Mims' Pathogenesis of Infectious Disease

Citation

Nash, A. A., Dalziel, R. G., & Fitzgerald, J. R. (2015). Mims' Pathogenesis of Infectious Disease (6th ed.). Academic Press (Elsevier).

Chapter Summary

The book has twelve short chapters, each tied to one stage of an infection, followed by a short appendix of conclusions, a glossary and an index. Every chapter ends with a bibliography. The order of the chapters follows the order of events in the body: entry, early growth, contact with phagocytes, spread, the immune response, damage, recovery, persistence, and finally the factors that make hosts more or less susceptible and the way vaccines intervene.

Chapter 1: General Principles

The opening chapter sets out the framework that the rest of the book uses: infection is treated as an interaction between microbe and host, and the factors common to all infectious diseases are described across viruses, bacteria, fungi and parasites rather than organism by organism.

Chapter 2: Attachment to and Entry of Microorganisms into the Body

The chapter begins with general considerations of adhesion and entry and then goes surface by surface: the skin, the respiratory tract, the gastrointestinal tract, the oropharynx, the urinogenital tract and the conjunctiva. It also covers the normal microbiota and the exit of microorganisms from the body, which closes the loop for transmission to a new host.

Chapter 3: Early Stages of Infection After Pathogen Entry

Covers what happens once a microbe has crossed a surface: growth in epithelial cells, intracellular microorganisms and their spread through the body, subepithelial invasion, and the nutritional requirements of invading microbes.

Chapter 4: Encounter of Microbes with Phagocytic Cells

Starts with the cell biology of phagocytosis in polymorphonuclear leucocytes and in macrophages, then turns to microbial strategy in relation to phagocytes: growth inside the phagocytic cell, killing the phagocyte, and entry into host cells by routes other than phagocytosis. It ends with the consequences of defects in the phagocytic cell and a summary.

Chapter 5: The Spread of Microbes Through the Body

Treats direct spread, the microbial factors that promote spread, and spread via lymphatics, via the blood and via other pathways.

Chapter 6: The Immune Response to Infection

Reviews the antibody response, the T-cell-mediated response, NK cells, macrophages, neutrophils and mast cells, and complement and related defence molecules, then draws conclusions about the immune response to microorganisms. It is written for readers who already know the basics of immunology and want them applied to infection.

Chapter 7: Microbial Strategies in Relation to the Immune Response

A catalogue of ways in which microbes avoid or exploit immunity: induction of immunological tolerance, immunosuppression, absence of a suitable target, residence in sites the immune response cannot reach, induction of inappropriate antibody and T-cell responses, antibodies mopped up by soluble microbial antigens, local interference with immune forces, reduced interferon induction or responsiveness, and antigenic variation.

Chapter 8: Mechanisms of Cell and Tissue Damage

Distinguishes infection with no cell or tissue damage from direct damage by microorganisms, microbial toxins, indirect damage via inflammation, indirect damage via the immune response (immunopathology) and other indirect mechanisms. A section on diarrhoea closes the chapter.

Chapter 9: Recovery from Infection

Looks at the immunological factors in recovery, inflammation, complement, interferons, a worked example of multimechanistic recovery, temperature, tissue repair and resistance to re-infection.

Chapter 10: Failure to Eliminate Microbe

Covers latency, persistent infection with shedding and its epidemiological significance, persistent infection without shedding, and the significance of persistent infections for the individual.

Chapter 11: Host and Microbial Factors Influencing Susceptibility

Considers genetic factors in the microorganism and in the host, stress and hormonal factors, and other factors.

Chapter 12: Vaccines and How They Work

Introduces general principles of vaccination, the complications and side effects of vaccines, and reverse vaccinology.

Key Concepts

Chapters 1–3: Entry and Early Infection

• Portals of entry: the skin, respiratory, gastrointestinal, urinogenital and conjunctival surfaces each present different barriers to attachment and entry.
• Normal microbiota: the resident flora discussed alongside entry and exit, which shapes what can establish itself on a surface.
• Subepithelial invasion: the step after growth in epithelial cells by which a microbe reaches deeper tissue.

Chapters 4–5: Phagocytes and Spread

• Phagocytosis: the uptake and killing of microbes by polymorphonuclear leucocytes and macrophages, which microbes may resist, exploit or destroy.
• Routes of spread: direct spread, lymphatics, the blood and other pathways, aided by microbial factors that promote spread.

Chapters 6–7: Immunity and Microbial Evasion

• Immune effector systems: antibody, T-cell responses, NK cells, phagocytic cells and complement.
• Antigenic variation: a microbial strategy that keeps the immune response one step behind.
• Immunosuppression and tolerance induction: ways in which infection can weaken or mislead the host response.

Chapters 8–10: Damage, Recovery and Persistence

• Immunopathology: tissue damage caused by the immune response itself rather than by the microbe.
• Latency and persistence: infections that are not cleared, with or without shedding of the microbe.

Chapters 11–12: Susceptibility and Vaccines

• Host and microbial genetics: genetic factors on both sides that influence the outcome of exposure.
• Reverse vaccinology: a vaccine-design approach listed among the vaccine topics.

Critical Analysis

Strengths

• A framework that cuts across organisms. The chapters are organised by stage of infection, so the same sequence (entry, early growth, phagocytes, spread, immunity, damage, recovery, persistence) is applied to viruses, bacteria, fungi and parasites. The publisher describes the book as dealing with the spectrum of microorganisms in an integrated manner.
• Concise. Twelve chapters, each with its own bibliography, make it a book that can be read through rather than only consulted. Quoted reviews of earlier editions on the publisher's page call it short but comprehensive, readable and suited to students of medicine, veterinary medicine and microbiology.
• Immunology applied to infection. Chapters 6 and 7 pair the immune effector systems with a systematic list of microbial counter-strategies, a combination that organism-by-organism texts often scatter.

Limitations

• Not a pathogen-by-pathogen reference. The contents list contains no chapters on individual organisms, diagnosis or treatment, so it cannot replace a systematic microbiology text for clinical detail.
• Assumes prior microbiology and immunology. Chapter 6 covers antibody, T-cell, NK-cell, phagocyte and complement responses in a single chapter, so it works as a review for someone who has already studied immunology rather than as a first introduction.
• Dated in places. This is the sixth edition of 2015 and remains the latest edition; developments since then are not included.

Where It Fits in the Course

Within this course list the book is the advanced, conceptual companion. Mims' Medical Microbiology and Immunology integrates microbiology with immunology and then works through infections organ system by organ system; Medical Microbiology and Infection at a Glance gives a brief illustrated map of pathogens, defences, diagnosis and treatment; Basic Immunology and How the Immune System Works cover the immune system on its own, the first as a short textbook and the second as a conversational introduction. Any of these should come first.

Jawetz, Melnick & Adelberg's Medical Microbiology is a single-volume reference organised by organism group, with diagnosis and treatment. The two books complement each other: Jawetz answers what a given organism does and how it is identified and treated, while Mims answers why infections in general take the course they do. Read Mims after a pathogen-based course, or alongside it to make sense of the details.

How to Use This Book

The book suits medical, veterinary and biomedical students who have completed core microbiology and immunology, as well as graduate students and trainees in infection biology; the publisher lists undergraduate and graduate students in microbiology and immunology, medical students and others new to infectious diseases as its readership.

A practical plan: read the chapters in order, since each builds on the previous stage, and keep a one-page table that records, for every pathogen you meet elsewhere, how it enters, where it grows, how it spreads, how it handles phagocytes and immunity, how it damages tissue and whether it persists. Treat Chapters 6 and 7 as the core of the book and revisit them after a course in immunology. Use Chapters 8 to 10 when studying disease mechanisms and Chapter 12 alongside any study of vaccination. The bibliographies at the end of each chapter are the route to primary literature for a seminar or project.