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J Infect. 2013 Sep;67(3):169-84. doi: 10.1016/j.jinf.2013.05.004. Epub 2013 May 21.

Cigarette smoking and mechanisms of susceptibility to infections of the respiratory tract and other organ systems.

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Division of Pulmonology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital, South Africa.


The predisposition of cigarette smokers for development of oral and respiratory infections caused by microbial pathogens is well recognised, with those infected with the human immunodeficiency virus (HIV) at particularly high risk. Smoking cigarettes has a suppressive effect on the protective functions of airway epithelium, alveolar macrophages, dendritic cells, natural killer (NK) cells and adaptive immune mechanisms, in the setting of chronic systemic activation of neutrophils. Cigarette smoke also has a direct effect on microbial pathogens to promote the likelihood of infective disease, specifically promotion of microbial virulence and antibiotic resistance. In addition to interactions between smoking and HIV infection, a number of specific infections/clinical syndromes have been associated epidemiologically with cigarette smoking, including those of the upper and lower respiratory tract, gastrointestinal tract, central nervous and other organ systems. Smoking cessation benefits patients in many ways, including reduction of the risk of infectious disease.


Adaptive immunity; Antibiotic resistance; Bacterial adhesins; Biofilm; COPD; Community-acquired pneumonia; HIV infection; Innate immunity; Periodontitis; Tuberculosis

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