title: A proof-of-concept model for the identification of the key events in the infection process with specific reference to Pseudomonas aeruginosa in corneal infections.
abstract: BACKGROUND
  It is a common medical practice to characterise an infection based on the causative agent and to adopt therapeutic and prevention strategies targeting the agent itself. However, from an epidemiological perspective, exposure to a microbe can be harmless to a host as a result of low-level exposure or due to host immune response, with opportunistic infection only occurring as a result of changes in the host, pathogen, or surrounding environment.
  
  
  METHODS
  We have attempted to review systematically the key host, pathogen, and environmental factors that may significantly impact clinical outcomes of exposure to a pathogen, using Pseudomonas aeruginosa eye infection as a case study.
  
  
  CONCLUSIONS
  Extended contact lens wearing and compromised hygiene may predispose users to microbial keratitis, which can be a severe and vision-threatening infection. P. aeruginosa has a wide array of virulence-associated genes and sensing systems to initiate and maintain cell populations at the corneal surface and beyond. We have adapted the well-known concept of the epidemiological triangle in combination with the classic risk assessment framework (hazard identification, characterisation, and exposure) to develop a conceptual pathway-based model that demonstrates the overlapping relationships between the host, the pathogen, and the environment; and to illustrate the key events in P. aeruginosa eye infection.
  
  
  CONCLUSIONS
  This strategy differs from traditional approaches that consider potential risk factors in isolation, and hopefully will aid the identification of data and models to inform preventive and therapeutic measures in addition to risk assessment. Furthermore, this may facilitate the identification of knowledge gaps to direct research in areas of greatest impact to avert or mitigate adverse outcomes of infection.
authors.affiliation: Safety and Environmental Assurance Centre, Unilever, Sharnbrook, UK; ilias.soumpasis@unilever.com.
authors.forename: Ilias
authors.initials: I
authors.lastname: Soumpasis
authors.affiliation: Safety and Environmental Assurance Centre, Unilever, Sharnbrook, UK.
authors.forename: Laura
authors.initials: L
authors.lastname: Knapp
authors.affiliation: Clinical Bacteriology Consultant, London, UK.
authors.forename: Tyrone
authors.initials: T
authors.lastname: Pitt
keywords: Pseudomonas aeruginosa; contact; dose–response; infection; keratitis; key events model