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The next stage of infection is invasion that is the penetration of the epithelium to generate pathogenicity. At the point of entry, usually at small breaks or lesions in the skin or mucosal surfaces, growth is often established in the submucosa. Growth can also be established on intact mucosal surfaces, especially if the normal flora is altered or eliminated. Pathogen growth may also be established at sites distant from the original point of entry. Access to distant, usually interior, sites occurs through the blood or lymphatic system.

If a pathogen gains access to tissues by adhesion and invasion, it must then multiply, a process called colonization. Colonization requires that the pathogen bind to specific tissue surface receptors and overcome any non-specific or immune host defenses. The initial inoculum is rarely sufficient to cause damage.

A pathogen must grow within host tissues in order to produce disease. If a pathogen is to grow, it must find appropriate nutrients and environmental conditions in the host. Temperature, pH and reduction potential are environmental factors that affect pathogen growth, but the availability of microbial nutrients in host tissues is most important. Not all nutrients may be plentiful in different regions.

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