Host factors that influence the behaviour of bacterial pathogens in vivo

Interest is increasing in how bacteria behave and produce virulence determinants within the infected host. There are three aspects of this process; observations on the bacteria themselves, recognition of host factors that affect them and investigation of metabolic interactions between the two. The first aspect is relatively easy to investigate and attracts much interest. The second and third are difficult to work on and hence understudied. The review aims to stimulate interest in them by indicating methods of investigation and describing some successful studies. After discussing host factors that determine growth in vivo consideration is given to factors that influence the production of the determinants of mucosal colonization, penetration, interference with host defence and damage to the host. The final section deals with the influence of host-derived cytidine 5'-monophospho-N-acetyl neuraminic acid and lactate on the pathogenicity of gonococci, meningococci and Haemophilus influenzae.