Bacterial infections of humans, epidemiology and control 4th ed p brachman, e abrutyn (springer, 2009)

Bacterial Infections
of Humans
Epidemiology and Control
FOURTH EDITION


Bacterial Infections
of Humans
Epidemiology and Control
FOURTH EDITION
Edited by

Philip S. Brachman
Emory University, Atlanta, Georgia, USA

and

Elias Abrutyn
Drexel University, Philadelphia, Pennsylvania, USA

Formerly edited by

Alfred S. Evans and Philip S. Brachman

123


Editors
Philip S. Brachman
Emory University

Rollins School of Public Health
1518 Clifton Road NE.
Atlanta GA 30322
USA

Elias Abrutyn
Drexel University
Philadelphia
Pennsylvania, USA

ISBN 978-0-387-09842-5
e-ISBN 978-0-387-09843-2
DOI 10.1007/978-0-387-09843-2
Library of Congress Control Number: 2009920956
© Springer Science+Business Media, LLC 1984, 1991,1998, 2009
All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer Science+Business
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respect to the material contained herein.
Printed on acid-free paper
springer.com


Contributors
Elias Abrutyn, Drexel University College of Medicine, Philadelphia, Pennsylvania 19102-1192, USA

(Deceased).
Ammar M. Ahmed, 518 Laurelwood Dr, Hercules, CA 94547, USA.
E. Russell Alexander, Seattle–King County Department of Public Health, Seattle, Washington 98104,
USA († Deceased).
Ban Mishu Allos, Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville,
Tennessee 37232, USA.
Jaffar A. Al-Tawfiq, Internal Medicine Services Division, Internal Medicine and Infectious Diseases,
Dhahran Health Center, Saudi Aramco Medical Services Organization, Saudi Aramco, Dhahran,
Saudi Arabia.
Donald Armstrong, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
Robert S. Baltimore, Departments of Pediatrics and Epidemiology and Public Health, Yale University
School of Medicine, New Haven, Connecticut 06520-8064, USA.
Philip S. Brachman, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, 30322, USA.
Julie S. Brantley, Center for Clinical Studies, Houston, Texas, USA.
Willard Cates, Family Health International, Research Triangle Park, North Carolina 27709, USA.
Richard E. Chaisson, Center for Tuberculosis Research, Johns Hopkins University, 1550 Orleans Street,
Baltimore, Maryland 21231, USA.
Roger P. Clark, Infectious Diseases, Division of Geographic Medicine and Infectious Diseases, TuftsNew England Medical Center, Boston, Massachusetts, USA.
George W. Comstock, Bloomberg School of Public Health, George W. Comstock Center for Public Health
Research and Prevention, The Johns Hopkins University, Box 2067, Hagerstown, Maryland 217422067, USA (Deceased).
Charles L. Daley, Division of Mycobacterial and Respiratory Infections, National Jewish Medical and
Research Center and the University of Colorado Health Sciences Center Head, Denver, Colorado
80206, USA.
Catherine de Martel, Department of Medicine, Stanford University School of Medicine, Stanford, California, 94305-5107, USA.
David T. Dennis, Division of Vector-Borne Diseases, National Center for Infectious Diseases, Centers
for Disease Control and Prevention, Public Health Service, US Department of Health and Human
Services, Fort Collins, Colorado 80521, USA.
Gaston De Serres, Institut national de sant´e publique du Qu´ebec, 2400 d’Estimauville, Quebec, PQ,
Canada, G1E 7G9.

v


vi

Contributors

J. Stephen Dumler, Division of Medical Microbiology, Department of Pathology, Johns Hopkins Medical
Institution, Baltimore, Maryland 21205, USA.
Herbert L. DuPont, Center for Infectious Diseases, The University of Texas – Houston School of Public
Health, Houston, Texas, USA; St. Luke’s Episcopal Hospital, Houston, Texas, USA; Baylor College
of Medicine, Houston, Texas, USA.
Charles N. Edwards, Queen Elizabeth Hospital, St. Michael BB11155, Barbados, West Indies.
M. Teresa Estrada-Garcia, Department of Molecular Biomedicine, CINVESTAV-IPN, Mexico D.F.
Alfred S. Evans, Department of Epidemiology and Public Health, Yale University School of Medicine,
New Haven, Connecticut 06510, USA († Deceased).
Charles Feldman, Division of Pulmonology, Department of Medicine, Faculty of Health Sciences, School
of Clinical Medicine, Johannesburg Hospital and University of the Witwatersrand, Johannesburg,
South Africa.
Barry S. Fields, Respiratory Diseases Branch, National Center for Infectious Diseases, Centers for Disease
Control and Prevention, Atlanta, Georgia, USA.
Vance G. Fowler, Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA.
Richard I. Frankel, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii 96813;
formerly Department of Veterans Affairs Pacific Islands Heath Care System, Honolulu, Hawaii
96819.
Jon Furuno, Department of Epidemiology and Preventive Medicine, University of Maryland School of
Medicine, Baltimore, Maryland 21201, USA, e-mail:
Dale N. Gerding, Edward Hines Jr. Veterans Affairs Hospital and Loyola University Chicago, Stritch
School of Medicine, Hines, Illinois 60141, USA.
Janet R. Gilsdorf, University of Michigan Medical School, Department of Pediatrics, L2225 Women’s

Hospital, Ann Arbor, Michigan 48109-0244, USA.
Barry M. Gray, Pediatric Infectious Diseases, University of Illinois College of Medicine at Peoria, Peoria,
Illinois 61637, USA.
Heather Green, University of Maryland School of Medicine, Laurel, Maryland 20708, USA.
Scott A. Halperin, Clinical Trials Research Center, Dalhousie University, IWK Health Centre, 5850/5980
University Avenue, Halifax, NS B3K 6R8, Canada.
Amy Horneman, Department of Epidemiology and Preventive Medicine, University of Maryland School
of Medicine, Baltimore, Maryland 21201, USA.
Linden T. Hu, MD, Associate Professor of Medicine, Division of Geographic Medicine and Infectious
Diseases, Tufts-New England Medical Center, 750 Washington St, Boston, Massachusetts 02111,
USA.
Zhi-Dong Jiang, Center for Infectious Diseases, The University of Texas – Houston School of Public
Health, Houston, Texas, USA.
Stuart Johnson , Edward Hines Jr. Veterans Affairs Hospital and Loyola University Chicago, Stritch
School of Medicine, Hines, Illinois 60141, USA.
Zeina A. Kanafani, Division of Infectious Diseases, Duke University Medical Center, Durham, North
Carolina, USA.
Arnold F. Kaufmann, 2155 Mountclaire Ct, Stone Mountain, GA 30087-1335, Atlanta, Georgia, 30087,
USA (Retired).
Gerald T. Keusch, Boston University School of Public Health, Boston, Massachusetts 02118, USA.


Contributors

Keith P. Klugman, William H Foege Professor of Global Health, Hubert Department of Global Health,
Rollins School of Public Health and Division of Infectious Diseases, School of Medicine, Emory
University, Atlanta, Georgia, USA; Respiratory and Meningeal Pathogens Research Unit, Medical
Research Council and University of the Witwatersrand, Johannesburg, South Africa.
Katrina Kretsinger, US PHS, Bacterial Vaccine-Preventable Diseases Branch National Immunization
Program, Centers for Disease Control and Prevention, Atlanta, Georgia, 30333, USA.

Ebbing Lautenbach, Associate Professor of Medicine, Infectious Diseases Division, University of Pennsylvania SOM, Philadelphia, Pennsylvania 19104, USA.
Paul N. Levett, Saskatchewan Disease Control Laboratory, Saskatchewan Health, Regina, Saskatchewan,
Canada S4S 5W6.
Myron M. Levine, Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA.
Michael E. St. Louis, Division of STD Prevention, National Center for HIV, STD, and TB Prevention,
Centers for Disease Control and Prevention, Atlanta, Georgia, 30333, USA.
Donald B. Louria , Professor of Preventive Medicine and Community Health, University of Medicine and
Dentistry –New Jersey Medical School, Newark, New Jersey 07103, USA.
Michael F. Lynch, Enteric Diseases Epidemiology Branch, Division of Foodborne, Bacterial and Mycotic
Diseases, National Center for Zoonotic, Vector-borne and Enteric Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
Vandana Madkan, Center for Clinical Studies, Houston, Texas, USA
Thomas J. Marrie, Walter C. Mackenzie Health Sciences Center, Edmonton, Alberta T6G 2B7, Canada
Susan E. Maslanka, National Botulism Surveillance and Reference Laboratory, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA
John E. McGowan, Department of Epidemiology, The Rollins School of Public Health of Emory University, Atlanta, Georgia 30322, USA
Paul S. Mead, Bacterial Zoonoses Branch, Centers for Disease Control and Prevention, Ft Collins, Colorado 80522, USA.
Natalia Mendoza, Center for Clinical Studies, Houston, Texas, USA
Manoj P. Menon, Enteric Diseases Epidemiology Branch, Division of Foodborne, Bacterial and Mycotic
Diseases, National Center for Zoonotic, Vectorborne, and Enteric Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA
Aaron Milstone, Division of Infectious Diseases, Department of Pediatrics, The Johns Hopkins University
School of Medicine, Baltimore, Maryland 21205, USA.
Eric D. Mintz, Diarrheal Diseases Section, Enteric Diseases, Epidemiology Branch, Division of Foodborne, Bacterial and Mycotic Diseases, National Center for Zoonotic, Vectorborne, and Enteric Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
Matthew R. Moore, Respiratory Diseases Branch, National Center for Infectious Diseases, Centers for
Disease Control and Prevention, Atlanta, Georgia 30333, USA.
J. Glenn Morris, University of Florida’s Emerging Pathogens Institute, Gainesville, Florida 32611, USA.
Julie Parsonnet, Department of Medicine, Stanford University School of Medicine, Stanford, California
94305-5107, USA.
Roopal Patel, Respiratory Diseases Branch, National Center for Infectious Diseases, Centers for Disease
Control and Prevention, Atlanta, Georgia 30333, USA.
Sharon Perry, Department of Medicine, Stanford University School of Medicine, Stanford, California
94305-5407, USA.

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viii

Contributors

Jeannine M. Petersen, Division of Vector-Borne Infectious Diseases, Centers for Disease Control and
Prevention, Fort Collins, Colorado 80522, USA.
Diana S. Pope, Portland VA Medical Center, Portland, Oregon 97239, USA.
Arthur E. Reingold, Division of Epidemiology, School of Public Health, University of California, Berkeley, California 94720-7360, USA.
Lee W. Riley, University of California – Berkeley , School of Public Health, 140 Warren Hall, Berkeley,
California 94720, USA.
Anne Rompalo, Johns Hopkins School of Medicine, Baltimore, Maryland 21205, USA.
Julius Schachter, Chlamydia Research Laboratory, Department of Laboratory Medicine, University of
California, San Francisco, California 94110, USA
D. Scott Schmid, National Center for Infectious Diseases, Centers for Disease Control and Prevention,
Atlanta, Georgia, USA.
Ann M. Schmitz, University of Wisconsin, Madison, Wisconsin, 53706, USA.
David M. Scollard, National Hansen’s Disease Program, Baton Rouge, Louisiana 70816, USA.
J. Erin Staples, Division of Vector-Borne Diseases, National Center for Infectious Diseases, Centers for
Disease Control and Prevention, Public Health Service, US Department of Health and Human Services, Fort Collins, Colorado 80521, USA.
Dennis L. Stevens, Infectious Disease Section, Veterans Affairs Medical Center Boise, Boise, Idaho
83702, USA.
David L. Swerdlow, National Surveillance Team, Enteric Diseases Epidemiology Branch Centers for
Disease Control and Prevention, Atlanta, Georgia 30333, USA.
Deborah F. Talkington, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
Robert V. Tauxe, Division of Foodborne, Bacterial and Mycotic Diseases, National Center for Zoonotic,
Vectorborne, and Enteric Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia

30333, USA.
Fred C. Tenover, Division of Healthcare Quality Promotion, National Center for the Prevention, Detection, and Control of Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
30333, USA.
Stephen K. Tyring, University of Texas Health Science Center, Houston, Texas, USA; Center for Clinical
Studies, Houston, Texas 77030, USA.
Ken B. Waites, Department of Pathology, WP 230, University of Alabama at Birmingham, Birmingham,
Alabama 35249, USA.
Steven G. F. Wassilak, National Immunization Program, Office of the Director, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
Melinda Wharton, National Immunization Program, Centers for Disease Control and Prevention, Atlanta,
Georgia 30333, USA.
Edward J. Young, Medical Service, Veterans Affairs Medical Center; Departments of Medicine, Microbiology, and Immunology, Baylor College of Medicine, Houston, Texas 77030, USA.
Patricia A. Yu, Strategic Science and Program Unit, Coordinating Center for Infectious Diseases, Centers
for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
Jonathan M. Zenilman, Infectious Diseases Division, Johns Hopkins Bayview Medical Center, Baltimore, Maryland 21224, USA.


Biographical Sketch – Elias Abrutyn
Elias Abrutyn, co-editor of this, the 4th Edition of Bacterial Infections of Humans, died unexpectedly on
February 22, 2007, at the age of 66 years. Eli was an extremely enthusiastic and energetic collaborator in
developing this edition. His knowledge of infectious diseases of both literature and current activities in the
field contributed significantly to the quality of this textbook.
Eli was born on April
15, 1940, in New Jersey and
received his BA degree from the
University of Pennsylvania in
1960. He attended the University of Basil in Basil, Switzerland from 1960 to 1963 and was
awarded his MD from the University of Pittsburgh in 1966.
He was an intern and medical resident at the Hospital of
the University of Pennsylvania
in Philadelphia from 1966 to

1968. He joined the Epidemic
Intelligence Service at the Centers for Disease Control and
Prevention in 1968 and worked
in the Field Services Branch,
Immunization Division, where
he became the acting assistant
Elias Abrutyn
director. In 1970, he assumed
1940–2007
the Chief Medical Residency
position at the University of
Pennsylvania Veterans Administration Medical Center. In 1971, he was a post-doctoral Fellow in Infectious Diseases at the Hospital of the University of Pennsylvania. In 1972, he became an assistant professor
of Medicine at the University of Pennsylvania School of Medicine and in 1984 was appointed an adjunct
professor of Medicine at the University of Pennsylvania School of Medicine, a position he held until 1996.
From 1982 to 1997, he was also a professor of medicine at the Medical College of Pennsylvania. From
1989 to 2005, he was a senior scholar in the Clinical Epidemiology Unit and then the Department of Epidemiology and Biostatistics at the University of Pennsylvania School of Medicine. From 1991 to 1996,
he was associate dean for Veteran’s Affairs at the Philadelphia Veterans Administration Medical Center.
In 1996, he became professor of medicine with tenure at the Medical College of Pennsylvania Hahnemann University and then Vice Chairman of the Department of Medicine. From 1998 to 2000, he was
also the interim chairman of the Department of Medicine at the Medical College of Pennsylvania Hahnemann University. In 2000, he became the Associate Provost and Associate Dean for Faculty Affairs at

ix


x

Biographical Sketch – Elias Abrutyn

Drexel University College of Medicine and the Allegheny University of Health Sciences. In 2002, he also
assumed the position of Interim Chief of Infectious Diseases at Drexel University College of Medicine. Eli
had his boards in Internal Medicine and Infectious Diseases.

He was a member of and held offices in a number of prestigious professional societies including
the American College of Physicians, American Medical Association, American Federation for Medical
Research, American Society for Microbiology, American Board of Internal Medicine, Association for
Practitioners in Infection Control, Association of Professors in Medicine, Hospital Infections Society
(England), Infectious Diseases Society of America, International Society for Cardiovascular Infectious
Diseases, and the Society for Healthcare Epidemiology of America. Among his accolades, Eli was past
president of the Society for Healthcare Epidemiology of America, a master of the American College of
Physicians Society for Internal Medicine, a Fellow of the Infectious Disease Society, and a member of the
council of the International Society of Cardiovascular Diseases. Additionally, he belonged to a number of
local and regional societies. He was an associate editor of Annals of Internal Medicine and was on the
editorial board of Infectious Disease Practice, and Clinical Performance in Quality Healthcare.
He was a consultant for a number of national and local organizations, including the chair of several
National Institutes of Health committees, and on a committee to review a program for controlling emerging
infectious diseases at the Centers for Disease Control and Prevention. He was a reviewer of manuscripts for
20 different scientific journals. He was a member of a number of national and local scientific committees
and was the chairman of a large number of these committees.
Over the years, Eli had a number of grants, primarily dealing with infectious diseases. He was author
and/or co-author of 103 publications in peer-reviewed journals, primarily reporting on infectious diseases,
including urinary tract infections, infective endocarditis, and influenza. He also published on antibiotics,
public health surveillance, hospital epidemiology, and health education. He wrote a number of editorials
published in peer-reviewed journals. He was senior author of a book “Infection Control Reference Service”
that is considered one of the authoritative texts in the field, in addition to being co-editor of this text book.
He was author and co-author of 46 chapters in textbooks and newsletter articles dealing primarily with
infectious diseases. He also wrote a number of commentaries and many abstracts, and gave presentations
at national and international meetings.
Eli was well respected by his peers and enjoyed teaching on topics in internal medicine with emphasis
on infectious diseases. He was a scholar, a careful researcher, well read on all infectious disease topics,
and recognized as a leader. He will be missed by his students, colleagues, and friends.

Preface
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, catalyst 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 first anesthesiologists and
an early researcher in the field 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, Pennsylvania; 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 officer 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 encephalitis vaccine. Al was invited by Dr. Paul to come to Yale
Alfred S. Evans
University to work on the identification of the cause of
1917–1996
infectious mononucleosis. He accepted this invitation
and became an associate professor of medicine in the
Department of Medicine from 1946 to 1950. He was then called back to active duty in the Army and acted
as chief of the Hepatitis Research Laboratory in Munich, Germany. It was there that he met his future wife.

In 1952, he joined the University of Wisconsin Medical School faculty and was professor and chairman of the Department of Preventive Medicine. In 1959 he also became director of the state Laboratory
of Hygiene. He took a sabbatical leave in 1960 to study for his M.P.H. degree, which he received from the
University of Michigan in 1961. In 1966 he accepted the position of John Rodman Paul Professor of Epidemiology at Yale University. Additionally, he became the director of the WHO’s Serum Reference Bank
at Yale. He remained active as a teacher and researcher until 1988 when he became an emeritus professor.
He retired from Yale in 1994.

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xii

Preface

Al was dedicated to teaching both undergraduate and graduate students, and his expertise included
a full range of topics in preventive medicine, public health, epidemiology (both applied and clinical),
infectious diseases, and other related subjects. He was one of the founders and the first director of the
Graduate Summer Session in Epidemiology, which was first held in the summer of 1965 at the University of
Wisconsin. He remained on its faculty when it was held at the University of Minnesota from 1967 to 1987,
and then at the University of Michigan School of Public Health from 1988 through the summer of 1994.
During his 29 years of association with the Graduate Summer Session, he was not only a lecturer, primarily
in epidemiology and infectious diseases, but was also an active participant on the Planning Committee and
was the unofficial social chairman for the 3-week session.
Al was a popular lecturer who used expected and unexpected visual aids and injected humor throughout his lectures. He enjoyed teaching, and his students were eager recipients, greatly stimulated by his
teaching, who frequently acknowledged his excellence with words, deeds, and appropriate awards, such
as the Bedpan Award for Clinical Teaching given at the University of Wisconsin in 1952. As a teacher he
constantly looked for new methods of presenting information to students. He was dedicated to the method
of problem-oriented sessions and developed his own infectious disease case studies, which he would incorporate into his lectures. Additionally, he was a popular guest lecturer at universities and institutions in the
United States and throughout the world. He was never too busy for his students and provided ongoing
consultation concerning their training and careers.
His research ranged over broad fields of infectious disease as well as public health and epidemiology,

with an emphasis on the Epstein–Barr virus and the relationships between cancer and infectious agents.
He was the author or coauthor of more than 230 scientific, peer-viewed publications covering a broad area
of topics, including such titles as “Sneezes, Wheezes, and Other Diseases” (1961), “Farm Injuries” (1958
and 1961), and “The Instant-Distant Infection” (1966). He was a medical historian, writing essays on John
Evans, Austin Flint, and Max von Pettenkofer. He constantly promoted the incorporation of presentations
on medical or public health history in the programs of various societies and training programs. He was an
active supporter of Yale’s historic Beaumont Medical Club.
Al firmly believed in the importance of accuracy in investigations, whether in the laboratory or in the
field. His initial involvement in a field investigation incorporated comprehensive descriptive epidemiology that, when appropriate, was followed by methodical and carefully conceived analytic epidemiological
methods. He was innovative in the use of observational field studies, which is reflected in his studies of the
Epstein–Barr virus. Al constantly promoted the development and use of serum banks, as reflected by the
WHO Serum Reference Bank at Yale. There are numerous examples of how this facility made significant
contributions to Al’s studies of infectious mononucleosis, other infectious diseases, and, more recently,
HIV/AIDS. He made significant contributions to the concepts of disease causation and researched and
reworked Koch’s postulates. In this regard, he acknowledged the important contributions that Jakob Henle
made to the topic and renamed Koch’s postulates the Henle–Koch postulates.
He was author or coauthor of five well-received textbooks: Viral Infections of Humans (which in
1977 received The American Medical Writers’ Association award for the best book written for physicians), Bacterial Infections of Humans, Methods in Observational Epidemiology, Causation and Disease:
A Chronological Journey, and Symposium on Latency and Masking in Viral and Rickettsial Infections. He
was also an editor of the Yale Journal of Biology and Medicine. He was a consultant to the WHO, the
Pan American Health Organization, the United States Public Health Service, and the National Aeronautics
and Space Agency and worked specifically with the space program in establishing the infection quarantine
programs for the Apollo 13 space mission. He frequently consulted with numerous Ministries of Health in
other countries, including Czechoslovakia, Kuwait, France, Spain, Taiwan, the Philippines, and Vietnam.
Al remained current with the medical literature, applied new technology in his own research, and
brought appropriate new information into his lectures and writings. He constantly acquainted his colleagues
and students with pertinent new written information culled from the current medical literature.
He belonged to and was an avid supporter of a number of societies, including the American Epidemiological Society, for which he served as secretary-treasurer (1968–1972) and president (1973); The
American College of Epidemiology, of which he was one of the cofounders and later served as president

Preface

(1990); The Society of Epidemiologic Research; The Infectious Disease Society of America; The Society
of Medical Consultants to the Armed Forces, for which he served as president (1983); and the American
Public Health Association (where he was president of the Epidemiology Section). He was also a fellow of
the American Association for the Advancement of Science.
Al received numerous prestigious awards and lectureships, including the Thomas Parron Lecturer
and Award, University of Pittsburgh (1977); the Thomas Francis Lectureship, University of Michigan
School of Public Health (1986); the Abraham Lilienfeld Lectureship, American College of Epidemiology
(1986); the First Harry Feldman Memorial Lectureship, American Epidemiological Society (1987); the
John R. Seal Award, The Society of Medical Consultants to the Armed Forces (1987); the W.B. Harrington
Lecture and Award, University of Buffalo (1988); the Abraham Lilienfeld Award, Epidemiology Section,
American Public Health Association (1990); and the Kass Lecturer, The Infectious Disease Society of
America (1995). He was a renowned poet, but never published any of his works. He enjoyed reciting them
in the classroom, in private discussions, and at social events.
During his life, he set standards to which others will aspire. The world is richer for the activities of
Alfred Spring Evans, and we will all be better scientists and humanitarians because of his contributions.
The contents of this book were written by experts in the specific topics of each chapter, many of whom
Al knew personally. The quality of the chapters reflects the multiple contributions that Alfred Spring Evans
made to each of our professional lives.

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Contents
Chapter 1

Epidemiological Concepts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Alfred S. Evans

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.

Chapter 2

1

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Definitions and Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Epidemics and Their Investigation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Agent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Environment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Host . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Routes of Transmission . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Pathogenesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Incubation Period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Immune Response . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Patterns of Host Response . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Diagnosis of Bacterial Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Proof of Causation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Control and Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Suggested Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1
2
7
11
14
15
17
20
21
22
26
34
38
38
46
50

Public Health Surveillance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

51

Philip S. Brachman

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Use of Surveillance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Data Sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Routine Surveillance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Special Surveillance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Data Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Reports . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Limitations of Surveillance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Suggested Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

51
51

52
53
56
56
60
62
65
66
66
66
67

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Contents

Chapter 3

Molecular Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

69

Lee W. Riley
1.
2.
3.
4.

5.
6.
7.

Chapter 4

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Epidemiologic Problems Addressed by Genotyping Techniques . . . . . . .
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Suggested Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

69
69
70
79
85
85
88

The Epidemiology of Bacterial Resistance to Antimicrobial Agents . . . . .

91

Fred C. Tenover and John E. McGowan, Jr.
1.
2.
3.

4.
5.
6.
7.
8.

Chapter 5

Anthrax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
Philip S. Brachman and Arnold F. Kaufmann
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.

Chapter 6

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
Historical Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
Mechanisms of Resistance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92
Epidemiology of Antimicrobial Resistance . . . . . . . . . . . . . . . . . . . . . . . . 98
Organisms of Special Importance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99

Unresolved Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
Suggested Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Historical Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Biological Characteristics of the Organism . . . . . . . . . . . . . . . . . . . . . . . .
Descriptive Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Mechanisms and Routes of Transmission . . . . . . . . . . . . . . . . . . . . . . . . . .
Pathogenesis and Immunity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Patterns of Host Responses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Control and Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Unresolved Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Suggested Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

105
105
106
107
108
112
112
113
115
116
117
119

Bacterial Foodborne Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
Heather Green, Jon Furuno, Amy Horneman, and J. Glenn Morris, Jr.
1.
2.
3.
4.
5.

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Historical Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Foodborne Disease Outbreak Surveillance . . . . . . . . . . . . . . . . . . . . . . . . .
Etiologic Patterns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Staphylococcus aureus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

121
122
123
126
127


Contents

6.
7.
8.
9.
10.
11.
12.

13.

Chapter 7

Bacillus cereus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Clostridium perfringens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
“Noncholera” Vibrio Species . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Aeromonas Species . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Plesiomonas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Control and Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Unresolved Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

129
132
136
142
145
147
149
149

Botulism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
Patricia A. Yu, Susan E. Maslanka, Michael E. St. Louis, and
David L. Swerdlow
1.
2.
3.
4.
5.

6.
7.
8.
9.
10.
11.
12.
13.

Chapter 8

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Historical Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Biological Characteristics of the Organism . . . . . . . . . . . . . . . . . . . . . . . .
Descriptive Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Mechanisms and Routes of Transmission . . . . . . . . . . . . . . . . . . . . . . . . . .
Pathogenesis and Immunity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Patterns of Host Response . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Prevention, Control, and Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Bioterrorism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Unresolved Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Suggested Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

159
159
160
162
162

166
167
168
170
172
172
172
176

Brucellosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177
Edward J. Young
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.

Chapter 9

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Historical Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Biological Characteristics of the Organism . . . . . . . . . . . . . . . . . . . . . . . .
Descriptive Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Mechanisms and Routes of Infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Pathogenesis and Immunity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Patterns of Host Response . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Control and Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Unresolved Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

177
177
178
179
180
183
183
184
185
185
185

Campylobacter Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189
Ban Mishu Allos
1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189
2. Historical Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189

xvii


xviii

Contents

3. Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191
4. Proof of Causation and Biological Characteristics of the Organism that
Affect the Epidemiological Pattern . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193
5. Descriptive Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 194
6. Mechanisms and Routes of Transmission . . . . . . . . . . . . . . . . . . . . . . . . . . 197
7. Pathogenesis and Immunity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198
8. Patterns of Host Response . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200
9. Control and Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202
10. Unresolved Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202
11. References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203

Chapter 10

Chancroid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213
Jaffar A. Al-Tawfiq
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.

Chapter 11

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Historical Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Etiologic Patterns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Descriptive Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Mechanisms and Routes of Transmission . . . . . . . . . . . . . . . . . . . . . . . . . .
Pathogenesis and Immunity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Patterns of Host Response . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Prevention, Control, and Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Unresolved Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Suggested Readings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

213
213
213
213
214
214
214
215
216
217
217
219

Chlamydial Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221
Julius Schachter and E. Russell Alexander
1.

2.
3.
4.
5.
6.
7.
8.
9.
10.
11.

Chapter 12

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Historical Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Biological Characteristics of the Organism . . . . . . . . . . . . . . . . . . . . . . . .
Descriptive Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Mechanism and Routes of Transmission . . . . . . . . . . . . . . . . . . . . . . . . . .
Pathogenesis and Immunity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Patterns of Host Response . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Control and Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Unresolved Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

221
221
223
225
227

231
233
235
242
244
245

Cholera . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 249
Manoj P. Menon, Eric D. Mintz, and Robert V. Tauxe
1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 249
2. Historical Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 249


Contents

3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Chapter 13

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Historical Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Biological Characteristics of the Organism (Etiologic Patterns) . . . . . . .
Descriptive Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Mechanisms and Routes of Transmission . . . . . . . . . . . . . . . . . . . . . . . . . .
Pathogenesis and Immunity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Patterns of Host Response . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Control and Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Unresolved Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Suggested Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

273
273
274
275
275
277
277
278
279
279
280
282

Diphtheria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 283
Melinda Wharton
1.
2.
3.
4.
5.

6.
7.
8.
9.
10.
11.
12.

Chapter 15

252
255
257
260
262
263
264
267
268
272

Clostridium difficile . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 273
Dale N. Gerding and Stuart Johnson
1.
2.
3.
4.
5.
6.
7.

8.
9.
10.
11.
12.

Chapter 14

Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Biological Characteristics of the Organism . . . . . . . . . . . . . . . . . . . . . . . .
Descriptive Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Mechanism and Routes of Transmission . . . . . . . . . . . . . . . . . . . . . . . . . .
Pathogenesis and Immunity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Patterns of Host Response . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Control and Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Unresolved Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Suggested Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Historical Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Biological Characteristics of the Organism . . . . . . . . . . . . . . . . . . . . . . . .
Descriptive Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Mechanism and Routes of Transmission . . . . . . . . . . . . . . . . . . . . . . . . . .
Pathogenesis and Immunity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Patterns of Host Response . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Control and Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Unresolved Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Suggested Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

283
283
284
286
286
289
290
290
291
293
293
297

Escherichia coli Diarrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 299
Herbert L. DuPont, M. Teresa Estrada-Garcia, and Zhi-Dong Jiang
1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 299
2. Historical Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 299

xix


xx

Contents

3.
4.
5.

6.
7.
8.
9.
10.
11.
12.

Chapter 16

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Historical Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Biological Characteristics of the Organism . . . . . . . . . . . . . . . . . . . . . . . .
Descriptive Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Mechanisms and Routes of Transmission . . . . . . . . . . . . . . . . . . . . . . . . . .
Pathogenesis and Immunity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Patterns of Host Response . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Control and Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Unresolved Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

315
315
316
318
319
323
323
325

327
331
331

Haemophilus influenzae . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 337
Janet R. Gilsdorf
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.

Chapter 18

300
302
303
306
307
308
310
311
311
314

Gonococcal Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 315
Jonathan M. Zenilman and J. McLeod Griffiss
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.

Chapter 17

Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Biological Characteristics of the Organisms . . . . . . . . . . . . . . . . . . . . . . .
Descriptive Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Mechanisms, Routes of Transmission and Reservoirs . . . . . . . . . . . . . . . .
Pathogenesis and Immunity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Patterns of Host Response . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Control and Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Unresolved Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Suggested Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Historical Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Biological Characteristics of H. influenzae . . . . . . . . . . . . . . . . . . . . . . . .
Descriptive Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Mechanisms and Routes of Transmission . . . . . . . . . . . . . . . . . . . . . . . . . .
Pathogenesis and Immunity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Patterns of Host Response . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Control and Prevention of H. influenzae Infections . . . . . . . . . . . . . . . . .
Unresolved Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

337
337
338
344
346
349
349
354
356
358
358

Helicobacter pylori . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 369
Sharon Perry, Catherine de Martel, and Julie Parsonnet
1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 369
2. Historical Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 369
3. Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 370


Contents

4.
5.
6.
7.
8.
9.
10.
11.

Chapter 19

Biological Characteristics of the Organism . . . . . . . . . . . . . . . . . . . . . . . .
Descriptive Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Mechanisms and Routes of Transmission . . . . . . . . . . . . . . . . . . . . . . . . . .
Pathogenesis and Immunity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Patterns of Host Response . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Control and Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Unresolved Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

372
373
376
378
380
382
383
384

Legionellosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 395
Roopal Patel, Matthew R. Moore, and Barry S. Fields
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

Chapter 20

395
395
396
400
403
404
405
405
407
408

Leprosy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 415
Richard I. Frankel and David M. Scollard
1.
2.

3.
4.
5.
6.
7.
8.
9.
10.
11.
12.

Chapter 21

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Historical Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Descriptive Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Mechanism and Routes of Transmission . . . . . . . . . . . . . . . . . . . . . . . . . .
Pathogenesis and Immunity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Patterns of Host Response . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Control and Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Unresolved Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Historical Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Biological Characteristics of the Organism . . . . . . . . . . . . . . . . . . . . . . . .
Descriptive Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Mechanisms and Routes of Transmission . . . . . . . . . . . . . . . . . . . . . . . . . .

Pathogenesis and Immunity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Patterns of Host Response . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Control and Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Unresolved Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Suggested Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

415
416
416
419
420
424
425
426
429
432
434
438

Leptospirosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 439
Paul N. Levett and Charles N. Edwards
1.
2.
3.
4.
5.

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Historical Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Biological Characteristics of the Organism . . . . . . . . . . . . . . . . . . . . . . . .
Descriptive Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

439
439
440
445
445

xxi


xxii

Contents

6.
7.
8.
9.
10.
11.
Chapter 22

Mechanisms and Routes of Transmission . . . . . . . . . . . . . . . . . . . . . . . . . .
Pathogenesis and Immunity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Patterns of Host Response . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Control and Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Unresolved Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

447
448
451
454
455
456

Listeria monocytogenes Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 461
Donald Armstrong and Donald B. Louria
1.
2.
3.
4.
5.
6.
7.
8.

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 461
Historical Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 462
Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 463
Biological Characteristics of the Organism . . . . . . . . . . . . . . . . . . . . . . . . 465
Descriptive Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 465
Mechanisms and Routes of Transmission . . . . . . . . . . . . . . . . . . . . . . . . . . 468
Pathogenesis and Immunity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 468
Patterns of Host ResponsePlease note that heading level 8 and 8.1 are
the same. Please check. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 469
9. Control and Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 470

10. Unresolved Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 471
11. References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 472
Chapter 23

Lyme Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 479
Roger P. Clark and Linden T. Hu
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.

Chapter 24

Historical Perspective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Microbiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Life Cycle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Pathophysiology: Host–Pathogen Interactions . . . . . . . . . . . . . . . . . . . . . .
Spectrum of Disease/Clinical Manifestations . . . . . . . . . . . . . . . . . . . . . . .
Possible New Borrelial Syndromes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Special Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

479
479
480
480
482
483
485
485
486
487
488
489
489

Meningococcal Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 495
Robert S. Baltimore
1.
2.
3.
4.
5.

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Historical Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Biological Characteristics of the Organism . . . . . . . . . . . . . . . . . . . . . . . .
Descriptive Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

495
495
497
498
500


Contents

6.
7.
8.
9.
10.
11.
12.

Chapter 25

505
506
507
509
512
513
517

Mycoplasma pneumoniae and Other Human Mycoplasmas . . . . . . . . . . . . . 519
Deborah F. Talkington and Ken B. Waites
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.

Chapter 26

Mechanisms and Routes of Transmission . . . . . . . . . . . . . . . . . . . . . . . . . .
Pathogenesis and Immunity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Patterns of Host Response . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Control and Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Unresolved Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Suggested Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Historical Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Etiologic Patterns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Descriptive Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Mechanisms and Routes of Transmission . . . . . . . . . . . . . . . . . . . . . . . . . .
Pathogenesis and Immunity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Patterns of Host Response . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Control and Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Unresolved Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other Human Mycoplasmas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

519
519
520
523
526
527
527
529
530
531
531
534

Healthcare-Acquired Bacterial Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . 543
Ebbing Lautenbach and Elias Abrutyn
1.
2.
3.
4.
5.
6.

7.
8.
9.
10.
11.
12.

Chapter 27

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Historical Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Biological Characteristics of Nosocomial Organisms . . . . . . . . . . . . . . . .
Descriptive Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Mechanisms and Routes of Transmission . . . . . . . . . . . . . . . . . . . . . . . . . .
Pathogenesis and Immunity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Patterns of Host Response: Clinical Features and Diagnosis . . . . . . . . . .
Control and Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Unresolved Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Suggested Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

543
543
544
550
551
558
559
560

561
566
567
575

Pertussis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 577
Scott A. Halperin and Gaston De Serres
1.
2.
3.
4.

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Historical Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Biological Characteristics of the Organism . . . . . . . . . . . . . . . . . . . . . . . .

577
577
577
579

xxiii


xxiv

Contents

5.

6.
7.
8.
9.
10.
11.
12.
Chapter 28

Descriptive Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Mechanisms and Routes of Transmission . . . . . . . . . . . . . . . . . . . . . . . . . .
Pathogenesis and Immunity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Patterns of Host Response . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Control and Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Unresolved Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Suggested Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

580
585
585
586
587
590
590
595

Plague . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 597
David T. Dennis and J. Erin Staples
1.

2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.

Chapter 29

597
597
598
598
600
603
603
604
606
608
609
611

Pneumococcal Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 613
Keith P. Klugman and Charles Feldman
1.

2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.

Chapter 30

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Historical Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Biological Characteristics of the Organism . . . . . . . . . . . . . . . . . . . . . . . .
Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Mechanisms and Routes of Transmission . . . . . . . . . . . . . . . . . . . . . . . . . .
Pathogenesis and Immunity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Patterns of Host Response . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Control and Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Unresolved Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Suggested Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Historical Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Biological Characteristics of the Organism . . . . . . . . . . . . . . . . . . . . . . . .
Descriptive Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Mechanisms and Routes of Transmission . . . . . . . . . . . . . . . . . . . . . . . . . .
Pathogenesis and Immunity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Patterns of Host Response . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Control and Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Unresolved Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Suggested Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

613
613
615
616
617
624
624
627
628
634
634
641

Q fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 643
Thomas J. Marrie
1.
2.
3.
4.

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Historical Aspects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Biological Characteristics of the Organism . . . . . . . . . . . . . . . . . . . . . . . .

643
643
644
644


Contents

5. Descriptive Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 645
6. Routes of Transmission . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 652
7. Biological Characteristics of the Organism:
Pathogenesis and Immunity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 653
8. Patterns of Host Response . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 653
9. Control and Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 653
10. Unresolved Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 654
11. References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 654
12. Suggested Readings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 660
Chapter 31

Rocky Mountain Spotted Fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 661
Aaron Milstone and J. Stephen Dumler
1.
2.
3.
4.

5.
6.
7.
8.
9.
10.
11.
12.

Chapter 32

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Historical Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Biological Characteristics of the Organism . . . . . . . . . . . . . . . . . . . . . . . .
Descriptive Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Mechanisms and Routes of Transmission . . . . . . . . . . . . . . . . . . . . . . . . . .
Pathogenesis and Immunity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Patterns of Host Response . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Control and Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Unresolved Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Suggested Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

661
661
662
664
665
667

667
669
671
673
673
676

Salmonellosis: Nontyphoidal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 677
Michael F. Lynch and Robert V. Tauxe
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.

Chapter 33

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Historical Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Biological Characteristics of the Organism . . . . . . . . . . . . . . . . . . . . . . . .
Descriptive Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Mechanisms and Routes of Transmission . . . . . . . . . . . . . . . . . . . . . . . . . .

Pathogenesis and Immunity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Patterns of Host Response . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Control and Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Unresolved Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Suggested Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

677
678
678
681
683
688
689
690
692
693
694
698

Shigellosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 699
Gerald T. Keusch
1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 699
2. Historical Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 699
3. Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 700

xxv


xxvi

Contents

4.
5.
6.
7.
8.
9.
10.
11.
12.
Chapter 34

702
705
710
711
714
716
718
719
724

Evans’ Infections of Humans: Staphylococcal Infections . . . . . . . . . . . . . . . 725
Zeina A. Kanafani and Vance G. Fowler, Jr.
1.
2.
3.
4.

5.
6.
7.
8.
9.
10.
11.
12.

Chapter 35

Biological Characteristics of the Organism . . . . . . . . . . . . . . . . . . . . . . . .
Descriptive Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Mechanisms and Routes of Transmission . . . . . . . . . . . . . . . . . . . . . . . . . .
Pathogenesis and Immunity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Patterns of Host Response . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Control and Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Unresolved Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Suggested Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Historical Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Biological Characteristics of the Organism . . . . . . . . . . . . . . . . . . . . . . . .
Descriptive Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Mechanisms and Routes of Transmission . . . . . . . . . . . . . . . . . . . . . . . . . .
Pathogenesis and Immunity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Patterns of Host Response . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Control and Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unresolved Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Suggested Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

725
725
725
726
727
729
729
730
734
734
735
741

Streptococcal Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 743
Barry M. Gray and Dennis L. Stevens
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.

12.

Chapter 36

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Historical Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Biological Characteristics of the Organisms . . . . . . . . . . . . . . . . . . . . . . .
Descriptive Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Mechanisms and Routes of Transmission . . . . . . . . . . . . . . . . . . . . . . . . . .
Pathogenesis and Immunity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Patterns of Host Response . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Control and Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Unresolved Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Suggested Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

743
743
746
754
758
765
766
768
771
775
776
782

Syphilis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 783
Anne Rompalo and Willard Cates
1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 783
2. Historical Aspects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 783
3. Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 785