Model for pathogenesis

From data accumulated from virulence studies, we are able to establish a model of pathogenesis for P. mirabilis, a virulent uropathogenic organism. P. mirabilis, which establishes itself around the periurethral area, can colonize the bladder epithelium via PMF fimbriae, which may bind to receptors on the bladder epithelium. We postulate that once established, highly flagellated differentiated swarmer cells ascend the ureters to the kidney. MR/P fimbria can then bind to the renal epithelium. Bacteria that are established in the kidney can hydrolyze urea, raising the local pH and cause precipitation of saturated polyvalent cations and anions to form kidney and bladder stones (struvite and apatite stones). Epithelial cell necrosis has been observed during this stage of infection. Hemolysin, a potent cytotoxin in vitro, may be involved once the organism has reached the kidney parenchyma. Bacteria may also invade or be internalized by renal tubule epithelial cells causing further damage, which may, in turn, allow the organism to breach this thin barrier and occasionally enter the bloodstream.

See also: ABO blood group system; Bacteria, immunity to; Bacterial cell walls; Molecular mimicry; Urinary tract infections.

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