLISHMENT (STAYING IN) © Professor P.M. Motta Et Al / Science Photo Library
  • 23. ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd Edition) © Garland Science ESTABLISHMENT (STAYING IN)  Pathogens can use adhesins (surface proteins) to adhere to tissue  An example of adherence is the plaque found on teeth  Plaque forms when a pellicle coats the tooth and bacteria subsequently adhere to it  As many as 300 to 400 different types of bacteria will adhere to each other building a biofilm on the tooth. This is the plaque
  • 24. ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd Edition) © Garland Science ESTABLISHMENT (STAYING IN) Spirochetes like Treponema pallidum (the causative agent of syphilis) corkscrew into tissues. © CDC/ Dr. David Cox
  • 25. ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd Edition) © Garland Science INCREASING THE NUMBERS  Increasing the number of pathogens can establish the infection in the host  Rapid growth and increased numbers of pathogens can happen very quickly  Some pathogens can double their numbers in as short a period as twenty minutes  An organism that doubles every twenty minutes will become 1 x 1021 organisms in just 24 hours
  • 26. ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd Edition) © Garland Science INCREASING THE NUMBERS  Some pathogens are more virulent than others – fewer pathogens are needed for a successful infection  We use the terms ID50 and LD50 to characterize these differences between pathogens
  • 27. ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd Edition) © Garland Science INCREASING THE NUMBERS  ID50 = infectious dose 50%  The number of organisms required for 50% of the host population to show signs of infection  LD50 = lethal dose 50%  The number of organisms required to kill 50% of a host population
  • 28. ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd Edition) © Garland Science INCREASING THE NUMBERS  Binary fission is the form of reproduction seen in most bacteria  One cell divides to yield two  Two divide to become four and so on  The number of bacteria can increase very quickly
  • 29. ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd Edition) © Garland Science INCREASING THE NUMBERS  In viral infections, the number of viruses increases even more dramatically  Virally infected cells will lyse and this releases millions of viral particles  Each particle can infect a new cell  Each newly infected cell will produce millions of viral particles
  • 30. ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd Edition) © Garland Science DEFEATING THE HOST’S DEFENSES  The body possesses powerful defense mechanisms  Pathogens must avoid, evade, or compromise these defenses in order to survive and thrive  Pathogens can defeat host defenses in two ways:  Passive defense – using built-in structures found on the pathogen cell  Active defense – attacking the host defenses
  • 31. ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd Edition) © Garland Science PASSIVE PROTECTION STRATEGIES: Capsules The main passive protection strategy is the bacterial capsule which inhibits phagocytosis by host cells.
  • 32. ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd Edition) © Garland Science PASSIVE PROTECTION STRATEGIES: Cell Walls  Another passive protection strategy is through components of the bacterial cell wall  M proteins are found in the cell wall of streptococcal organisms  They increase virulence by increasing adherence to host cells  They can also inhibit phagocytosis
  • 33. ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd Edition) © Garland Science PASSIVE PROTECTION STRATEGIES: Cell Walls  Another passive protection strategy is through components of the bacterial cell wall  Mycolic acid is a waxy material found in the cell walls of Mycobacterium species  It can inhibit phagocytosis and the entry of antibiotics
  • 34. ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd Edition) © Garland Science ACTIVE PROTECTION STRATEGIES: Enzymes  Active bacterial protection strategies involve the production of extracellular enzymes which can:  Increase protection against host defenses  Enable the spread of infection by attacking and killing host defensive cells
  • 35. ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd Edition) © Garland Science EXAMPLES OF BACTERIAL PROTECTIVE ENZYMES  Leukocidins – destroy white blood cells  Hemolysins – attack red and white blood cells  Coagulase – causes the formation of fibrin clots  Kinases – break down fibrin and destroy clots  Hyaluronidase and collagenase – break down connective tissue and collagen
  • 36. ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd Edition) © Garland Science EXAMPLES OF BACTERIAL PROTECTIVE ENZYMES
  • 37. ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd Edition) © Garland Science HIDING FROM THE HOST DEFENSE  Pathogens can also hide in order to defend themselves  Getting inside a host cell can protect the pathogen from the host immune defense:  Viruses are obligate intracellular parasites and can easily enter host cells  Bacteria have to use the host cell cytoskeleton (microtubules and microfilaments) to get into and move around a host cell  Bacteria can also use the molecule cadherin to move into adjacent cells
  • 38. ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd Edition) © Garland Science DAMAGING THE HOST  Most of the damage to a host can be divided into two causes:  Damage that occurs because pathogens are present and active  Damage that occurs because of host defense mechanisms
  • 39. ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd Edition) © Garland Science DAMAGING THE HOST  Damage to the host committed by the pathogen can be direct or indirect  Direct damage  Is obvious and includes the destruction of host cells or tissues  Is usually controlled by the host immune response  Indirect damage  Involves systemic infection as a result of toxin production by the pathogen
  • 40. ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd Edition) © Garland Science BACTERIAL TOXINS  Bacterial toxins are:  Very poisonous  Soluble in aqueous solutions  Easily diffusible into blood and lymph which causes distal pathology
  • 41. ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd Edition) © Garland Science BACTERIAL TOXINS  Bacterial toxins can produce fatal outcomes in patients  They produce common symptoms such as fever, shock, diarrhea, cardiac and neurological trauma, and the destruction of blood vessels  There are two types of toxins:  Exotoxins  Endotoxins
  • 42. ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd Edition) © Garland Science EXOTOXINS  Exotoxins are are specific to a certain pathogen and secreted by the pathogen and can then even enter host cells  They are among the most lethal substances known  They are usually an enzymatic protein soluble in the blood and lymphatic system
  • 43. ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd Edition) © Garland Science EXOTOXINS  Exotoxins rapidly diffuse into tissues where they inhibit metabolic function  They are usually produced as pro-enzymes  Many genes that code for toxins are carried on prophages or plasmids
  • 44. ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd Edition) © Garland Science EXOTOXINS
  • 45. ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd Edition) © Garland Science EXOTOXINS  There are three types of exotoxins:  Cytotoxins – kill cells  Neurotoxins – interfere with neurological signaling  Enterotoxins – affect the lining of the digestive system
  • 46. ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd Edition) © Garland Science EXOTOXINS
  • 47. ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd Edition) © Garland Science EXOTOXINS: Anthrax Toxin  Anthrax toxin is a cytotoxin  It is produced by Bacillus anthracis (a Gram- positive rod commonly found in soil of pastures)  It is made up of three parts which are:  Produced separately within the pathogen  Assembled outside the anthrax organism cell wall  It interrupts signaling capability of host macrophages and dendritic cells
  • 48. ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd Edition) © Garland Science EXOTOXINS: Diphtheria Toxin  Diphtheria toxin is a cytotoxin  It is produced by Corynebacterium diphtheriae  It is first produced in an inactive form  It inhibits protein synthesis in the host  A single molecule can kill a host cell
  • 49. ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd Edition) © Garland Science EXOTOXINS: Diphtheria Toxin  The structure of diphtheria toxin is well studied and composed of two chains called A and B  The B chain binds to the target cell and facilitates the entry of the A chain  The A chain causes inhibition of protein synthesis
  • 50. ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd Edition) © Garland Science EXOTOXINS: Botulinum Toxin  Botulinum toxin is a neurotoxin  It is produced by Clostridium botulinum  There are seven forms of this toxin, all of which inhibit the release of the neurotransmitter acetylcholine  This disrupts neurological signaling of the skeletal muscle  This disruption causes paralysis
  • 51. ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd Edition) © Garland Science EXOTOXINS: Tetanus Toxin  Tetanus toxin is a neurotoxin  It is produced by Clostridium tetani  It causes loss of skeletal muscle control  Prevents muscle relaxation  Causes uncontrollable convulsive muscle contractions  Lockjaw is an early symptom
  • 52. ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd Edition) © Garland Science EXOTOXINS: Cholera Toxin  Cholera toxin is an enterotoxin  It is produced by Vibrio cholerae  It has a two chain polypeptide structure  The B chain binds to the target cell  The A chain causes cells to release large amounts of electrolytes  The release of large amounts of electrolytes causes potentially lethal diarrhea and vomiting
  • 53. ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd Edition) © Garland Science EXOTOXINS: S. aureus Toxin  Toxic shock syndrome is caused by the enterotoxin from Staphylococcus aureus  This condition causes excessive loss of electrolyte fluids  The loss of the fluids leads to hypotensive shock
  • 54. ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd Edition) © Garland Science ENDOTOXINS  The damage to the host caused by endotoxins is very different from the damage caused by exotoxins  Endotoxins are part of Gram-negative cell walls and are released on the death of the bacterium  Lipopolysaccharides contain a particular lipid called lipid A, which has endotoxin properties
  • 55. ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd Edition) © Garland Science ENDOTOXINS
  • 56. ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd Edition) © Garland Science EXOTOXINS AND ENDOTOXINS
  • 57. ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd Edition) © Garland Science ENDOTOXINS  Endotoxins cause the following symptoms:  Chills  Fever  Aches  Muscle weakness  Large amounts of endotoxins can cause disseminated intravascular coagulation (DIC)
  • 58. ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd Edition) © Garland Science ENDOTOXINS  Exotoxins can elicit an immune response  Endotoxins do not elicit an immune response  Endotoxins can contaminate materials and equipment  There are tests for endotoxin contamination
  • 59. ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd Edition) © Garland Science VIRAL PATHOGENIC EFFECTS  Viral host cell damage is referred to as a cytopathogenic effect (CPE)  The cytopathogenic effect of viruses occurs in three ways:  From viral overload  From cytocidal effects (killing of host cells)  From non-cytocidal effects (damage caused by host defense)
  • 60. ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd Edition) © Garland Science VIRAL PATHOGENIC EFFECTS  Viral cytopathology can be seen microscopically  Viral inclusions such as Negri bodies can be seen in rabies infections  Syncytia (giant cells) can be present
  • 61. ISBN: 978-0-8153-6514-3Microbiology: A Clinical Approach, by Tony Srelkauskas © Garland ScienceMicrobiology: A Clinical Approach (2nd Edition) © Garland Science VIRAL PATHOGENIC EFFECTS © CDC/ Dr. Edwin P. Ewing, Jr.