According to modern concepts, pathogenic micro-organisms may produce both systemic and local manifestations of disease by means of various mechanisms. One of these is through the elaboration of toxic products (toxins) that are intrinsically harmful to the tissues of the host. Another mechanism depends on the creation of a state of hypersensitivity to nontoxic, primarily innocuous constituents or products of the invading micro-organisms (bacterial allergens, fungous allergens and the like).
It appears probable today that both of these mechanisms play a part in most infectious diseases. In some diseases (e. g., diphtheria and tetanus) the toxic element undoubtedly predominates. In others (e. g., syphilis, tuberculosis, leprosy and mycotic conditions) the sensitization mechanism is the more important responsible factor. And in still other diseases (e. g., scarlet fever and the pyodermas due to streptococci and to staphylococci) it would appear as though both mechanisms were involved, and to different degrees, varying
SULZBERGER MB, ROSTENBERG A, GOETZE D. RECURRENT ERYSIPELAS-LIKE MANIFESTATIONS OF THE LEGS: THEIR RELATIONSHIP TO FUNGOUS INFECTIONS OF THE FEET. JAMA. 1937;108(26):2189–2193. doi:10.1001/jama.1937.02780260017006
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