Abstract
Bacteria that readily adapt to different natural environments, can also exploit this versatility upon infection of the host to persist. Pseudomonas aeruginosa, a ubiquitous Gram-negative bacterium, is harmless to healthy individuals, and yet a formidable opportunistic pathogen in compromised hosts. When pathogenic, P. aeruginosa causes invasive and highly lethal disease in certain compromised hosts. In others, such as individuals with the genetic disease cystic fibrosis, this pathogen causes chronic lung infections which persist for decades. During chronic lung infections, P. aeruginosa adapts to the host environment by evolving toward a state of reduced bacterial invasiveness that favors bacterial persistence without causing overwhelming host injury. Host responses to chronic P. aeruginosa infections are complex and dynamic, ranging from vigorous activation of innate immune responses that are ineffective at eradicating the infecting bacteria, to relative host tolerance and dampened activation of host immunity. This review will examine how P. aeruginosa subverts host defenses and modulates immune and inflammatory responses during chronic infection. This dynamic interplay between host and pathogen is a major determinant in the pathogenesis of chronic P. aeruginosa lung infections.
Highlights
Bacterial pathogens are most commonly studied for their ability to invade and injure the host, causing acute and invasive infections
For Pseudomonas aeruginosa (PA), this has been best documented in chronic cystic fibrosis (CF) lung infection, and we suggest several excellent recent reviews [33, 116, 119] for a detailed discussion of the topic
Chronic PA infection illustrates a paradigm of chronic bacterial infections where pathogens dampen host defenses, adapt and evolve within the host to persist
Summary
Bacterial pathogens are most commonly studied for their ability to invade and injure the host, causing acute and invasive infections. Chronic infections present a distinct paradigm in infection pathogenesis which may challenge conventional notions of bacterial virulence and host defenses. PA is a formidable opportunistic pathogen that can cause invasive and fulminant infections, such as acute pneumonia or bloodstream infections, in immune compromised hosts. The same pathogen causes chronic infections that persist for months to decades, such as the chronic lung infection in individuals with the genetic disease cystic fibrosis (CF). Chronic PA infections result from a dynamic and complex interplay between pathogen and host, where bacteria persist without causing overwhelming host injury, and where host defenses fail to eradicate the pathogen
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