The innate immune system has a number of first line barriers to infection that are in place to prevent the entry and growth of pathogens.
This article shall consider the physical, physiological, chemical and biological barriers that perform this role, as well as clinical conditions that may result from their failure.
Physical Barriers
These barriers provide a physical block against pathogens from entering the immune system. The largest barrier comprises of the skin, which has a large surface area and covers the majority of the external surfaces of the body.
The mucous membranes of the mouth, respiratory tract, GI tract and urinary tract also line the the areas of the body that are in contact with the external environment, preventing pathogens from crossing.
The final physical barrier of the innate system is the bronchial cilia. These cells form a mucociliary escalator which allows gradual removal of pathogens from the respiratory system.
Physiological Barriers
The physiological barriers of the body are processes that occur in response to pathogens in order to remove them from the system and vary depending on the location and situation. The main physiological barriers are:
- Diarrhoea
- Vomiting
- Coughing
- Sneezing
Chemical Barriers
There are two main chemical barriers to infection, the relatively low pH of parts of the body and antimicrobial molecules. The following areas of the body have an acidic pH:
- Skin, pH 5.5
- Gastric acid, pH 1-3
- Vagina, pH 4.4
These pHs create a hostile environment that pathogens struggle to thrive in and certainly in the case of gastric acid, can denature the proteins of pathogens.
There are also a variety of innate antimicrobial molecules throughout the body which can aid in the destruction of pathogens:
- IgA, present in tears, saliva and mucous membranes
- Lysozyme, present in sebum, perspiration and urine
- Mucus, present in mucous membranes
- Beta-defensins, present in epithelia
- Pepsin, present in the gastrointestinal tract
Biological Barriers
The main biological barrier to pathogens is the normal flora found within the body. These are non-pathogenic microbes found within strategic locations of the body – those in contact with the external environment. They are typically found in the:
- Nasopharynx
- Mouth and throat
- Skin
- GI tract
- Vagina
These compete with pathogens for attachment sites and resources, and may even produce antimicrobial chemicals. In addition to this, a number of them also produce essential vitamins, such as Vitamin K and B12.
Fig 2 – Mechanisms by which normal flora can prevent infection.
Clinical Relevance
Meningitis
Meningitis is an acute infection of the protective membranes covering the brain and spinal cord – the meninges. It can the result of either a bacterial or viral infection, although the majority are viral cases. The main pathogen responsible for bacterial infections is Neisseria meningitidis. The most common symptoms are:
- Fever
- Headache
- Neck stiffness
- Confusion
- Altered consciousness
- Vomiting
- Photophobia
Cases caused by meningococcal bacteria may also present with a characteristic, non-blanching rash. Due to the proximity of the infection to the central nervous system it is classified as a medical emergency, and is can be diagnosed with a lumbar puncture.
Treatment varies depending on the cause, for example, in suspected bacterial meningitis empirical antibiotics (ceflosporins) should be immediately commenced. In addition to this supportive therapy, such as fluids and potentially corticosteroids are given. In severe cases, admission to an intensive care unit may be required, especially in cases with altered consciousness and respiratory failure.
