1-1 Commensal organisms cause little host damage while pathogens damage host tissues by a variety of mechanisms.
We recognize four broad categories of disease-causing microorganisms, or pathogens: viruses, bacteria and archaea, fungi, and the unicellular and multicellular eukaryotic organisms collectively termed parasites (Fig. 1.4). These microorganisms vary tremendously in size and in how they damage host tissues. The smallest are viruses, which range from five to a few hundred nanometers in size and are obligate intracellular pathogens. Viruses can directly kills cells by inducing lysis during their replication. Somewhat larger are intracellular bacteria and mycobacteria. These can kill cells directly or damage cells by producing toxins. Many single-celled intracellular parasites, such as members of the Plasmodium genus that cause malaria, also directly kill infected cells. Pathogenic bacteria and fungi growing in extracellular spaces can induce shock and sepsis by releasing toxins into the blood or tissues. The largest pathogens—parasitic worms, or helminths—are too large to infect host cells but can injure tissues by forming cysts that induce damaging cellular responses in the tissues into which the worms migrate.
Not all microbes are pathogens. Many tissues, especially the skin, oral mucosa, conjunctiva, and gastrointestinal tract, are constantly colonized by microbial communities—called the microbiome—that consist of archaea, bacteria, and fungi but cause no damage to the host. These are also called commensal microorganisms, since they can have a symbiotic relationship with the host. Indeed, some commensal organisms perform important functions, as in the case of the bacteria that aid in cellulose digestion in the stomachs of ruminants. The difference between commensal organisms and pathogens lies in whether they induce damage. Even enormous numbers of microbes in the intestinal microbiome normally cause no damage and are confined within the intestinal lumen by a protective layer of mucus, whereas pathogenic bacteria can penetrate this barrier, injure intestinal epithelial cells, and spread into the underlying tissues.