![]() ![]() ![]() Selective pressure from different mucosal environments probably leads to changes in the outer membrane of the organism, including expression of variants of pili, opacity or Opa proteins (formerly protein II), and LOS. Gonococci that invade the lymphatics and blood vessels may cause inguinal lymphadenopathy perineal, perianal, ischiorectal, and periprostatic abscesses and disseminated gonococcal infection (DGI).Ī number of gonococcal virulence and host immune factors are involved in the penetration of the mucosal barrier and subsequent manifestations of local and systemic infection. Dissemination from the fallopian tubes through the peritoneum to the liver capsule results in perihepatitis (Fitz-Hugh–Curtis syndrome). Gonococci may ascend the urogenital tract, causing urethritis or epididymitis in postpubertal males and acute endometritis, salpingitis, and peritonitis (collectively termed acute pelvic inflammatory disease or PID) in postpubertal females. LOS activates complement, which also contributes to the acute inflammatory response. Tumor necrosis factor (TNF) and other cytokines are thought to mediate the cytotoxicity of gonococcal infections. The gonococcal LOS (endotoxin) exhibits direct cytotoxicity, causing ciliostasis and sloughing of ciliated epithelial cells. Mucosal invasion by gonococci results in a local inflammatory response that produces a purulent exudate consisting of PMNs, serum, and desquamated epithelium. gonorrhoeae infects primarily columnar epithelium, because stratified squamous epithelium is relatively resistant to invasion. Kliegman MD, in Nelson Textbook of Pediatrics, 2020 Pathogenesis and Pathology ![]()
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