Bacterial Infections of Humans (eBook)

Epidemiology and Control

Philip S. Brachman, Elias Abrutyn (Herausgeber)

eBook Download: PDF

2010 | 4th ed. 2009
XXIX, 975 Seiten
Springer US (Verlag)
978-0-387-09843-2 (ISBN)

Infos

In Memoriam of Alfred S. Evans The third edition of Bacterial Infections of Humans is dedicated to Alfred Spring Evans, who died on January 21, 1996, 2 ½ years after a diagnosis of cancer. Al was the senior editor of this textbook, which he founded with Harry Feldman in 1982. Al was a clinician, epidemiologist, educator, ca- lyst for biomedical research, historian, author, speaker, seeker of the truth, sincere friend of students, sports enthusiast, traveler, and truly a man of all seasons. He was a devoted husband to Brigette Klug Evans, father of three children, and grandfather of four. Al was born in Buffalo, New York, on August 21, 1917, to Ellen Spring and John H. Evans, M. D. , one of the United States's ?rst anesthesiologists and an early researcher in the ?eld of oxygen therapy. He received his undergraduate training at the University of Michigan; was awarded an M. D. degree in 1943 from the University of Buffalo; interned in Pittsburgh, Pe- sylvania; and performed his medical residency at the Goldwater Hospital in New York City. He was in the United States Army from 1944 to 1946, assigned as a public health of?cer to a base in Okinawa, Japan. It was there that he met Drs. Albert Sabin and John R. Paul, who came to Okinawa to test a new Japanese encepha- tis vaccine. Al was invited by Dr. Paul to come to Yale Alfred S.

---

In Memoriam of Alfred S. Evans The third edition of Bacterial Infections of Humans is dedicated to Alfred Spring Evans, who died on January 21, 1996, 2 1/2 years after a diagnosis of cancer. Al was the senior editor of this textbook, which he founded with Harry Feldman in 1982. Al was a clinician, epidemiologist, educator, ca- lyst for biomedical research, historian, author, speaker, seeker of the truth, sincere friend of students, sports enthusiast, traveler, and truly a man of all seasons. He was a devoted husband to Brigette Klug Evans, father of three children, and grandfather of four. Al was born in Buffalo, New York, on August 21, 1917, to Ellen Spring and John H. Evans, M. D. , one of the United States's ?rst anesthesiologists and an early researcher in the ?eld of oxygen therapy. He received his undergraduate training at the University of Michigan; was awarded an M. D. degree in 1943 from the University of Buffalo; interned in Pittsburgh, Pe- sylvania; and performed his medical residency at the Goldwater Hospital in New York City. He was in the United States Army from 1944 to 1946, assigned as a public health of?cer to a base in Okinawa, Japan. It was there that he met Drs. Albert Sabin and John R. Paul, who came to Okinawa to test a new Japanese encepha- tis vaccine. Al was invited by Dr. Paul to come to Yale Alfred S.

Inhalt

Contributors 5
Biographical Sketch – Elias Abrutyn 9
Preface 11
Contents 14
Chapter 1 Epidemiological Concepts 29
1.1 Introduction 29
1.2 Definitions and Methods 30
2.1. Definitions 30
2.2. Methods 32
2.2.0. Types of Epidemiological Studies. 32
2.2.1. Experimental Epidemiology. 34
2.2.2. Serological Epidemiology. 35
1.3 Epidemics and Their Investigation 35
3.1. Pathogenesis of an Outbreak 35
3.2. Investigation of an Outbreak 36
3.2.0. Determination of the Presence of an Epidemic. 36
3.2.1. Determination of the Circumstances Under Which the Outbreak Occurred. 37
3.3. Example of Investigating a Foodborne Outbreak 38
1.4 Agent 39
4.1. Characteristics of Organisms That are Involved in Spread Through the Environment 39
4.2. Characteristics of Organisms That are Involved in Production of Infection 39
4.3. Characteristics of Organisms That are Involved in Production of Disease 40
1.5 Environment 42
1.6 Host 43
1.7 Routes of Transmission 45
7.1. Respiratory or Airborne 45
7.2. Contact 47
7.3. Genital or Sexually Transmitted 47
7.4. Gastrointestinal or Fecal--Oral 47
7.5. Urinary 48
7.6. Perinatal 48
7.7. Insect Vectors 48
1.8 Pathogenesis 48
8.1. Localized or Superficial Infections 48
8.2. Systemic Infections 49
1.9 Incubation Period 49
1.10 Immune Response 50
10.1. Nonspecific Immunity 51
10.2. Humoral Immunity 51
10.3. Cell-Mediated Immunity 52
10.4. Cellular Interaction in Immune Responses 53
10.5. The Generation of Diversity in Antigen Recognition 54
1.11 Patterns of Host Response 54
11.1. Biological Gradient 55
11.2. Clinical Syndromes 56
11.2.0. Infections of the CNS. 56
11.2.1. Acute Respiratory Infections. 57
11.2.2. Acute Otitis Media. 58
11.2.3. Intestinal Infections and Intoxications. 59
11.2.4. Acute Urinary Tract Infections. 60
11.2.5. Sexually Transmitted Diseases. 60
11.2.6. Hospital (Nosocomial) Infections. 61
1.12 Diagnosis of Bacterial Infections 62
12.1. Collection of Specimens 62
12.2. Requests for Testing 63
12.3. Tests Employed 63
12.4. Interpretation of Tests 65
1.13 Proof of Causation 66
1.14 Control and Prevention 66
14.1. Environmental Control 66
14.1.0. Air. 67
14.1.1. Water. 67
14.1.2. Sewage and Garbage. 67
14.1.3. Milk and Food. 67
14.1.4. Animals and Insect Vectors. 68
14.2. Host Factors 69
14.2.0. Quarantine and Isolation. 69
14.2.1. Hygiene. 69
14.2.2. Immunization. 69
14.2.3. Antibiotic Prophylaxis. 73
Chapter 2 Public Health Surveillance 79
2.1 Introduction 79
2.2 History 79
2.3 Use of Surveillance 80
2.4 Data Sources 81
4.1. Mortality Data 81
4.2. Morbidity Data 81
4.3. Individual Case Reports 81
4.4. Epidemic Reporting 82
4.5. Epidemic Field Investigation 82
4.6. Laboratory Reporting 82
4.7. Hospital Reporting 83
4.8. Surveys 83
4.9. Animal Reservoir and Vector Distribution 83
4.10. Biologics and Drug Distribution 83
4.11. Demographic and Environmental Data 83
4.12. News Media 84
2.5 Routine Surveillance 84
2.6 Reporting 84
6.1. Motivation 85
6.2. Ease of Reporting 86
6.3. Case Definition 86
6.4. Passive Reporting 86
6.5. Active Reporting 86
6.6. Sentinel Physician Reporting 87
6.7. Laboratory Surveillance 87
6.8. Hospital Surveillance 87
6.9. Absenteeism Surveillance 87
6.10. Syndromic Surveillance 88
2.7 Special Surveillance 88
7.1. Influenza 88
7.2. Gastroenteritis 88
7.3. GuillainéBarré Syndrome 89
7.4. Reye's Syndrome 89
7.5. Infant Botulism 89
7.6. Legionnaires' Disease 89
7.7. Hospital Infections 89
7.8. Arbovirus Diseases 89
7.9. High-Risk Population 90
7.10. Emerging Infections 90
7.11. Serosurveillance 90
2.8 Data Analysis 90
8.1. Frequency of Review 91
8.2. Time 91
8.3. Place 92
8.4. Person 93
2.9 Reports 93
2.10 Evaluation 93
2.11 Limitations of Surveillance 94
Chapter 3 Molecular Epidemiology 96
3.1 Introduction 96
3.2 Definitions 96
3.3 Methodology 97
3.1. Phenotyping Methods 98
3.1.0. Differentiation by Growth and Morphologic Characteristics. 98
3.1.1. Typing Based on Biochemical Characteristics. 98
3.1.2. Typing by Serologic Characteristics. 98
3.1.3. Typing by Functional or Physiologic Characteristics . 99
3.2. Genotyping Methods 99
3.2.0. Extrachromosomal DNA Genotyping Methods. 99
3.2.1. Genome-Based Typing Methods. 100
3.2.2. Restriction Endonuclease Analysis (REA). 100
3.2.3. Southern Blot Hybridization. 100
3.2.4. Pulsed Field Gel Electrophoresis (PFGE). 101
3.2.5. Whole-Genome Sequence Comparison. 101
3.2.6. Microarray Comparisons. 102
3.2.7. PCR-Based Genotyping Methods. 102
3.2.8. Overview of PCR. 102
3.2.9. PCR-Based Strain Typing Methods. 103
3.2.10. PCR Typing Methods Based on Sequence Polymorphism in the Whole Genome. 104
3.2.11. PCR-Restriction Enzyme Analysis. 104
3.2.12. PCR Typing Methods Based on DNA Repetitive Elements. 104
3.2.13. Insertion Sequence (IS)-Based PCR. 104
3.2.14. Multilocus Sequence Typing (MLST). 105
3.4 Epidemiologic Problems Addressed by Genotyping Techniques 106
4.1. Studying Dynamics of Disease Transmission in Geographically Widespread Areas 106
4.2. Identifying and Quantitating Risk in Sporadic Occurrence of Infectious Diseases 106
4.3. Stratifying Data to Refine Epidemiologic Study Designs 107
4.4. Distinguishing Pathovars from Nonpathovars 109
4.5. Addressing Hospital and Institutional Infectious Disease Problems 109
4.6. Identifying Genetic Determinants of Disease Transmission 110
3.5 Summary 112
Chapter 4 The Epidemiology of Bacterial Resistance to Antimicrobial Agents 117
4.1 Introduction 117
4.2 Historical Background 117
2.1. Importance of Changes in Resistance Epidemiology 118
4.3 Mechanisms of Resistance 118
3.1. Intrinsic Resistance 118
3.2. Acquired Resistance 118
3.3. Molecular Mechanisms 119
3.4. Epidemiologic Pathways 119
3.4.0. Introduction from Outside. 119
3.4.1. Exchange of Resistance Determinants. 119
3.4.2. Emergence or Selection. 120
3.4.3. Clonal Dissemination. 120
3.4.4. Combinations of Pathways. 120
3.5. Examples of Resistance Mechanisms for Various Classes of Antimicrobial Agents 120
3.5.0. -Lactam Agents. 120
3.5.1. Macrolides, Azalides, Lincosamides, and Streptogramins. 120
3.5.2. Aminoglycosides. 121
3.5.3. Tetracycline. 121
3.5.4. Trimethoprim and Sulfonamides. 121
3.5.5. Glycopeptides. 121
3.5.6. Fluoroquinolones. 121
3.5.7. Oxalidinones. 122
3.6. Key Factors in the Development of Resistant Microorganisms 122
3.6.0. Selection of Resistant Mutations. 122
3.6.1. Genetic Exchange Among Bacteria. 122
3.6.2. Selective Pressure Arising from Antimicrobial Use. 122
3.7. Mechanisms of Gene Dissemination 122
4.4 Epidemiology of Antimicrobial Resistance 124
4.1. Resistance in Health Care Contrasted with Community Settings 124
4.2. New Challenges Related to Resistance Epidemiology 124
4.2.0. Alteration of Antimicrobial Use Patterns. 124
4.2.1. Interference with Effective Treatment. 125
4.2.2. Complexity of Diagnosis. 125
4.2.3. Altering Requirements for Surveillance. 125
4.5 Organisms of Special Importance 125
5.1. Health-Care-Associated Pathogens 125
5.2. Community-Acquired Pathogens 126
4.6 Unresolved Problems 126
Chapter 5 Anthrax 131
5.1 Introduction 131
5.2 Historical Background 131
5.3 Methodology 132
3.1. Sources of Mortality and Morbidity Data 132
3.2. Surveys 132
3.3. Laboratory Diagnosis 132
3.3.0. Isolation and Identification 132
3.3.1. Serological and Immunologic Diagnostic Methods. 133
3.3.2. Pathology. 133
5.4 Biological Characteristics of the Organism 133
5.5 Descriptive Epidemiology 134
5.1. Prevalence and Incidence 134
5.2. Epidemic Behavior and Contagiousness 135
5.3. Geographic Distribution 136
5.4. Temporal Distribution 136
5.5. Age 136
5.6. Sex 136
5.7. Race 136
5.8. Occupation 136
5.9. Cases Related to Commercial Products 137
5.10. Socioeconomic and Other Factors 137
5.6 Mechanisms and Routes of Transmission 138
5.7 Pathogenesis and Immunity 138
7.1. Pathogenesis 138
7.1.0. Cutaneous Anthrax. 138
7.1.1. Inhalational Anthrax. 139
7.1.2. Gastrointestinal Anthrax. 139
7.2. Immunity 139
5.8 Patterns of Host Responses 139
8.1. Clinical Features 139
8.1.0. Cutaneous Anthrax. 139
8.1.1. Inhalational Anthrax. 140
8.1.2. Gastrointestinal Anthrax. 140
8.1.3. Other Forms. 140
8.2. Diagnosis 141
5.9 Control and Prevention 141
9.1. General Concepts 141
9.2. Antibiotic Prophylaxis and Chemotherapeutics 142
9.3. Immunization 142
9.4. Immune Serum 142
5.10 Unresolved Problems 142
Chapter 6 Bacterial Foodborne Disease 146
6.1 Introduction 146
6.2 Historical Background 147
6.3 Foodborne Disease Outbreak Surveillance 147
3.1. Surveillance of Sporadic Diarrheal Illness 150
6.4 Etiologic Patterns 151
6.5 Staphylococcus aureus 152
5.1. Historical Background 152
5.2. Microbiology 152
5.2.0. Biological Characteristics of the Organism. 152
5.2.1. Laboratory Diagnosis. 153
5.3. Descriptive Epidemiology 153
5.3.0. Prevalence and Incidence. 153
5.3.1. Epidemic Behavior and Contagiousness. 153
5.3.2. Geographic Distribution. 153
5.3.3. Temporal Distribution. 153
5.3.4. Age, Gender, Race, and Occupation. 153
5.3.5. Occurrence in Different Settings. 153
5.3.6. Foods Implicated in Outbreaks. 153
5.4. Mechanisms and Routes of Transmission 154
5.5. Pathogenesis and Immunity 154
5.5.0. Pathogenesis. 154
5.5.1. Immunity. 154
5.6. Patterns of Host Response 154
5.6.0. Clinical Features. 154
5.6.1. Diagnosis. 154
6.6 Bacillus cereus 154
6.1. Historical Background 154
6.2. Microbiology 155
6.2.0. Biological Characteristics of the Organism. 155
6.2.1. Laboratory Diagnosis. 155
6.3. Descriptive Epidemiology 156
6.3.0. Prevalence and Incidence. 156
6.3.1. Epidemic Behavior and Contagiousness. 156
6.3.2. Geographic, Temporal, Age, Gender, Racial, and Occupational Distribution. 156
6.3.3. Occurrence in Different Settings. 156
6.3.4. Other Factors. 156
6.4. Mechanisms and Routes of Transmission 156
6.5. Pathogenesis and Immunity 157
6.5.0. Pathogenesis. 157
6.5.1. Immunity. 157
6.6. Patterns of Host Response 157
6.6.0. Clinical Features. 157
6.6.1. Diagnosis. 157
6.7 Clostridium perfringens 157
7.1. Historical Background 157
7.2. Microbiology 158
7.2.0. Biological Characteristics of the Organism. 158
7.2.1. Laboratory Diagnosis. 159
7.3. Descriptive Epidemiology 159
7.3.0. Prevalence and Incidence. 159
7.3.1. Epidemic Behavior and Contagiousness. 159
7.3.2. Geographic, Age, Gender, Racial, and Occupational Distribution. 159
7.3.3. Temporal Distribution. 159
7.3.4. Occurrence in Different Settings. 159
7.3.5. Nutritional Factors. 160
7.4. Mechanisms and Routes of Transmission 160
7.5. Pathogenesis and Immunity 160
7.5.0. Pathogenesis. 160
7.5.1. Immunity. 160
7.6. Patterns of Host Response 160
7.6.0. Clinical Features. 160
7.6.1. Diagnosis. 160
7.7. Enteritis Necroticans 161
6.8 Noncholera Vibrio Species 161
8.1. Historical Background 161
8.2. Microbiology 162
8.2.0. Biological Characteristics of the Organisms. 162
8.2.1. Laboratory Diagnosis. 162
8.3. Descriptive Epidemiology 163
8.3.0. Prevalence and Incidence. 163
8.3.1. Epidemic Behavior and Contagiousness. 163
8.3.2. Geographic and Temporal Distribution. 164
8.3.3. Age, Gender, Race, and Other Host Factors. 164
8.4. Mechanisms and Routes of Transmission 165
8.5. Pathogenesis and Immunity 165
8.5.0. Pathogenesis 165
8.5.1. Immunity. 166
8.6. Patterns of Host Response 166
8.6.0. Nonepidemic V. cholerae . 166
8.6.1. V. parahaemolyticus. 167
8.6.2. Other Pathogenic Vibrio Species. 167
6.9 Aeromonas Species 167
9.1. History 167
9.2. Microbiology 167
9.2.0. Biological Characteristics of the Organism. 167
9.2.1. Laboratory Diagnosis. 168
9.3. Descriptive Epidemiology 168
9.4. Mechanisms and Routes of Transmission 169
9.5. Pathogenesis and Immunity 169
9.6. Patterns of Host Response 170
6.10 Plesiomonas 170
10.1. History 170
10.2. Microbiology 170
10.2.0. Biological Characteristics of the Organism. 170
10.2.1. Laboratory Diagnosis. 171
10.3. Descriptive Epidemiology 171
10.4. Mechanisms and Routes of Transmission 171
10.5. Pathogenesis and Immunity 171
10.6. Patterns of Host Response 171
6.11 Control and Prevention 172
11.1. General Concepts 172
11.1.0. Food Safety Regulation in the United States. 172
11.1.1. Methods to Further Reduce Foodborne Bacterial Disease 172
11.2. Antibiotics and Chemotherapeutics 174
11.3. Immunizations 174
6.12 Unresolved Problems 174
Chapter 7 Botulism 184
7.1 Introduction 184
7.2 Historical Background 184
7.3 Methodology 185
3.1. Sources of Mortality and Morbidity Data 185
3.2. Laboratory Confirmation 186
7.4 Biological Characteristics of the Organism 187
7.5 Descriptive Epidemiology 187
5.1. Foodborne Botulism 187
5.2. Infant Botulism 189
5.3. Wound Botulism 190
5.4. Child or Adult Botulism from Intestinal Colonization 190
5.5. Iatrogenic Botulism 190
7.6 Mechanisms and Routes of Transmission 191
6.1. Foodborne Botulism 191
6.2. Infant, Wound, and Child or Adult Botulism from Intestinal Colonization 192
7.7 Pathogenesis and Immunity 192
7.8 Patterns of Host Response 193
8.1. Clinical Features 193
8.2. Diagnosis 194
7.9 Prevention, Control, and Treatment 195
9.1. Prevention and Control 195
9.2. Treatment 196
7.10 Bioterrorism 197
7.11 Unresolved Problems 197
Chapter 8 Brucellosis 202
8.1 Introduction 202
8.2 Historical Background 202
8.3 Methodology 203
3.1. Sources of Data 203
3.2. Surveys 203
3.3. Laboratory Diagnosis 203
3.3.0. Isolation and Identification of the Organism. 203
3.3.1. Serological and Immunological Tests. 204
8.4 Biological Characteristics of the Organism 204
8.5 Descriptive Epidemiology 205
5.1. Prevalence and Incidence 205
5.1.0. High-Risk Categories. 205
5.2. Epidemic Behavior and Contagiousness 205
5.3. Geographic Distribution 207
5.4. Temporal Distribution 207
5.5. Age and Sex Distribution 208
5.6. Brucellosis During Pregnancy 208
5.7. Innate Immunity 208
8.6 Mechanisms and Routes of Infection 208
6.1. Brucellosis in Wildlife 208
8.7 Pathogenesis and Immunity 208
8.8 Patterns of Host Response 209
8.1. Clinical Features 209
8.2. Diagnosis 209
8.9 Control and Prevention 210
9.1. General Concepts 210
9.2. Chemotherapy and Prophylaxis 210
9.3. Immunization 210
8.10 Unresolved Problems 210
Chapter 9 Campylobacter Infections 214
9.1 Introduction 214
9.2 Historical Background 214
9.3 Methodology 216
3.1. Sources of Mortality Data 216
3.2. Sources of Morbidity Data 216
3.3. Serological Surveys 216
3.4. Laboratory Diagnosis 216
9.4 Proof of Causation and Biological Characteristics of the Organism that Affect the Epidemiological Pattern 217
9.5 Descriptive Epidemiology 219
5.1. Prevalence and Incidence 219
5.2. Epidemic Behavior 220
5.3. Geographic Distribution 221
5.4. Temporal Distribution 221
5.5. Age and Sex 221
5.6. Occupation 221
5.7. Other Factors 222
5.8. Atypical Campylobacter Species 222
9.6 Mechanisms and Routes of Transmission 222
9.7 Pathogenesis and Immunity 223
9.8 Patterns of Host Response 225
8.1. Clinical Features 225
8.2. Diagnosis 227
9.9 Control and Prevention 227
9.10 Unresolved Problems 227
Chapter 10 Chancroid 237
10.1 Introduction 237
10.2 Historical Background 237
10.3 Methodology 237
3.1. Sources of Morbidity and Mortality Data 237
3.2. Surveys 237
10.4 Etiologic Patterns 237
10.5 Descriptive Epidemiology 238
5.1. Prevalence and Incidence 238
5.2. The Roles of Race and Gender in Chancroid 238
10.6 Mechanisms and Routes of Transmission 238
10.7 Pathogenesis and Immunity 238
7.1. Pathogenesis 238
7.2. Immunity 239
10.8 Patterns of Host Response 239
8.1. Clinical Features 239
8.2. Diagnosis 240
10.9 Prevention, Control, and Treatment 240
9.1. Prevention and Control 240
9.2. Treatment 240
10.10 Unresolved Problems 241
Chapter 11 Chlamydial Infections 244
11.1 Introduction 244
11.2 Historical Background Historical Background 244
11.3 Methodology Methodology 246
3.1. Sources of Mortality Data Sources of Mortality Data 246
3.2. Sources of Morbidity Data Sources of Morbidity Data 246
3.3. Surveys Surveys 246
3.4. Laboratory Diagnosis Laboratory Diagnosis 246
3.4.0. Cytological Identification. 246
3.4.1. Isolation 247
3.4.2. Antigen and Nucleic Acid Probes. 247
3.4.3. Serological and Immunological Diagnostic Methods. 248
11.4 Biological Characteristics of the Organism Biological Characteristics of the Organism 248
11.5 Descriptive Epidemiology Descriptive Epidemiology 250
5.1. Trachoma Trachoma 250
5.1.0. Prevalence and Incidence. 250
5.1.1. Epidemic Behavior and Contagiousness. 250
5.1.2. Geographic Distribution. 250
5.1.3. Temporal Distribution. 250
5.1.4. Age. 250
5.1.5. Sex. 250
5.1.6. Race. 250
5.1.7. Occupation. 250
5.1.8. Socioeconomic Factors. 250
5.1.9. Other Factors. 251
5.2. Oculogenital Diseases Oculogenital Diseases 251
5.2.0. Prevalence and Incidence. 251
5.2.1. Epidemic Behavior and Contagiousness. 252
5.2.2. Geographic Distribution. 252
5.2.3. Temporal Distribution. 252
5.2.4. Age, Sex, Race, Occupation, Occurrence in Different Settings, Socioeconomic Factors, and Other Factors. 252
5.3. Lymphogranuloma Venereum Lymphogranuloma Venereum 253
5.3.0. Prevalence and Incidence. 253
5.3.1. Epidemic Behavior and Contagiousness. 253
5.3.2. Geographic Distribution. 253
5.3.3. Temporal Distribution. 253
5.3.4. Age and Sex. 253
5.3.5. Race. 253
5.3.6. Other Factors. 253
5.4. Psittacosis Psittacosis 253
5.4.0. Prevalence and Incidence. 253
5.4.1. Epidemic Behavior and Contagiousness. 253
5.4.2. Geographic Distribution. 253
5.4.3. Temporal Distribution. 253
5.4.4. Age, Sex, Race, and Occupation. 253
5.4.5. Socioeconomic Factors. 254
5.5. Chlamydia pneumoniae Infections C. pneumoniae Infections 254
5.5.0. Prevalence and Incidence. 254
5.5.1. Epidemic Behavior and Contagiousness. 254
5.5.2. Geographic Distribution. 254
5.5.3. Temporal Distribution. 254
5.5.4. Age and Sex. 254
5.5.5. Race, Occupation, Occurrence in Different Settings, and Socioeconomic Factors. 254
11.6 Mechanism and Routes of Transmission Mechanisms and Routes of Transmission 254
6.1. Trachoma Trachoma 254
6.2. Oculogenital Diseases Oculogenital Diseases 255
6.3. Lymphogranuloma Venereum Lymphogranuloma Venereum 255
6.4. Psittacosis Psittacosis 255
6.5. Chlamydia pneumoniae Infections C. pneumoniae Infections C. pneumoniae Infections 255
11.7 Pathogenesis and Immunity Pathogenesis and Immunity 256
7.1. Trachoma Trachoma 256
7.2. Oculogenital Diseases Oculogenital Diseases 256
7.3. Lymphogranuloma Venereum Lymphogranuloma Venereum 257
7.4. Psittacosis Psittacosis 258
7.5. Chlamydia pneumoniae Infections C. pneumoniae Infections C. pneumoniae Infections 258
11.8 Patterns of Host Response Patterns of Host Response 258
8.1. Trachoma Trachoma 258
8.1.0. Clinical Features. 258
8.1.1. Diagnosis. 259
8.2. Oculogenital Diseases 259
8.2.0. Clinical Features (see Table 1 ) 259
8.2.1. Diagnosis. 261
8.3. Lymphogranuloma Venereum Lymphogranuloma Venereum 262
8.3.0. Clinical Features. 262
8.3.1. Diagnosis. 263
8.4. Psittacosis Psittacosis 263
8.4.0. Clinical Features. 263
8.4.1. Diagnosis. 264
8.5. Chlamydia pneumoniae Infections C. pneumoniae Infections 264
8.5.0. Clinical Features. 264
8.5.1. Diagnosis. 265
11.9 Control and Prevention Control and Prevention 265
9.1. Trachoma Trachoma 265
9.1.0. General Concepts. 265
9.1.1. Antibiotic and Chemotherapeutic Approaches. 266
9.1.2. Immunization. 266
9.2. Oculogenital Diseases Oculogenital Diseases 266
9.2.0. General Concepts. 266
9.2.1. Prophylaxis. 266
9.2.2. Immunization. 267
9.3. Lymphogranuloma Venereum Lymphogranuloma Venereum 267
9.3.0. General Concepts. 267
9.3.1. Prophylaxis and Immunization. 267
9.4. Psittacosis Psittacosis 267
9.4.0. General Concepts. 267
9.4.1. Prophylaxis and Immunization. 267
11.10 Unresolved Problems Unresolved Problems 267
10.1. Trachoma Trachoma 267
10.2. Oculogenital Diseases Oculogenital Diseases 267
10.2.0. Epidemiology and Disease Spectrum. 267
10.2.1. Diagnostic Tests. 267
10.2.2. Host Response. 268
10.2.3. Control. 268
10.3. Lymphogranuloma Venereum Lymphogranuloma Venereum 268
10.4. Psittacosis Psittacosis 268
10.5. Chlamydia pneumoniae Infections C. pneumoniae Infections 268
Chapter 12 Cholera 271
12.1 Introduction 271
12.2 Historical Background 271
12.3 Methodology 274
3.1. Sources of Mortality Data 274
3.2. Sources of Morbidity Data 275
3.3. Surveys 276
3.4. Laboratory Diagnosis 276
3.4.0. Isolation and Identification of the Organism. 276
3.4.1. Serological and Immunologic Diagnostic Methods. 277
12.4 Biological Characteristics of the Organism 277
12.5 Descriptive Epidemiology 279
5.1. Prevalence and Incidence 279
5.2. Epidemic Behavior and Contagiousness 279
5.3. Geographic Distribution 280
5.4. Temporal Distribution 280
5.5. Age 281
5.6. Sex 281
5.7. Race 281
5.8. Occupation 281
5.9. Occurrence in Different Settings 281
5.10. Socioeconomic Factors 282
5.11. Other Factors 282
12.6 Mechanism and Routes of Transmission 282
12.7 Pathogenesis and Immunity 284
12.8 Patterns of Host Response 285
8.1. Clinical Features 285
8.2. Diagnosis 286
12.9 Control and Prevention 286
9.1. General Concepts 286
9.2. Antibiotic and Chemotherapeutic Approaches to Chemoprophylaxis 287
9.3. Immunization 288
12.10 Unresolved Problems 289
Chapter 13 Clostridium difficile 295
13.1 Introduction 295
13.2 Historical Background 295
13.3 Methodology 296
3.1. Sources of Mortality Data 296
3.2. Sources of Morbidity Data 296
3.3. Surveys 296
3.4. Laboratory Diagnosis 296
3.4.0. Toxin Detection. 296
3.4.1. Organism Detection. 296
3.4.2. Detection of Pseudomembranous Colitis. 297
3.4.3. Pathology. 297
13.4 Biological Characteristics of the Organism (Etiologic Patterns) 297
13.5 Descriptive Epidemiology 297
5.1. Prevalence and Incidence 297
5.2. Epidemic Behavior and Contagiousness 298
5.3. Geographic Distribution 298
5.4. Temporal Distribution 298
5.5. Age 298
5.6. Gender 299
5.7. Race 299
5.8. Occupation 299
13.6 Mechanisms and Routes of Transmission 299
13.7 Pathogenesis and Immunity 299
13.8 Patterns of Host Response 300
8.1. Clinical Features 300
8.2. Diagnosis 300
13.9 Control and Prevention 301
9.1. General Concepts 301
9.2. Prophylaxis 301
9.3. Immunizations 301
13.10 Unresolved Problems 301
10.1. Epidemiology 301
10.2. Control and Prevention 301
Chapter 14 Diphtheria 305
14.1 Introduction 305
14.2 Historical Background 305
14.3 Methodology 306
3.1. Sources of Morbidity and Mortality Data 306
3.2. Surveys 306
3.3. Laboratory Diagnosis 306
3.3.0. Isolation and Identification of the Organism. 306
3.3.1. Serological and Immunologic Diagnostic Methods. 307
14.4 Biological Characteristics of the Organism 308
14.5 Descriptive Epidemiology 308
5.1. Prevalence and Incidence 308
5.2. Epidemic Behavior and Contagiousness 310
5.3. Geographic Distribution 310
5.4. Temporal Distribution 310
5.5. Age 310
5.6. Sex 310
5.7. Race 311
5.8. Occupation 311
5.9. Occurrence in Different Settings 311
5.10. Socioeconomic Factors 311
14.6 Mechanism and Routes of Transmission 311
14.7 Pathogenesis and Immunity 311
14.8 Patterns of Host Response 312
8.1. Clinical Features 312
8.1.0. Carrier State. 312
8.1.1. Respiratory Diphtheria. 312
8.1.2. Cutaneous Diphtheria. 313
8.1.3. Other Sites. 313
8.1.4. Invasive Disease. 313
8.2. Diagnosis 313
8.3. Treatment 313
14.9 Control and Prevention 313
9.1. General Concepts 313
9.2. Antibiotic and Chemotherapeutic Approaches to Prophylaxis 314
9.3. Immunization 314
14.10 Unresolved Problems 315
Chapter 15 Escherichia coli Diarrhea 320
15.1 Introduction 320
15.2 Historical Background 320
15.3 Methodology 321
3.1. Sources of Mortality Data 321
3.2. Sources of Morbidity Data 322
3.3. Surveys 322
3.4. Laboratory Diagnosis 322
3.4.0. Isolation and Identification of Organisms. 322
15.4 Biological Characteristics of the Organisms 323
15.5 Descriptive Epidemiology 324
5.1. Prevalence and Incidence 324
5.2. Epidemic Behavior and Contagiousness 325
5.3. Geographic Distribution 325
5.4. Temporal Distribution 326
5.5. Age 326
5.6. Sex 326
5.7. Race 326
5.8. Occupation 327
5.9. Occurrence in Different Settings 327
5.10. Socioeconomic Factors 327
15.6 Mechanisms, Routes of Transmission and Reservoirs 327
15.7 Pathogenesis and Immunity 328
15.8 Patterns of Host Response 329
8.1. Clinical Features 329
8.2. Diagnosis 330
15.9 Control and Prevention 330
9.1. General Concepts 331
9.2. Antibiotic and Chemotherapeutic Approaches to Prophylaxis 331
9.3. Immunization 332
15.10 Unresolved Problems 332
Chapter 16 Gonococcal Infections 336
16.1 Introduction 336
16.2 Historical Background 336
16.3 Methodology 337
3.1. Sources of Mortality Data 337
3.2. Sources of Morbidity Data 337
3.3. Surveys 337
3.4. Laboratory Diagnosis 338
3.4.0. Isolation of the Organism. 338
3.4.1. Immunologic and Molecular Diagnostic Methods. 339
16.4 Biological Characteristics of the Organism 339
16.5 Descriptive Epidemiology 340
5.1. Prevalence and Incidence 340
5.2. Epidemic Behavior and Contagiousness 341
5.3. Geographic Distribution 341
5.4. Temporal Distribution 342
5.5. Age and Sex 342
5.6. Race 342
5.7. Occupational and Socioeconomic Factors 342
5.8. Homosexuality 342
5.9. Gonorrhea and HIV 343
5.10. Antimicrobial Resistance 343
5.10.0. Penicillin and Beta-Lactam Resistance. 343
5.10.1. Tetracycline-Resistant Gonorrhea (TRNG). 343
5.10.2. Fluoroquinolones and Resistance. 343
16.6 Mechanisms and Routes of Transmission 344
16.7 Pathogenesis and Immunity 344
7.1. Pathogenesis 344
7.1.0. Pathogenesis for the Male Urethra. 344
7.1.1. Pathogenesis for the Female Endocervix. 344
7.1.2. Disseminated Gonococcal Infection (DGI). 345
7.2. Immunity 345
7.2.0. Protein Antibodies. 345
7.2.1. Lipooligosaccharide (LOS) Antibodies. 346
16.8 Patterns of Host Response 346
8.1. Clinical Features 346
8.1.0. Urethritis in Men. 346
8.1.1. Endocervicitis. 346
8.1.2. Upper Genital Tract Infection and PID. 346
8.1.3. Anorectal Infections. 347
8.1.4. Pharyngeal Infection. 347
8.1.5. Disseminated Gonococcal Infection. 347
8.1.6. Gonococcal Ophthalmia. 348
8.1.7. Pediatric Gonorrhea. 348
8.2. Diagnosis 348
16.9 Control and Prevention 348
9.1. Principles of Control 348
9.1.0. Clinical Services. 348
9.1.1. Epidemiological Process. 349
9.1.2. Transmitters or Nontransmitters. 349
9.1.3. Diagnostic Screening. 349
9.1.4. Epidemiological Treatment. 349
9.1.5. Health Education. 350
9.1.6. Partner Management. 350
9.2. Macro-Level Epidemiological Approaches 351
9.2.0. Social Networks. 351
9.3. Personal Prophylaxis 351
9.4. Possibilities of Immunization 351
16.10 Unresolved Problems 352
Chapter 17 Haemophilus influenzae 358
17.1 Introduction 358
17.2 Historical Background 358
17.3 Methodology 358
3.1. Epidemiologic Reporting 359
3.2. H. influenzae Typing Methods 359
3.2.0. Phenotype-Based Typing Methods 359
3.2.1. Molecular-Based Genotyping Methods. 360
3.3. Laboratory Diagnosis of H. influenzae Infection 364
3.3.0. Culture. 364
3.3.1. Identification of H. influenzae . 364
3.3.2. Antigen Detection. 364
3.3.3. Polymerase Chain Reaction (PCR). 364
3.3.4. Serology. 364
17.4 Biological Characteristics of H. influenzae 364
4.1. Growth Requirements 365
4.2. Natural Competency 365
4.3. Genetic Variability 365
4.3.0. Genome Sequence. 365
4.3.1. Mechanisms of Genetic Diversity. 365
4.4. Antibiotic Resistance 366
17.5 Descriptive Epidemiology 367
5.1. Epidemiology of Infections Caused by Type b H. influenzae (Hib) 367
5.1.0. Classical Hib Epidemiology in Non-immune Individuals. 367
5.1.1. Current Hib Epidemiology, US Children. 367
5.1.2. Current Hib Epidemiology, US Adults. 369
5.1.3. Hib Epidemiology Worldwide. 369
5.1.4. Risk Factors for Hib Infections. 369
5.2. Epidemiology of Infections Caused by Types a, c0f H. influenzae 369
5.3. Epidemiology of Infections Caused by Non-typeable H. influenzae 370
17.6 Mechanisms and Routes of Transmission 370
17.7 Pathogenesis and Immunity 370
7.1. H. influenzae Colonization 370
7.1.0. Colonization with H. influenzae Type b (Hib). 370
7.1.1. Colonization with Non-typeable H. influenzae (NTHi). 371
7.1.2. H. influenzae and Biofilms. 371
7.2. H. influenzae Virulence Factors 371
7.2.0. Polysaccharide Capsule. 371
7.2.1. Attachment Factors. 371
7.2.2. Lipooligosaccharide (LOS). 372
7.2.3. Iron and Heme Uptake. 372
7.2.4. IgA Protease. 372
7.2.5. Other Virulence Factors. 373
7.3. Immunity 373
7.3.0. Immunity Against the Type b Capsule. 373
7.3.1. Immunity Against Non-capsular Antigens. 374
17.8 Patterns of Host Response 375
8.1. Infections with Typeable H. influenzae 375
8.1.0. Diseases Caused by Encapsulated H. influenzae . 375
8.1.1. Mechanisms of Disease Caused by Encapsulated H. influenzae . 375
8.2. Infections with Non-typeable H. influenzae (NTHi) 375
8.2.0. Diseases Caused by NTHi. 375
8.2.1. Mechanisms of Disease Caused by NTHi. 376
8.3. Infections Caused by Unique H. influenzae Strains 376
8.3.0. Conjunctival Infections. 376
8.3.1. Brazilian Purpuric Fever. 376
8.3.2. Genital Infections. 376
17.9 Control and Prevention of H. influenzae Infections 377
9.1. Prevention of Type b Infections 377
9.1.0. Hib Vaccines. 377
9.1.1. Antibiotic Prophylaxis Against Hib Infection. 378
9.2. Vaccines Against NTHi 379
17.10 Unresolved Problems 379
Chapter 18 Helicobacter pylori 389
18.1 Introduction 389
18.2 Historical Background 389
18.3 Methodology 390
3.1. Sources of Mortality Data 390
3.2. Sources of Morbidity Data 390
3.3. Surveys 390
3.4. Laboratory Diagnosis 390
3.4.0. Isolation and Identification. 390
3.4.1. Other Endoscopic Methods of Diagnosis. 391
3.4.2. Nonendoscopic Diagnostic Tests. 391
18.4 Biological Characteristics of the Organism 392
18.5 Descriptive Epidemiology 393
5.1. Prevalence and Incidence 393
5.2. Age and Birth Cohort 395
5.3. Gender 395
5.4. Race--Ethnicity 395
5.5. Socioeconomic Status 396
18.6 Mechanisms and Routes of Transmission 396
6.1. Person-to-Person Transmission 397
6.2. Transmission from a Common Environmental Source 398
6.3. Iatrogenic Transmission 398
18.7 Pathogenesis and Immunity 398
18.8 Patterns of Host Response 400
8.1. Clinical Spectrum of Disease 400
8.1.0. Acute Symptomatic Gastritis. 400
8.1.1. Non-ulcer Dyspepsia. 400
8.1.2. Peptic Ulcer Disease. 401
8.1.3. Gastric Adenocarcinoma. 401
8.1.4. Gastric Lymphoma. 401
8.1.5. Esophageal Diseases. 402
8.2. Diagnosis 402
18.9 Control and Prevention 402
9.1. General Concepts 402
9.2. Antibiotic and Chemotherapeutic Approaches to Disease Prevention 403
9.3. Immunization 403
18.10 Unresolved Problems 403
Chapter 19 Legionellosis 415
19.1 Introduction 415
19.2 Historical Background 415
19.3 Methodology 416
3.1. Sources of Mortality Data 416
3.2. Sources of Morbidity Data 417
3.3. Surveys 417
3.4. Laboratory Diagnosis 417
3.4.0. Isolation and Identification. 417
3.4.1. Serological Diagnostic Methods. 418
3.4.2. Urine Antigen Detection. 418
3.4.3. Nucleic Acid Detection. 419
3.4.4. Biological Characteristics of the Organism. 419
19.4 Descriptive Epidemiology 420
4.1. Incidence and Prevalence 420
4.2. Epidemic Behavior and Contagiousness 420
4.3. Geographic Distribution 421
4.4. Seasonal Distribution 421
4.5. Age 421
4.6. Sex 422
4.7. Race 422
4.8. Occupation 422
4.9. Occurrence in Special Settings 422
4.9.0. Health Care-Associated Infection. 422
4.9.1. Disease among Travelers. 422
4.10. Socioeconomic Factors 423
4.11. Other Factors 423
4.11.0. Cigarette Smoking. 423
4.11.1. Alcohol Consumption. 423
4.11.2. Underlying Medical Conditions. 423
19.5 Mechanism and Routes of Transmission 423
19.6 Pathogenesis and Immunity 424
19.7 Patterns of Host Response 425
7.1. Clinical Features 425
19.8 Control and Prevention 425
8.1. General Concepts 425
8.2. Antibiotic and Chemotherapeutic Approaches to Prophylaxis 427
8.3. Immunization 427
19.9 Unresolved Issues 427
9.1. Rapid Diagnostic Tests 427
9.2. Risk Assessment 427
9.3. Prevention 428
Chapter 20 Leprosy 434
20.1 Introduction 434
20.2 Historical Background 435
20.3 Methodology 435
3.1. Sources of Data 435
3.1.0. Sources of Mortality Data. 435
3.1.1. Sources of Morbidity Data. 435
3.2. Surveys 436
3.3. Laboratory Diagnosis 437
3.3.0. Isolation and Identification of Organism. 437
3.3.1. Serological and Immunological Tests. 437
20.4 Biological Characteristics of the Organism 438
20.5 Descriptive Epidemiology 439
5.1. Prevalence and Incidence 439
5.2. Epidemic Behavior and Contagiousness 440
5.3. Geographic Distribution 441
5.4. Temporal Distribution 441
5.5. Age 441
5.6. Sex 441
5.7. Race 441
5.8. Occupation 442
5.9. Occurrence in Different Settings 442
5.10. Socioeconomic Factors 442
5.11. Other Factors 443
20.6 Mechanisms and Routes of Transmission 443
20.7 Pathogenesis and Immunity 444
20.8 Patterns of Host Response 445
20.9 Control and Prevention 448
9.1. General Concepts 448
9.2. Antimicrobial Chemotherapy of Leprosy 448
9.3. Follow-Up after Antimicrobial Therapy 450
9.4. Follow-Up of Contacts 450
9.5. Chemotherapeutic Approaches to Prophylaxis 450
9.6. Immunization 451
20.10 Unresolved Problems 451
Chapter 21 Leptospirosis 458
21.1 Introduction 458
21.2 Historical Background 458
21.3 Methodology 459
3.1. Sources of Data 459
3.2. Surveys 459
3.3. Laboratory Diagnosis 460
3.3.0. Isolation and Identification of Leptospires 460
3.3.1. Serological Tests. 462
21.4 Biological Characteristics of the Organism 464
21.5 Descriptive Epidemiology 464
5.1. Prevalence and Incidence 464
5.2. Epidemic Behavior and Contagiousness 465
5.3. Geographical Distribution 465
5.4. Temporal Distribution 465
5.5. Age 465
5.6. Sex 465
5.7. Race 466
5.8. Occupation 466
5.9. Occurrence in Different Settings 466
5.10. Socioeconomic Factors 466
21.6 Mechanisms and Routes of Transmission 466
21.7 Pathogenesis and Immunity 467
7.1. Incubation Period 467
7.2. Virulence and Its Attributes 467
7.3. The Course of Events in Infection 467
7.3.0. Entry. 467
7.3.1. Spread. 467
7.3.2. Lesions. 468
7.3.3. Transplacental Spread. 468
7.3.4. Recovery. 468
7.3.5. Carrier State. 468
7.3.6. Autoimmunity and Hypersensitivity. 468
7.4. Immunity 469
7.4.0. Specific and Nonspecific Immunity. 469
7.4.1. Antibodies. 469
7.4.2. Antigens Related to Pathogenesis and Immunity. 469
7.4.3. Vaccines. 469
21.8 Patterns of Host Response 470
8.1. Clinical Features 470
8.1.0. Congenital Leptospirosis. 471
8.1.1. Clinical Laboratory Findings. 471
8.1.2. Prognosis. 471
8.1.3. Treatment. 471
8.2. Diagnosis 472
8.2.0. Clinical Diagnosis. 472
8.2.1. Laboratory Bacteriologic Diagnosis. 472
8.2.2. Differential Diagnosis. 472
21.9 Control and Prevention 473
9.1. General Concepts 473
9.1.0. Education, Laboratory Services, and Notification. 473
9.1.1. Control Measures in Animals 473
9.1.2. Treatment of the Carrier State. 474
9.1.3. Occupational Hygiene. 474
9.2. Antimicrobial Prophylaxis 474
9.3. Immunization 474
21.10 Unresolved Problems 474
Chapter 22 Listeria monocytogenes Infections 480
22.1 Introduction 480
22.2 Historical Background 481
22.3 Methodology 482
3.1. Sources of Mortality Data 482
3.2. Sources of Morbidity Data 483
3.3. Surveys 483
3.4. Laboratory Diagnosis 483
3.4.0. Isolation and Identification of the Organism. 483
3.4.1. Serological and Immunological Diagnostic Methods. 484
22.4 Biological Characteristics of the Organism 484
22.5 Descriptive Epidemiology 484
5.1. Prevalence and Incidence 484
5.1.0. Asymptomatic Carriage. 484
5.1.1. Gastroenteritis. 485
5.1.2. Invasive Infection. 485
5.2. Epidemic Behavior and Contagiousness 486
5.3. Geographic Distribution 486
5.4. Temporal Distribution 486
5.5. Age 487
5.6. Sex 487
5.7. Race 487
5.8. Occupation 487
5.9. Occurrence in Different Settings 487
5.10. Socioeconomic Factors 487
5.11. Other Factors 487
22.6 Mechanisms and Routes of Transmission 487
22.7 Pathogenesis and Immunity 487
22.8 Patterns of Host Response Please note that heading level 8 and 8.1 are the same. Please check. 488
8.1. Patterns of Host Response 488
8.1.0. Non-perinatal Listeriosis. 488
8.1.1. Perinatal Listeriosis. 488
8.2. Diagnosis 489
8.3. Differential Diagnosis 489
22.9 Control and Prevention 489
9.1. General Concepts 489
9.2. Antibiotic and Chemotherapeutic Approaches to Prophylaxis and Treatment 489
9.3. Immunization 490
22.10 Unresolved Problems 490
Chapter 23 Lyme Disease 497
23.1 Historical Perspective 497
23.2 Microbiology 497
23.3 Life Cycle 498
23.4 Epidemiology 498
23.5 Pathophysiology: HostPathogen Interactions 500
23.6 Spectrum of Disease/Clinical Manifestations 501
6.1. Cutaneous 501
6.2. Cardiac 502
6.3. Neurologic 502
6.4. Musculoskeletal 502
23.7 Possible New Borrelial Syndromes 503
23.8 Diagnosis 503
23.9 Special Considerations 504
9.1. Pregnancy 504
9.2. Immunosuppression 504
9.3. Co-infection 505
23.10 Prevention 505
23.11 Treatment 506
23.12 Conclusion 507
Chapter 24 Meningococcal Infections 512
24.1 Introduction 512
24.2 Historical Background 512
24.3 Methodology 514
3.1. Sources of Mortality Data 514
3.2. Sources of Morbidity Data 514
3.3. Surveys 514
3.4. Laboratory Diagnosis 515
3.4.0. Isolation and Identification of the Organism. 515
3.4.1. Serological and Immunologic Diagnostic Methods. 515
24.4 Biological Characteristics of the Organism 515
4.1. Serotypes and Serogroups 516
4.2. Antibiotic Susceptibility 516
24.5 Descriptive Epidemiology 517
5.1. Prevalence and Incidence 517
5.2. Epidemic Behavior and Contagiousness 517
5.3. Geographic Distribution 518
5.4. Temporal Distribution 519
5.5. Age 519
5.6. Sex 520
5.7. Race 520
5.8. Occupation 520
5.9. Occurrence in Different Settings 521
5.10. Socioeconomic Factors 522
5.11. Other Factors 522
24.6 Mechanisms and Routes of Transmission 522
6.1. Secondary Attack Rate 522
24.7 Pathogenesis and Immunity 523
24.8 Patterns of Host Response 524
8.1. Clinical Features 524
8.1.0. Genetic Determinants of Meningococcal Disease: Complement Deficiency. 525
8.1.1. Other Genetic Determinants of Meningococcal Disease. 526
8.2. Diagnosis 526
24.9 Control and Prevention 526
9.1. General Concepts 526
9.2. Antibiotic and Chemotherapeutic Approaches to Prophylaxis: Suggestions for the Management of Outbreaks 526
9.3. Immunization 527
9.3.0. Application. 528
24.10 Unresolved Problems 529
Chapter 25 Mycoplasma pneumoniae and Other Human Mycoplasmas 535
25.1 Introduction 535
25.2 Historical Background 535
25.3 Methodology 536
3.1. Clinical Diagnosis 536
3.2. Laboratory Diagnosis 537
3.2.0. Clinical Laboratory Diagnosis. 537
3.3. In Vitro Antibiotic Susceptibility Testing 539
25.4 Etiologic Patterns 539
4.1. M. pneumoniae Syndromes 539
4.1.0. Pneumonia. 539
4.1.1. Asthma. 539
4.1.2. Extrapulmonary Syndromes. 540
25.5 Descriptive Epidemiology 542
5.1. Geographic Distribution 542
5.2. Age Distribution 543
5.3. Transmission in Families 543
25.6 Mechanisms and Routes of Transmission 543
25.7 Pathogenesis and Immunity 543
7.1. Incubation Period 543
7.2. Pathogenesis 544
7.3. Immunity 545
25.8 Patterns of Host Response 545
8.1. Clinical Features 545
8.2. Diagnosis 545
25.9 Control and Prevention 546
9.1. Treatment 546
9.2. Vaccines 546
25.10 Unresolved Problems 547
25.11 Other Human Mycoplasmas 547
11.1. Background, Classification, and Disease Associations 547
11.2. Pathogenesis and Immunity 548
11.3. Transmission 549
11.4. Laboratory Detection 549
11.5. Treatment 550
11.6. Unresolved Problems 550
Chapter 26 Healthcare-Acquired Bacterial Infections 558
26.1 Introduction 558
26.2 Historical Background 558
26.3 Methodology 559
3.1. Criteria for Infection 559
3.2. Sources of Mortality Data 559
3.3. Sources of Morbidity Data 560
3.4. Surveillance 561
3.4.0. Microbiological Surveys. 561
3.4.1. Prevalence Surveys. 562
3.4.2. Surveillance Studies. 562
3.5. Laboratory Diagnosis 563
3.5.0. Isolation and Identification of Organisms. 563
3.5.1. Evaluation of Specimens: Initial Screening. 564
3.5.2. In Vitro Susceptibility Testing. 564
3.5.3. Quality Control in the Laboratory. 564
3.5.4. Special Studies for Examining the Relatedness of Isolates. 564
26.4 Biological Characteristics of Nosocomial Organisms 565
4.1. Infecting Normal Flora 566
4.2. Antimicrobial Resistance 566
26.5 Descriptive Epidemiology 566
5.1. Prevalence and Incidence 566
5.1.0. Mortality Data. 566
5.1.1. Prevalence Studies. 566
5.1.2. Incidence Studies. 567
5.1.3. Site-Pathogen Analysis. 567
5.2. Epidemic Behavior and Contagiousness 570
5.3. Geographic Distribution 570
5.4. Temporal Distribution 570
5.5. Age 570
5.6. Sex 571
5.7. Race 571
5.8. Occupation 571
5.9. Occurrence in Different Settings 571
5.10. Socioeconomic Factors 571
5.11. Other Host Factors 572
5.12. Treatment Factors 572
5.12.0. Antibiotics. 572
5.12.1. Other Drugs. 572
5.12.2. Device- and Procedure-Related Infections. 573
26.6 Mechanisms and Routes of Transmission 573
6.1. Inanimate Reservoirs 573
6.1.0. Structural or Engineering Reservoirs. 573
6.1.1. Equipment Reservoirs. 574
6.2. Animate Reservoirs 574
26.7 Pathogenesis and Immunity 574
26.8 Patterns of Host Response: Clinical Features and Diagnosis 575
8.1. Urinary Tract Infection 575
8.2. Nosocomial Pneumonia 575
8.3. Surgical Site Infection 576
8.4. Bacteremia 576
8.5. Infection at Other Sites 576
26.9 Control and Prevention 576
9.1. General Concepts 576
9.1.0. Preventive Engineering. 576
9.1.1. Equipment Control. 577
9.1.2. Personnel Programs. 577
9.2. Special Control Programs 577
9.2.0. Hand Washing. 577
9.2.1. Standard Precautions and Isolation Control. 577
9.2.2. Epidemic Investigation and Control. 578
9.2.3. Nosocomial Urinary Tract Infection. 578
9.2.4. Nosocomial Surgical Site Infection. 578
9.2.5. Nosocomial Respiratory Infections. 579
9.2.6. Nosocomial Intravascular Infection. 580
9.2.7. Antimicrobial Prophylaxis. 580
9.2.8. Immunization. 581
9.2.9. Cellular and Transplantation Methods. 581
26.10 Unresolved Problems 581
10.1. Efficacy and Cost--Benefit Evaluation: Acute Care 581
10.2. Coordinated Programs 581
10.3. Need and Efficacy in Developing Countries 581
10.4. Efficacy in Nonacute Care 582
10.5. Public Reporting of Hospital Infections 582
Chapter 27 Pertussis 591
27.1 Introduction 591
27.2 Historical Background 591
27.3 Methodology 591
3.1. Sources of Mortality Data 591
3.2. Sources of Morbidity Data 592
3.3. Surveys 592
3.4. Laboratory Diagnosis 592
27.4 Biological Characteristics of the Organism 593
27.5 Descriptive Epidemiology 594
5.1. Prevalence and Incidence 594
5.1.0. High-Risk Groups. 596
5.2. Epidemic Behavior and Contagiousness 596
5.3. Geographic Distribution 597
5.4. Temporal Distribution 597
5.5. Age 597
5.6. Sex 597
5.7. Race/Ethnicity 597
5.8. Other Factors 599
27.6 Mechanisms and Routes of Transmission 599
27.7 Pathogenesis and Immunity 599
7.1. Pathogenesis 599
7.2. Immunity 599
27.8 Patterns of Host Response 600
8.1. Clinical Features 600
8.2. Diagnosis 601
27.9 Control and Prevention 601
9.1. Isolation 601
9.2. Antibiotics 602
9.3. Passive Immunization 602
9.4. Active Immunization 602
27.10 Unresolved Problems 604
Chapter 28 Plague 610
28.1 Introduction 610
28.2 Historical Background 610
28.3 Methodology 611
3.1. Sources of Morbidity and Mortality Data 611
3.2. Surveys 611
28.4 Biological Characteristics of the Organism 611
4.1. Etiologic Agent, Yersinia pestis 611
4.2. Virulence Factors 612
4.3. Geographic Biotypes 612
4.4. Flea Vectors 612
4.5. Rodent Reservoirs 613
28.5 Epidemiology 613
5.1. Occurrence of Human Plague 613
5.2. Contagiousness 614
5.3. Geographic Distribution 614
5.4. Environmental Factors 614
5.5. Demographic Factors 614
5.6. Occupation and Recreation 615
5.7. Occurrence in Different Settings 615
5.8. Socioeconomic Factors 616
28.6 Mechanisms and Routes of Transmission 616
28.7 Pathogenesis and Immunity 616
7.1. Pathogenesis 616
7.2. Incubation Period 617
7.3. Immunity 617
28.8 Patterns of Host Response 617
8.1. Clinical Features 617
8.2. Differential Diagnosis 618
8.3. Laboratory Diagnosis 618
8.3.0. Clinical Specimen Collection and Staining. 618
8.3.1. Cultural Isolation of Y. pestis . 619
8.3.2. Serological Diagnostic Methods. 619
8.3.3. Rapid Detection Tests. 619
8.3.4. Reference Diagnostic Testing. 619
8.3.5. Diagnostic Categories. 619
28.9 Control and Prevention 619
9.1. General Concepts 619
9.2. Antibiotic Treatment 620
9.3. Antibiotic Prophylaxis 620
9.4. Immunization 620
9.5. Public Health Management of the Use of Plague as a Weapon of Terrorism 621
28.10 Unresolved Problems 621
Chapter 29 Pneumococcal Infections 625
29.1 Introduction 625
29.2 Historical Background 625
29.3 Methodology 627
3.1. Sources of Epidemiological Data 627
3.2. Surveys 627
3.3. Laboratory Diagnosis 627
3.3.0. Isolation and Identification of the Organism. 627
3.3.1. Serological Methods. 628
29.4 Biological Characteristics of the Organism 628
29.5 Descriptive Epidemiology 629
5.1. Prevalence and Incidence 629
5.1.0. Occurrence of Penicillin-Resistant Pneumococci. 630
5.1.1. Distribution of Pneumococcal Types. 631
5.1.2. Occurrence in Carriers. 632
5.2. Epidemic Behavior and Contagiousness 632
5.3. Geographic Distribution 633
5.4. Temporal Distribution 633
5.5. Age 633
5.6. Gender 634
5.7. Race 634
5.8. HIV Infection 634
5.9. Cigarette Smoking 634
5.10. Occupation 634
5.11. Occurrence in Families 635
5.12. Occurrence in Animals 635
5.13. Laboratory Infections 635
5.14. Nutrition 635
5.15. Alcoholism 635
5.16. Association with Viral Infections 636
29.6 Mechanisms and Routes of Transmission 636
29.7 Pathogenesis and Immunity 636
7.1. Pathogenesis 636
7.1.0. Virulence Factors. 637
7.1.1. Host Defenses. 638
7.2. Immunity 639
29.8 Patterns of Host Response 639
8.1. Clinical Features 639
29.9 Control and Prevention 640
9.1. Antibiotic Treatment 640
9.2. Prevention 640
9.3. Pneumococcal Polysaccharide Vaccine 640
9.4. Pneumococcal Conjugate Vaccines 644
29.10 Unresolved Problems 646
Chapter 30 Q fever 655
30.1 Introduction 655
30.2 Historical Aspects 655
30.3 Methodology 656
3.1. Sources of Data 656
3.2. Surveys 656
3.3. Laboratory Diagnosis 656
30.4 Biological Characteristics of the Organism 656
30.5 Descriptive Epidemiology 657
5.1. Epidemiology of Q Fever in Selected Countries 657
5.1.0. United States. 657
5.1.1. Germany. 657
5.1.2. Australia Including Post Q Fever Fatigue Syndrome (QFFS). 657
5.1.3. France Including Age and Sex Distribution. 658
5.1.4. United Kingdom. 659
5.1.5. Q Fever in Other Countries. 660
5.2. Q Fever, the Military and Bioterrorism -- Including Contagiousness 660
5.3. Epidemiology of Q Fever at the Community Level 660
5.4. Q Fever in Animals 663
30.6 Routes of Transmission 663
6.1. Inhalation of Contaminated Aerosols 664
6.2. Oral Route 664
6.3. Percutaneous Route 664
6.4. Vertical Transmission 664
6.5. Person-to-Person Transmission 664
6.6. Sexual Transmission 664
30.7 Biological Characteristics of the Organism: Pathogenesis and Immunity 664
30.8 Patterns of Host Response 665
8.1. Acute Q Fever 665
8.1.0. A Self-Limited Febrile Illness. 665
8.1.1. Pneumonia. 665
8.1.2. Hepatitis. 665
8.1.3. Miscellaneous Manifestations. 665
8.1.4. Q Fever in Immunocompromised Host. 665
8.2. Chronic Q Fever 665
30.9 Control and Prevention 665
9.1. General Concepts 665
9.2. Chemotherapy and Prophylaxis 666
9.3. Immunization 666
30.10 Unresolved Issues 666
Chapter 31 Rocky Mountain Spotted Fever 673
31.1 Introduction 673
31.2 Historical Background 673
31.3 Methodology 674
3.1. Sources of Mortality Data 674
3.2. Sources of Morbidity Data 674
3.3. Laboratory Diagnosis 675
3.3.0. Isolation and Identification of R. rickettsii . 675
3.3.1. Serological Tests. 675
31.4 Biological Characteristics of the Organism 676
31.5 Descriptive Epidemiology 677
5.1. Prevalence and Incidence 677
5.2. Epidemic Behavior and Contagiousness 677
5.3. Geographic Distribution 678
5.4. Temporal Distribution 678
5.5. Age, Sex, and Occupational Factors 678
31.6 Mechanisms and Routes of Transmission 679
31.7 Pathogenesis and Immunity 679
7.1. Pathogenesis 679
7.2. Immunity 681
31.8 Patterns of Host Response 681
8.1. Common Clinical Features 681
8.1.0. Fever. 681
8.1.1. Headache. 681
8.1.2. Rash. 681
8.1.3. Cardiovascular and Respiratory Signs. 681
8.1.4. Hepatic and Renal Signs. 682
8.1.5. Gastrointestinal Signs. 682
8.1.6. Neurological Signs. 682
8.2. Clinical Course and Complications 682
8.3. Diagnosis 682
31.9 Control and Prevention 683
9.1. Vector Control 683
9.2. Chemotherapy and Prophylaxis 684
9.3. Immunization 684
31.10 Unresolved Problems 685
Chapter 32 Salmonellosis: Nontyphoidal 689
32.1 Introduction 689
32.2 Historical Background 690
32.3 Methodology 690
3.1. Sources of Mortality Data 690
3.2. Sources of Morbidity Data 690
3.3. Surveys and Investigations 691
3.4. Laboratory Diagnosis 692
3.4.0. Isolation and Identification. 692
3.4.1. Serological Diagnostic Methods. 692
32.4 Biological Characteristics of the Organism 693
4.1. Antimicrobial Resistance 693
32.5 Descriptive Epidemiology 695
5.1. Prevalence and Incidence 695
5.2. Epidemic Behavior and Contagiousness 696
5.3. Geographic Distribution 697
5.4. Temporal Distribution 698
5.5. Age and Sex 698
5.6. Race 698
5.7. Occupation 699
5.8. Occurrence in Different Settings 699
5.9. Salmonella Infections in the Compromised Host 700
5.10. Salmonella Infections and AIDS 700
32.6 Mechanisms and Routes of Transmission 700
32.7 Pathogenesis and Immunity 701
32.8 Patterns of Host Response 702
8.1. Clinical Features 703
8.2. Diagnosis 703
32.9 Control and Prevention 704
32.10 Unresolved Problems 705
Chapter 33 Shigellosis 711
33.1 Introduction 711
33.2 Historical Background 711
33.3 Methodology 712
3.1. Sources of Mortality and Morbidity Data 712
3.2. Surveys 713
3.3. Laboratory Diagnosis, Isolation, and Identification of the Organism 713
33.4 Biological Characteristics of the Organism 714
4.1. Invasiveness and Intercellular Spread 714
4.1.0. Invasion. 714
4.1.1. Vesicle Lysis and Intracellular Multiplication. 715
4.1.2. Intra- and Intercellular Spread. 715
4.1.3. Cell Death. 715
4.2. Acid Resistance 715
4.3. Other Virulence Determinants 715
4.4. Toxins 716
4.5. Antimicrobial Resistance 717
33.5 Descriptive Epidemiology 717
5.1. Prevalence and Incidence 717
5.2. Epidemic Behavior 719
5.3. Geographic Distribution 719
5.4. Seasonal Transmission 720
5.5. Age 720
5.6. Gender and Sexual Practices 721
5.7. Race 721
5.8. Occupation 721
5.9. Occurrence in Different Settings 721
5.10. Socioeconomic Factors 722
33.6 Mechanisms and Routes of Transmission 722
33.7 Pathogenesis and Immunity 723
7.1. Pathogenesis 723
7.2. Immunity 725
33.8 Patterns of Host Response 726
8.1. Clinical Features 726
8.2. Diagnosis 727
33.9 Control and Prevention 728
9.1. General Concepts 728
9.2. Antibiotic and Chemotherapeutic Approaches to Prophylaxis and Treatment 728
9.3. Immunization 729
33.10 Unresolved Problems 730
10.1. Epidemiology 730
10.2. Pathogenesis 730
10.3. Antimicrobial Resistance 730
10.4. Clinical Complications 731
10.5. Vaccines 731
Chapter 34 Evans' Infections of Humans: Staphylococcal Infections 737
34.1 Introduction 737
34.2 Historical Background 737
34.3 Methodology 737
3.1. Sources of Mortality Data 737
3.2. Sources of Morbidity Data 738
3.3. Surveys 738
3.4. Laboratory Diagnosis 738
34.4 Biological Characteristics of the Organism 738
34.5 Descriptive Epidemiology 739
5.1. Prevalence and Incidence 739
5.2. Nasal Carriage 739
5.3. Epidemic Behavior and Contagiousness 739
5.4. Geographic Distribution 740
5.5. Age 740
5.6. Sex 740
5.7. Race 740
5.8. Occupation 740
5.9. Socioeconomic Factors 740
5.10. Other Factors 740
34.6 Mechanisms and Routes of Transmission 740
34.7 Pathogenesis and Immunity 741
7.1. Pathogenesis 741
7.2. Immunity 741
34.8 Patterns of Host Response 742
8.1. Clinical Features 743
8.1.0. Boils, Furuncles, and Carbuncles. 743
8.1.1. Wound Infections. 743
8.1.2. Breast Infections. 743
8.1.3. Pneumonia. 743
8.1.4. Endocarditis. 743
8.1.5. Skin Infections. 743
8.1.6. Intravenous Catheter-Related Infections. 743
8.1.7. Bacteremia. 744
8.1.8. Osteomyelitis. 744
8.1.9. Septic Arthritis. 744
8.1.10. Food Poisoning. 744
8.1.11. Parotitis. 744
8.1.12. Toxic Shock Syndrome. 745
8.1.13. Peritonitis. 745
8.1.14. Urinary Tract Infection. 745
8.1.15. CSF Shunt Infection. 745
8.1.16. Pyomyositis. 745
8.1.17. Meningitis. 745
8.2. Diagnosis 745
34.9 Control and Prevention 746
34.10 Unresolved Problems 746
Chapter 35 Streptococcal Infections 754
35.1 Introduction 754
35.2 Historical Background 754
35.3 Methodology 757
3.1. Sources of Mortality Data 757
3.2. Sources of Morbidity Data 757
3.3. Surveys 757
3.4. Laboratory Diagnosis 757
3.4.0. Isolation and Identification. 757
3.4.1. Serologic and Immunologic Diagnostic Methods. 764
35.4 Biological Characteristics of the Organisms 765
4.1. Cellular Antigens and Enzymes 765
4.1.0. Group A Streptococcal Cellular Antigens and Enzymes. 765
4.1.1. Group B Streptococcal Cellular Antigens and Enzymes. 767
4.1.2. Pneumococcal Cellular Antigens and Enzymes. 767
4.1.3. Components of Other Streptococci. 767
4.2. Antibiotic Susceptibility 768
35.5 Descriptive Epidemiology 769
5.1. Prevalence and Incidence 769
5.2. Epidemiology and Contagiousness 772
5.3. Geographic Distribution 773
5.4. Temporal Distribution 773
5.5. Age 774
5.6. Sex 775
5.7. Race and Genetic Factors 775
5.8. Occupation 775
5.9. Other Settings and Predisposing Factors 775
35.6 Mechanisms and Routes of Transmission 776
35.7 Pathogenesis and Immunity 777
7.1. Pathogenesis 777
7.2. Immunity 778
35.8 Patterns of Host Response 779
8.1. Clinical Features 779
35.9 Control and Prevention 782
9.1. General Preventive Measures 782
9.2. Antibiotics in Treatment and Prevention of Group A Streptococcal Disease 782
9.3. Surgical Approaches to Recurrent Group A Streptococcal Disease 783
9.4. Antibiotics in Treatment and Prevention of Endocarditis 783
9.5. Intrapartum Chemoprophylaxis Against Group B Streptococcal Disease 784
9.6. Passive Immune Prophylaxis Against Streptococcal Infections 784
9.7. Immunization Against Streptococcal Infections 784
9.8. Prevention of Dental Caries 786
35.10 Unresolved Problems 786
Chapter 36 Syphilis 794
36.1 Introduction 794
36.2 Historical Aspects 794
2.1. Early History 794
2.2. Social Attitudes 794
2.3. Control Programs 795
2.4. Funding Levels and Syphilis Incidence 795
2.5. The National Plan to Eliminate Syphilis from the United States 796
36.3 Methodology 796
3.1. Sources of Mortality and Morbidity Data 796
3.2. Serological Surveys 797
3.3. Laboratory Diagnosis 797
3.3.0. Identification of the Organism. 797
3.3.1. Serology. 797
36.4 Biological Characteristics of the Organism 797
36.5 Descriptive Epidemiology 798
5.1. Prevalence and Incidence 798
5.2. Contagiousness 798
5.3. Geographic Distribution 799
5.4. Temporal Distribution 799
5.5. Age and Gender 800
5.6. Race 800
5.7. Occupation 800
5.8. Occurrence in High-Risk Environments 801
5.9. Socioeconomic Factors 801
36.6 Mechanisms and Routes of Transmission 802
36.7 Pathogenesis and Immunity 802
36.8 Patterns of Host Response 802
8.1. Clinical Features 802
8.1.0. Primary Stage. 803
8.1.1. Secondary Stage. 803
8.1.2. Clinical (Infectious) Secondary Relapse. 803
8.1.3. Late Benign Syphilis. 803
8.1.4. Cardiovascular Syphilis. 803
8.1.5. Neurosyphilis. 804
8.2. Diagnosis 804
36.9 Control and Prevention 804
9.1. Epidemiological Basis for Syphilis Control Activities 804
9.1.0. Transmission Dynamics. 804
9.1.1. Core Populations. 805
9.2. Control and Prevention 807
9.2.0. Screening. 807
9.2.1. Clinical Diagnosis as a Tool for Disease Control. 807
9.2.2. The Role of Treatment. 808
9.2.3. Partner Notification. 808
9.2.4. Health Education. 810
9.2.5. Immunization. 810
36.10 Unresolved Problems 810
Chapter 37 Nonvenereal Treponematoses 814
37.1 Introduction 814
37.2 Historical Background 814
37.3 Methodology 816
3.1. Sources of Mortality Data 816
3.2. Sources of Morbidity Data 816
3.3. Surveys 816
3.4. Laboratory Diagnosis 816
3.4.0. Isolation and Identification of the Organisms. 816
3.4.1. Serological and Diagnostic Methods. 816
37.4 Biological Characteristics of the Organism 817
37.5 Descriptive Epidemiology 817
5.1. Prevalence and Incidence 817
5.2. Epidemic Behavior and Contagiousness 817
5.3. Geographic Distribution 817
5.4. Temporal Distribution 818
5.5. Age 818
5.6. Sex 818
5.7. Race 818
5.8. Occupation 819
5.9. Occurrence in Different Settings 819
5.10. Socioeconomic Factors 819
37.6 Mechanisms and Routes of Transmission 819
37.7 Pathogenesis and Immunity 819
37.8 Patterns of Host Response 819
8.1. Clinical Features 819
8.1.0. Pinta. 820
8.1.1. Yaws. 820
8.1.2. Endemic Syphilis. 820
8.2. Diagnosis 820
37.9 Control and Prevention 821
9.1. Antibiotic and Chemotherapeutic Approaches to Prophylaxis 821
9.2. Immunization 821
37.10 Unresolved Problems 821
Chapter 38 Tetanus 823
38.1 Introduction 823
38.2 Historical Background 823
38.3 Methodology 823
3.1. Sources of Mortality Data 824
3.2. Sources of Morbidity Data 824
3.3. Serological Surveys 824
3.4. Laboratory Diagnosis 825
38.4 Biological Characteristics of the Organism 825
38.5 Descriptive Epidemiology 826
5.1. Prevalence and Incidence 826
5.2. Epidemic Behavior 827
5.3. Geographic Distribution 827
5.4. Temporal Distribution 827
5.5. Age 827
5.6. Sex 828
5.7. Race 828
5.8. Occupation and Location 828
5.9. Occurrence in Different Settings 828
5.10. Socioeconomic Factors 829
38.6 Mechanisms and Routes of Transmission 829
6.1. Children and Adults 829
6.2. Neonates 829
38.7 Pathogenesis and Immunity 829
7.1. Pathogenesis 830
7.2. Immunity 830
38.8 Patterns of Host Response 830
8.1. Clinical Features in Children and Adults 831
8.2. Clinical Features in Neonatal Tetanus 831
8.3. Diagnosis 831
38.9 Control and Prevention 832
9.1. Passive Immunization 832
9.2. Active Immunization 833
9.2.0. Production and Testing of Tetanus Toxoid. 833
9.2.1. Use of Tetanus Toxoid. 834
9.2.2. Adverse Events. 836
9.2.3. Wound Management. 837
9.3. Antimicrobials 838
9.4. Summary 838
38.10 Unresolved Problems 838
Chapter 39 Toxic Shock Syndrome (Staphylococcal) 843
39.1 Introduction 843
39.2 Historical Background 843
39.3 Methodology 843
3.1. Sources of Mortality Data 844
3.2. Sources of Morbidity Data 844
3.3. Surveys 844
3.4. Laboratory Diagnosis 844
3.4.0. Isolation and Identification of the Organism. 844
3.4.1. Serological and Immunologic Diagnostic Methods. 844
39.4 Biological Characteristics of the Organism 845
39.5 Descriptive Epidemiology 845
5.1. Prevalence and Incidence 845
5.2. Epidemic Behavior and Contagiousness 846
5.3. Geographic Distribution 846
5.3.0. United States. 846
5.3.1. Other Countries. 846
5.4. Temporal Distribution 846
5.5. Age 847
5.6. Sex 849
5.7. Race 849
5.8. Occupation 849
5.9. Occurrence in Different Settings 849
5.10. Socioeconomic Factors 849
5.11. Other Factors 849
5.11.0. Menstrual TSS. 849
5.11.1. Postpartum TSS. 850
5.11.2. Postoperative TSS. 851
5.11.3. Other Nonmenstrual TSS. 851
39.6 Mechanisms and Routes of Transmission 851
39.7 Pathogenesis and Immunity 851
39.8 Patterns of Host Response 852
8.1. Clinical Features 852
8.2. Diagnosis 853
39.9 Control and Prevention 854
9.1. General Concepts 854
9.1.0. Menstrual TSS. 854
9.1.1. Postpartum TSS. 854
9.1.2. Hospital-Acquired TSS. 854
9.2. Antibiotic and Chemotherapeutic Approaches to Prophylaxis 854
9.3. Immunization 854
39.10 Unresolved Problems 855
Chapter 40 Tuberculosis 859
40.1 Introduction 859
40.2 Historical Background 859
40.3 Methodology 861
3.1. Sources of Mortality Data 861
3.2. Sources of Morbidity Data 861
3.3. Surveys 862
3.4. Laboratory Diagnosis 862
3.4.0. Isolation and Identification of the Organism. 862
3.4.1. Serological and Immunologic Diagnostic Methods. 863
40.4 Biological Characteristics of the Organism 864
40.5 Descriptive Epidemiology 864
5.1. Prevalence and Incidence 864
5.1.0. Infection. 864
5.1.1. Disease. 865
5.2. Epidemic Behavior and Contagiousness 865
5.3. Geographic Distribution 866
5.4. Temporal Distribution 867
5.5. Age 868
5.6. Sex 868
5.7. Genetic Factors and Race 869
5.8. Occupation 870
5.9. Socioeconomic Factors 870
5.10. Smoking 871
5.11. Nutrition 871
5.12. Human Immunodeficiency Virus---HIV 872
5.13. Size of Tuberculin Reaction 872
40.6 Mechanisms and Routes of Transmission 873
40.7 Pathogenesis and Immunity 873
40.8 Patterns of Host Response 874
40.9 Control and Prevention 875
9.1. General Concepts 875
9.2. Decontamination of Air and Milk 875
9.3. Case-Finding and Chemotherapy 876
9.4. Preventive Therapy 877
9.5. Immunization 878
40.10 Unresolved Problems 878
Chapter 41 Nontuberculous Mycobacterial Infections 888
41.1 Introduction 888
41.2 Historical Background 888
41.3 Methodology 888
3.1. Sources of Data 889
3.2. Laboratory Diagnosis 889
3.2.0. Isolation and Identification of NTM. 889
3.2.1. Drug Susceptibility Testing. 889
3.2.2. Serological and Immunologic Tests. 890
41.4 Biological Characteristics of the Nontuberculous Mycobacteria 890
41.5 Descriptive Epidemiology 891
5.1. Prevalence and Incidence 891
5.1.0. Risk Factors for Infection and Disease. 891
5.2. Epidemic Behavior and Contagiousness 892
5.3. Geographic Distribution 892
5.4. Temporal Distribution 892
5.5. Age and Sex Distribution 893
41.6 Mechanisms and Routes of Transmission 893
6.1. Nontuberculous Mycobacteria in the Environment 893
41.7 Pathogenesis and Immunity 894
41.8 Patterns of Host Response 894
8.1. Clinical Features 894
8.1.0. Pulmonary Disease. 894
8.1.1. Lymphadenitis. 896
8.1.2. Soft Tissue, Skin, and Bone Infection. 896
8.1.3. Disseminated Infections. 896
8.2. Diagnosis 897
8.2.0. Pulmonary Disease. 897
8.2.1. Lymphadenitis. 897
8.2.2. Soft Tissue. 897
8.2.3. Disseminated Disease. 897
41.9 Control and Prevention of NTM Infections 897
9.1. General Concepts 897
9.2. Chemotherapy 898
9.2.0. Chemotherapy of Pulmonary Infections. 898
9.2.1. Chemotherapy of Lymphadenitis. 899
9.2.2. Chemotherapy of Skin, Soft Tissue, and Bone/Joint Infections. 899
9.2.3. Chemotherapy for Disseminated Infections. 900
9.3. Prophylaxis of NTM Infections 900
9.4. Immunization 900
41.10 Unresolved Problems 900
Chapter 42 Tularemia 905
42.1 Introduction 905
42.2 Historical Background 905
42.3 Methodology 905
3.1. Sources of Data 906
3.2. Surveys 906
42.4 Biological Characteristics 906
4.1. Bacteriology 906
4.2. Ecology 906
42.5 Descriptive Epidemiology 907
5.1. Prevalence and Incidence 907
5.2. Epidemic Behavior 907
5.3. Geographic Distribution 909
5.4. Seasonal Distribution 909
5.5. Age and Sex Distribution 909
5.6. Occupation and Recreation 910
5.7. Other Factors 910
5.8. Occurrence in Different Settings 910
42.6 Transmission to Humans 910
42.7 Pathogenesis and Immunity 911
7.1. Pathogenesis 911
7.2. Immunity 911
42.8 Patterns of Host Response 911
8.1. Clinical Features 912
8.2. Laboratory Diagnosis 913
8.2.0. Isolation and Identification of the Organism. 913
8.2.1. Serological and Immunological Tests. 913
8.3. Prognosis 914
42.9 Control and Prevention 914
9.1. General Concepts 914
9.2. Chemotherapeutic Approaches to Prophylaxis 915
9.3. Immunization 915
42.10 Unresolved Issues 915
Chapter 43 Typhoid Fever 920
43.1 Introduction 920
43.2 Historical Background 920
43.3 Methodology 921
3.1. Sources of Mortality Data 922
3.2. Sources of Morbidity Data 922
3.3. Surveys 922
3.4. Laboratory Diagnosis 924
3.4.0. Isolation and Identification of the Organism. 924
3.4.1. Serological Diagnostic Methods. 924
3.4.2. Rapid Immunoassays. 925
43.4 Biological Characteristics of the Organism 925
43.5 Descriptive Epidemiology 926
5.1. Prevalence and Incidence 926
5.1.0. In the United States. 926
5.1.1. Worldwide. 927
5.1.2. Prevalence of Carriers. 928
5.1.3. Prevalence of Antibody. 929
5.2. Epidemic Behavior and Contagiousness 929
5.3. Geographic Distribution 930
5.4. Temporal Distribution 931
5.5. Age 931
5.6. Sex 932
5.7. Race 932
5.8. Occupation 932
5.9. Occurrence in Different Settings 933
5.10. Socioeconomic Factors 933
5.11. Other Factors 933
43.6 Mechanisms and Routes of Transmission 933
43.7 Pathogenesis and Immunity 934
7.1. Pathogenesis 934
7.2. Immunity 935
43.8 Patterns of Host Response 935
8.1. Clinical Features 935
8.2. Diagnosis 936
43.9 Control and Prevention 936
9.1. General Concepts 936
9.2. Antibiotic and Chemotherapeutic Approaches to Prophylaxis 937
9.3. Immunization 937
9.3.0. Ty21a. 937
9.3.1. Vi Polysaccharide Vaccine. 938
9.3.2. New Generation Typhoid Vaccines. 938
43.10 Unresolved Problems 939
Chapter 44 Yersinia enterocolitica Infections 945
44.1 Introduction 945
44.2 Historical Background 945
44.3 Methodology 946
3.1. Sources of Mortality Data 946
3.2. Sources of Morbidity Data 946
3.3. Surveys and Investigations 946
3.4. Laboratory Diagnosis 946
3.4.0. Isolation and Identification of the Organism. 946
3.4.1. Serological Diagnostic Methods. 947
44.4 Biological Characteristics of the Organism 948
44.5 Descriptive Epidemiology 949
5.1. Prevalence and Incidence 949
5.2. Epidemic Behavior and Contagiousness 950
5.3. Geographic Distribution 952
5.4. Temporal Distribution 953
5.5. Age 953
5.6. Sex 953
5.7. Occupation 954
5.8. Race and Ethnicity 954
5.9. Occurrence in Different Settings 954
5.10. Socioeconomic Factors 954
44.6 Mechanisms and Routes of Transmission 954
44.7 Pathogenesis and Immunity 955
44.8 Patterns of Host Response 956
8.1. Clinical Features 956
8.2. Diagnosis 957
44.9 Control and Prevention 957
9.1. General Concepts 957
9.2. Antibiotic and Chemotherapeutic Approaches to Prophylaxis 958
9.3. Immunization. 958
44.10 Unresolved Problems 958
Index 964

Produkt-Details

• Erscheint lt. Verlag: 5.4.2010
• Zusatzinfo: XX, 1600 p.
• Verlagsort: New York
• Sprache: englisch
• Themenwelt: Sachbuch/Ratgeber ► Gesundheit / Leben / Psychologie ► Krankheiten / Heilverfahren
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Mikrobiologie / Infektologie / Reisemedizin
• Themenwelt: Studium ► 1. Studienabschnitt (Vorklinik) ► Biochemie / Molekularbiologie
• Themenwelt: Studium ► Querschnittsbereiche ► Epidemiologie / Med. Biometrie
• Themenwelt: Studium ► Querschnittsbereiche ► Infektiologie / Immunologie
• Themenwelt: Studium ► Querschnittsbereiche ► Prävention / Gesundheitsförderung
• Themenwelt: Naturwissenschaften ► Biologie
• Themenwelt: Naturwissenschaften ► Physik / Astronomie
• Themenwelt: Technik
• Schlagworte: acute bacterial infections • Antimicrobial • Bacteria • bacterial epidemiolgy and control • bacterial infection • Bacterial Infections • encyclopedia of bacteria • Infection • Infections • Infectious • infectious disease • Infectious Diseases
• ISBN-10: 0-387-09843-7 / 0387098437
• ISBN-13: 978-0-387-09843-2 / 9780387098432