Infectious diseases depend on the interplay between the ability of pathogens to invade and/or proliferate in the body and the degree to which the body is able to resist. If the ability of a microorganism to invade, proliferate, and cause damage in the body exceeds the body's protective capacities, a disease state occurs. Infection refers to the growth of microorganisms in the body of a host. Infection is not synonymous with disease because infection does not always lead to injury, even if the pathogen is potentially virulent (able to cause disease). In a disease state, the host is harmed in some way, whereas infection refers to any situation in which a microorganism is established and growing in a host, whether or not the host is harmed.

The steps of pathogenesis, the progression of a disease state, include entry, colonization, and growth. Pathogens like bacteria use several strategies to establish virulence. The bacteria must usually gain access to host tissues and multiply before damage can be done. In most cases this requires the penetration of the skin, mucous membranes, or intestinal epithelium, surfaces that normally act as microbial barriers. Passage through the skin into subcutaneous layers almost always occurs through wounds and in rare instances pathogens penetrate through unbroken skin.

Most infections begin with the adherence of bacteria to specific cells on the mucous membranes of the respiratory, alimentary, or genitourinary tract. Many bacteria possess surface macromolecules that bind to complementary acceptor molecules on the surfaces of certain animal cells, thus promoting specific and firm adherence. Certain of these macromolecules are polysaccharides and form a meshwork of fibers called the glycocalyx. This can be important for fixing bacteria to host cells. Other proteins are specific, e.g., M-proteins on the surface of Streptococcus pyogenes which facilitate binding to the respiratory mucosal receptor. Also structures known as fimbrae may be important in the attachment process. For example, the fimbrae of Neiseria gonorrhoeae play a key role in the attachment of this organism to the urogenital epithelium where it causes a sexually transmitted disease. Also, it has been shown that fimbriated strains of Escherichia coli are much more frequent causes of urinary tract infections than strains lacking fimbrae, showing that these structures can indeed promote the capacity of bacteria to cause infection.

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