Pathogenesis

The organisms first colonize the mouth and throat and then are carried to the lung by inspired air or a ball of aspirated mucus. Evidence indicates that specific adhesins aid colonization, but their exact nature is not yet known. The capsule is an essential virulence factor, probably functioning like the pneumococcal capsule in interfering with the action of C3b, a critically important opsonin before the appearance of antibody. Unlike Streptococcus pneumoniae, K. pneumoniae causes death of tissue and rapid formation of lung abscesses. The infection often enters the bloodstream, causing abscesses in other tissues, release of endotoxin, and shock. Therefore, even with effective antibacterial medication, the lung can be permanently damaged and death may occur. ■ endotoxin, p. 475

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