Abstract
Immune responses of the host to any infectious agents vary in controlling the pathogens. The process begins by the entry of microorganisms into the host to initiate host immune response to understand the type of microorganisms and react accordingly for possible elimination of the organisms. In some cases the host co-exists with the pathogens or unable to effectively deal with them leading to disease condition. Thus, the pathogens establish, multiply and cause disease. The review considered the mode of acquisition of infection, pathogenesis and immune responses to microbial infection. Other areas included the enhancement of immune responses to control infection, immune responses of the host under drug treatment and the control of microbial infection. The understanding of the relationship between infectious microbes and the host immune system leading to protective immunity or disease state will give much information about treatment and controlling of microbial infection in our environment.
Keywords
- immune response
- host-microbial
- pathogens
- infectious agents
- drug treatment
1. Introduction
Several human diseases are caused by pathogenic microorganisms which are diverse and are divided into four major groups namely bacteria, viruses, parasites and fungi [1]. Thus, different pathogens cause varied diseases. Members in each group were classified into subgroups based on unique characteristics they possess [2]. Bacteria were differentiated based on their staining properties due to variation in the cell wall components and those without cell wall, hence there are gram-positive, gram-negative, acid-fast and cell wall defective bacteria. These were subdivided by their shape (spherical and rod-shaped bacteria), growth requirement (e.g. aerobic and anaerobic) among others [3]. Viruses have DNA and RNA with each kind having either single-stranded or double-stranded nucleic acid. These were further classified by the presence or absence of an outer envelope, shape, size and other characteristics [3, 4]. The parasites included protozoa, helminths and arthropods. Unlike helminths and arthropods, which were multicellular, the protozoans were unicellular and conveniently classified by their mode of locomotion. The protozoans included amoebas, ciliates, flagellates and apicomplexans. The helminths were classified according to their shape: nematodes (roundworms) and platyhelminths (flatworms and tapeworms). The arthropods were also considered as vectors of pathogens mainly viruses and bacteria [3, 4]. Finally, the fungi were made up of unicellular forms (
Generally, pathogenic microorganisms are either primary/true pathogens or opportunistic pathogens. The primary pathogens were those capable of causing diseases in the host irrespective of the host’s immune system. Thus, they cause diseases in immunocompetent and immunocompromised individuals and persons with slight imbalances of the immune system. However, the opportunistic pathogens mostly included the normal flora and only cause diseases in immunocompromised individuals as well as when they occur in parts of the body that were not natural to them [5]. When infection occurs, there is interaction between the host immune system and the pathogens. The outcome involved either immune control towards the infection or disease development with pathological manifestations due to the inability of the host immune responses to effectively deal with the pathogens [5, 6]. Understanding the immune responses to microbial infections with or without medication is necessary in the management, control and prevention of infectious diseases. This chapter focuses on the mode of acquiring infections, pathogenesis and immune responses to microbial infection, enhancement of immune responses to control infection, immune responses of the host under drug treatment and preventing microbial infection.
2. Modes of transmission of infectious diseases
Infection is the multiplication of pathogens in or on the body of the infected host whereas disease is the impairment in the normal function of the host because of damage to the host’s cells by the infection [7, 8]. Thus, for infection or disease to occur, the pathogens must attach to or enter the body of the host, multiply, evade the immune responses, cause damage to the host cells and spread to new hosts. In some individuals, the disease is symptomatic while in others, it is asymptomatic. The time interval between infection and appearance of the first clinical sign or symptoms of disease was known as incubation period and this was the time the infection can be spread without the person knowledge [7]. The incubation period is influenced by several factors such as dose of a pathogen, route of inoculation, rate of replication of infectious agent, host susceptibility and immune responses. Hence, incubation period varies among diseases. For instance, non-typhoidal
3. Pathogenicity of microbial infection
The ability of a microbe to cause disease is known as pathogenicity and the degree or extend of the pathogenicity is termed virulence. Virulence varied from mild to severe with varying virulent factors that directly or indirectly play a role in pathogenicity and virulence [22]. Hence, some pathogenic microbes are avirulent causing diseases only occasionally, moderately virulent that cause mild diseases while others are highly virulent causing diseases with severe clinical presentations. For a microbe to cause a disease, the pathogens must attach to and/or enter the host body with the help of virulent factors and colonize [23, 24, 25]. The main attachment and entry sites for microorganisms include the skin, conjunctiva, alimentary, respiratory and urinogenital tracts. Some microbes attached to and sometimes penetrate the host body surfaces such as the skin and cells (nucleated and non-nucleated) using adhesins (proteins) located on the surface of the pathogen [26]. The adhesins bind to specific host receptors, which could be transmembrane glycoproteins or extracellular matrix proteins. Others entered directly through open surfaces like skin wounds, through inhalation, a vector such as bites from infected arthropods, mammals like dogs involved in rabies cases and piercing by contaminated devices such as needles [25, 27, 28, 29, 30]. The conjunctiva is mostly infected by the fingers, face towels, flies that settle there among others.
Regarding the urinogenital tract, it is mostly sterile as a result of frequent flushing by urine, hence most invaded pathogens are flushed out and do not get access into the system. However, certain pathogens like
4. Microbial infections and the corresponding immune response towards their elimination
Infection of the host by the pathogens responses in the host with initial reaction of the innate immune response followed by the adaptive immune responses. Infection involving bacteria is associated with various mechanisms to evade or survive the host immune response. Some of the bacteria form capsules, complex structures which present many diverse antigenic targets to the host body surface [40, 41]. The capsules are effective at hiding many bacterial surfaces and preventing opsonization to enable them circulate systemically within the body. Some of these bacteria involved in capsule formation included
Viruses also evolve a number of techniques for evading the immune responses by avoiding complement system through rearrangement of epitopes in their surface proteins. The
5. Enhancement of immune response to control infection
Antigenic features of microbes known as pathogen-associated molecular patterns (PAMPs) are recognized by Pattern Recognition Receptors (PRRs). These involve Toll-like receptors (TLRs), NOD-like receptors (NLRs), AIM2-like receptors (ALRs) and RIG-I-like receptors (RLRs) and stimulation with ligands promptly potentiated the production of proinflammatory cytokines and chemokines [52] which facilitated the clearing of bacterial infections. There was significant reduction in the number of
Most bacterial killing are enhanced by autophagy activity in response to cellular stresses, including hypoxia, energy loss, and nutrient deprivation. This process provided a mechanism for the adaptation to starvation and regulated cellular metabolism and homeostasis [57], therefore play a major role in homeostatic maintenance. The use of autophagy as innate immune mechanism for the clearance of intracellular pathogens [58] enhances the efficient immune responses in dealing with pathogens. Alternatively, bacterial clearance could also occur through LC3-associated phagocytosis (LAP), which was mediated through single-membrane phagocytic vesicles that contain engulfed pathogenic bacteria including
Again, macrophages and neutrophils produced reactive oxygen species (ROS) and reactive nitrogen species (RNS) molecules that acted as a defense mechanism to trigger the clearance of the phagocytosed microorganisms [65]. However, an imbalance in the production and elimination of ROS is associated with human diseases.
6. Drug treatment regime in microbial infection and the interaction with immune response
The treatment of any infections targets the clearing of the pathogens involved and allows the immune system to develop and fully functions. Therapeutic strategies for the treatment of microbial infections have mainly relied on the antibiotics that target pathogenic proteins, DNA, RNA, or cell wall synthesis. In some cases, not all the pathogens are cleared and some may resist clearance. In Tuberculosis (TB) infection, effective drugs have been available for decades, but the disease remained a major infectious disease at global level [66, 67]. This might be due to the emergence of
Drug-resistant viral strains has also compromised the effectiveness of treatment, or even lead to its failure. Drug-resistant viruses occurred as a result of mutation at high frequencies of the viral RNA or DNA [76]. Their genotypes could be advantageous in hosts where the drug was present and could become the dominant genotypes in such hosts [77]. Influenza virus also developed resistance to oseltamivir drugs through mutations and there might be possible exchange of genetic information between resistant and susceptible viral strains [78]. The therapeutic options against HIV-1 include more than 20 drugs through their action mechanisms. These targeted to four different points of the viral replication cycle such as the entry of the virus into the cell, inverse transcription, the integration of viral genetic material into the cell nucleus, and maturation of virions [79]. This phenomenon has been associated with the high replicative capacity of the virus and the high error rate in the transcription of its genetic material. These might be due to the presence of specific mutations resulting from pharmacological pressure and suboptimal viral suppression under a treatment scheme [80]. Herpes virus infection depended upon viral inhibition of several cell functions including the turning off of host protein synthesis, inhibition of mRNA splicing, blocking presentation of antigenic peptides on the cell surface and apoptosis [81]. Treatment of HSV-infections with nucleoside analogs was very common but the development of drug-resistant virus from immunosuppress patients with prolonged exposure to the antiviral agent has been established [82, 83, 84]. Mutations of the herpes viral Thymidine kinase (TK) and DNA polymerase (DNApol) occurred and involved in mechanisms of resistance to acyclovir and penciclovir [85, 86]. The development of point mutations by the pathogens to survive drugs as well as the host immune response involve various factors associated with the infection. In some cases, less aggressive chemotherapeutic regimens substantially reduce the probability of onward transmission of resistance without significant changes in host pathology [87, 88]. In contrast, high dose aggressive treatment in controlling the resistant populations were effective in
7. Controlling microbial infection: The best way
Currently, the phenomenon of multi-drug resistance due to indiscriminate administration of high-doses of antibiotics has been the bane of controlling microbial infection. The indiscriminate and inappropriate use of drug in treating infection has also led to significant toxicity in the infected patients, which present other challenges to tackle. The environment plays a major role in facilitating transmission of several important health care-associated pathogens. These included vancomycin-resistant
Together in the environment, microorganisms form complex communities that play critical roles in either maintaining the well-being of their hosts or destroying the host. In order not to allow their survival to the detriment of the existence of the host, they have to be cleared in both the host and the environment. Therefore, several treatment means have been developed to control microbial infections and these have led to the development of antimicrobial drug resistance pathogens. Addressing this challenge, appropriate use of antimicrobials in human medicine is needed. There should be a means of ensuring timely production and communication of critical diagnostic results and standardized drug susceptibility testing reports in accordance with local treatment guidelines [96, 97]. Also, there should be provision of facility-specific cumulative susceptibility reports for bacterial pathogens against antibiotics, daily counseling to clinicians on etiological infection diagnoses and management, and interpretation of test results. Targeted therapy of difficult-to-treat resistant pathogens and complicated infections are very important guidelines in successful treatment of patients. However, some treatment regimens have been developed to be very useful to avoid the development of microbial resistance. These included the use of nanoparticles to destroy the biofilms and also lessen the doses of antibiotics required in treating patients [98]. The development of a recombinant lysis-deficient
Mast cells (MCs) have also been shown to contribute to host–defense responses in certain bacterial infections. Treatment with recombinant IL-6 from engrafted mast cells enhances bacterial killing and resulted in the control of wound infection and normal wound healing [103]. Taken together, host innate immune response will be a potential means in boosting the clearing of microbial organisms.
Generally, public health strategies in controlling infectious diseases needed proper coordination, planning of infection control activities, post-prescription review, and feedback [93, 104, 105]. There should be a team of Clinical Microbiologist and well equipped laboratories with experience staff, working together to inform and improve individual patient care, contribute to outbreak management of infection and provide accurate surveillance data on infectious diseases. This information could be subsequently used in the review of local treatment guidelines, the design and evaluation of national health policies [106].
8. Conclusion
The microbial infection involved the use of many strategies by the pathogens to survive in the host. These have resulted in the development of drug resistance strains in many pathogens, which persist and continue to be harmful to the host. Many treatment strategies have been failing and making it difficult in controlling diseases. This requires the development of revised scientific means to successfully control infections. Therefore, successful treatment of infections including bacterial and viral infections is the enhancement in both the use of antibiotics (for bacterial infections), antiviral (viral infections) and the host’s immune defenses. As a result of the development of drug resistant strains in many treatment cases the enhancement of mostly innate immune response together with the adaptive immune response will go a long way in treating patients without difficulty.
Acknowledgments
The authors would like to thank the staff of the Department of Microbiology and Immunology, School of Medical sciences, University of Cape Coast for their support during the preparation of the manuscript.
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