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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Neutrophils are constitutively bactericidal to a high degree for gram-positive and gram-negative cocci and enteric bacilli. To maintain this constitutive defense, neutrophils have special functional properties, to be discussed below. A defect in any one of these important functions invariably leads to a life-threatening infection. However, neutrophils have less or little activity against facultative or obligate intracellular pathogens such as mycobacteria, dimorphic fungi, and protozoans. The human immune system has evolved other mechanisms for dealing with these pathogens.
It will be incomprehensible to them that we allowed antibiotics to be used in animal feed, to be used to treat colds and bronchitis due to viruses, and to be given to inpatients and outpatients without careful diagnostic evaluation. Will future generations eventually blame societal need to be "cost-effective" and the emergence of so-called managed care? Will they blame the pharmaceutical industry, whose need to make a profit led to misleading advertising, often directed at patients themselves? Will they blame physicians who did not learn microbiology and never bothered to consider the public health implications of their prescribing practices?
C5a diffuses from the site of inflammation, which sets up a concentration gradient that directs phagocyte emigration by chemotaxis. Still later in the cascade a complex forms composed of C7, C8, and C9—the membrane attack complex (MAC). The MAC inserts itself into the outer lipid bilayers of gram-negative bacteria-forming pores visible by electron microscopy; this drastic perturbation leads to bacteriolysis. Bacteriolysis effected by the MAC is thus a mechanism for killing bacteria by fluid phase components—a phagocyte is not directly involved.
Current Diagnosis & Treatment in Infectious Diseases 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