Ebook Radiology of infectious diseases (Vol 2): Part 1

Hongjun Li
Editor

Radiology of
Infectious Diseases
Volume 2

123


Radiology of Infectious Diseases: Volume 2



Hongjun Li
Editor

Radiology of Infectious
Diseases: Volume 2


Editor
Hongjun Li
Beijing You An Hospital
Capital Medical University
Diagnostic Radiology Department
Beijing
China

ISBN 978-94-017-9875-4
ISBN 978-94-017-9876-1

DOI 10.1007/978-94-017-9876-1

(eBook)

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I am unwilling to alienate my wife, daughter, seniors, friends, and students.
However, in order to publish this book, I had to give up my chances of
enjoying family gatherings, and I had to give up chances of having good
times with the seniors and my friends to write.
To my wife, Dongying Bao, I dedicate this treatise, for her support, encouragements, and trust to my persistence in academic career development.
To my daughter, Zhen Li, I dedicate this treatise, for giving me strength.
To my leaders and my team, I dedicate this treatise, to appreciate their
powerful support to my work.

Hongjun Li



Foreword I

In recent years, remarkable progress has been achieved in the prevention and control of infectious diseases in China. However, along with social development, environmental and human
behaviors change. As a consequence, new infectious diseases have been identified, with recurrence of traditional infectious diseases, both of which impose great challenges to the healthcare system in China. Complications of infectious diseases and their proper management are
of great importance to the therapeutic outcomes of the diseases and the quality of patients’ life,
which deserve focused scholarly and clinical attention. Radiology, as an essential method for
the diagnosis and differential diagnosis of these complications, constitutes an important procedure in the whole course of preventing and controlling infectious diseases.
Although recent years witness an increasing number of publications in radiology, those
concerning infectious diseases are rare. Committed to clinical application and basic research
of radiology of infectious diseases for years, Prof. Li has gained much experience and abundant data in this field. Based on his previous gains and contributions, he, as the chief editor, led
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Foreword I

his team composed mainly by professionals from the Department of Radiology at Beijing
You’an Hospital to finish compiling this treatise, Radiology of Infectious Diseases, within 4
years.
This book falls into 3 parts, with 59 chapters in about 2 million bytes and over 3,000 figures.
The comprehensive and original content makes it a treatise with newness and importance in the
field of radiology. I believe and expect that the publication of this book plays a positive role in
preventing and controlling the infectious diseases as well as in promoting the development of
radiology.

Academician of Chinese Engineering Academy
Fuwai Hospital of Chinese Academy of Medical Sciences
Beijing, China


Foreword II

The profound changes of environment and human behaviors have produced tremendous
impacts on the occurrence and prevalence of infectious diseases, such as SARS in 2004, influenza caused by H1N1 in 2009, and influenza caused by H7N9 in 2013. The current occurrence
and prevalence of infectious diseases are characterized by continual emergence of new infectious diseases and recurrence of traditional infectious diseases, which impose threats to the
health of human beings.
Since the common cause of death in patients with infectious diseases is the occurrence of
complications, the early diagnosis and differential diagnosis of these complications turn out to
be critical for the survival and quality of life of the patients. While diagnostic imaging, such as
CT, X-ray, and MRI, plays an important role in the early diagnosis and differential diagnosis
of complications, radiology thus constitutes an important procedure for the favorable outcomes of infectious diseases. The insufficient systematic knowledge about radiology of infectious diseases and the urgent need for its clinical application underline the compilation and
publication of this book.
Currently, scientific literature on systematic theories about the clinical radiology of the 39
national legitimated and over 10 infectious diseases is still rarely found. The classical original
treatise, Radiology of Infectious Diseases, has not been published. Previous radiological data
on infectious diseases is either lost or scattered, which necessitates their collection, summarization, and systematic studies for compilation of a treatise. It is urgent to incorporate relevant
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Foreword II

resources worldwide for multiple-centered research and systematic knowledge in the field.
Such a book definitely helps to avoid the embarrassment of no referential data in protecting

against traditional infectious diseases.
On these accounts, Prof. Li proceeded from his 15-year observations and studies on clinical
applications of radiology of infectious diseases to compile texts and data, with key points and
generalizations. Based on his previous publications of ten treatises in either Chinese or English,
including Atlas of Differential Diagnosis in HIV/AIDS (PMPH Press, Beijing), Radiology of
Influenza A (H1N1) (Springer), and Radiology of HIV/AIDS (Springer), Prof. Li completed this
book, Radiology of Infectious Diseases. He has consecutively received supports from the
National Science and Technology Publishing Fund. Three of his books have been chosen as the
planning project book in the program of internationally publishing referential books in Western
medicine initiated by the Ministry of Health in China. From conception to completion of the
manuscript, lasting for more than 2 years, the contributors had been comprehensively trained
three times. Guided and organized by several professionals, more than 40 medical institutions
and 50 professionals contributed to compiling the manuscript and collecting cases. The
resources nationwide were incorporated for the final manuscript. This book encompasses 3
parts, with 59 chapters in about 2 million bytes and over 3,000 figures. Its contents range from
imaging morphology to molecular imaging, including general introduction to medical radiology, procedures of diagnostic imaging, general introduction to infectious diseases, and specific
sections of radiology of infectious diseases. The well-structured and systematic knowledge is
reader friendly, with convenience for searching and reading. It well demonstrates radiology of
infectious diseases, providing valuable guidance for accurate radiological diagnosis of infectious diseases, preventing related complications, and improving therapeutic outcomes. It also
provides scientific basis and technological support for reducing the incidence and mortality of
infectious diseases. All the firsthand data in the book lay a solid foundation for further research
in radiology of infectious diseases. Radiology of Infectious Diseases, edited by Prof. Hongjun
Li, will jointly be published by Elsevier and People’s Medical Publishing House and present
to domestic and international professionals a new area of medical radiology. The book will
serve as an important reference for prevention, treatment, and research of infectious diseases
in both fields of clinical medicine and medical radiology.
It is my great honor and pleasure to compose the foreword for this book, because it has
taken the editor and contributors 4 years to complete the manuscript, with comprehensive and
systematic contents as well as a highly readable style. I believe the book will improve the public cognition to infectious diseases, promote related academic communication, and advance
the development in preventing and controlling infectious diseases.

Jianping Dai
Board Chair at International Medical Communication Foundation, China
Vice President of Chinese Medical Association
Foreign Academician, Academy of American Medical Sciences


Foreword III

As a special group of diseases in the disease spectrum, infectious diseases, especially those
highly contagious, are isolated from common health-care institutions. Within institutions specialized in preventing and controlling infectious diseases, those acute infectious conditions
bear insufficient data in diagnostic imaging due to their pernicious and short courses of illness.
Therefore, medical radiology contributes little to diagnosis and treatment of such diseases.
Regarding those infectious diseases with a long course, due to the limitations of radiological
equipments within institutions and the defects in the system for preventing and controlling
infectious diseases, the radiological data may be insufficient or confined within the institution.
Therefore, systematic and intensive studies in radiology of infectious diseases have been rarely
conducted and reported. Meanwhile, patients with infectious diseases are excluded from those
eligible to services by common health-care institutions. Scholarly and clinical attentions are
rarely paid to them. Generally speaking, not only patients with infectious disease but also
radiological data about infectious diseases are quarantined, which is common both domestically and internationally. In various book fairs accompanying international conferences, a treatise entitled with radiology of infectious disease is rarely found.
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Foreword III

The past 10 years (actually even a longer period) saw dramatic changes of infectious disease spectrum that we have to pay close attention to. More infectious diseases have great
crossovers with noninfectious diseases in the course of illness. The devastating SARS in 2003

perplexed the medical professionals in common health-care hospitals, leaving them no option
but to establish a fever clinic for the first-line screening of SARS. And the earliest radiological
data on SARS were collected and studied by first-line professionals who were not specialized
in infectious diseases. This event denoted a significant turning point that the common healthcare institutions may need to serve patients with infectious diseases that have not been definitely diagnosed. The field of medical radiology with traditional spectrum between infectious
and noninfectious diseases should be integrated into a whole system. The radiologists from
common health-care institutions and institutions specialized in infectious diseases should
make joint efforts to study radiological data on traditional and newly emerging infectious diseases. The consequent scholarly achievements should be applied for prevention and control of
infectious diseases. Especially, the radiologists from common health-care institutions should
have knowledge about radiological data on infectious diseases to ensure its early accurate
diagnosis and differential diagnosis.
As one of the pioneering radiologists dedicated to the prevention and treatment of AIDS in
China, Prof. Hongjun Li has directed his team to conduct basic scientific research in the field
of AIDS radiology and pathology. Their accomplishments have been widely recognized as
outstanding by both domestic and international scholars. After joining Beijing You’an Hospital,
Prof. Li, along with his increasing achievements, has continued his scholarly focus on radiology of HIV/AIDS and has extended his research interests into radiology of most infectious
diseases. More importantly, he has led a team of radiologists nationwide specialized in infectious diseases to widen and deepen our knowledge about radiology of infectious diseases. The
work was granted the second prize for the 2011 Chinese Medical Scientific and Technological
Progress Award and the second prize for the 2012 Beijing Scientific and Technological Progress
Award. In the year of 2013, he was invited by Springer Press to write and publish Radiology of
Influenza A (H1N1), indicating the international recognition of his contributions to the field of
medical radiology.
This book, Radiology of Infectious Diseases, is another achievement by Prof. Hongjun Li,
with contributions from over 40 hospitals and 50 authors nationwide in China. The book will
undoubtedly fill the blank in the field of medical radiology and serve as a reference for prevention and treatment of infectious diseases. It will also offer a way for radiologists in common
health-care institutions to gain knowledge about infectious diseases. Therefore, they can define
infectious diseases in their daily work.
I sincerely congratulate the publication of this book and am honored to write the foreword.
Meanwhile, I recommend this book to scholars and professionals working in the field of medical radiology.

Ke Xu

Chairman, Radiology Branch of Chinese Medical Association


Preface

Definition for Radiology of infectious diseases: Radiology of infectious diseases is a discipline
to primarily study the imaging features of infectious diseases caused by different pathogens,
and to explore their evolution law.
Changes of the environment and human behaviors greatly impact on the occurrence and prevalence of infectious diseases, with manifestations of continual emerging of new infectious diseases and resurgence of traditional infectious diseases. All these pose threats to human health.
Since the common cause of deaths induced by infectious diseases is closely pertinent to the
development of complications, early diagnosis of these complications proves key to prolonging
the survival and improving the survival quality of patients with infectious diseases as well as intervention assessment. Moreover, radiology constitutes an important way for the diagnosis and differential diagnosis of the complications, which remains as a key procedure in the prevention and
control of infectious diseases. Therefore, the lack of systematic theories about radiology of infectious diseases and the urgency for its clinical application underpin the compilation of this book.
Currently, studies for systematic theories on clinical radiology of the 39 legitimated and
over 10 infectious diseases are still rare. No classical blue-cover treatise, Radiology of
Infectious Diseases, has been published to guide the clinical practice. Due to the characteristic
transient prevalence or outbreak of infectious diseases, the previous sporadic data on radiology
of infectious diseases has been either lost or scattered, which further necessitates their collection, summarization, and systematic studies for compilation of a comprehensive treatise. It is
therefore urgent to incorporate relevant resources across the whole nation and even across the
world for multiple-centered studies for the compilation of a landmark book on radiology of
infectious diseases. Such a book will definitely help to avoid the embarrassing shortage of
referential data in the cases of resurgence of traditional infectious diseases.
Since 1998, the authors have been dedicated to radiology of infectious diseases. Till now,
they have accumulated and analyzed large quantities of firsthand data and abundant clinical
and research experience, which bear consecutive publications from 2006 to 2013. His published treatises, Atlas of Differential Diagnosis In HIV/AIDS (PMPH Press, Beijing), Radiology
of Influenza A (H1N1) (Springer Press), and Radiology of HIV/AIDS (Springer Press), have
been supported by the national publishing foundation for scientific and technological treatises.
The books have been officially listed into the program for the international publication planning in biomedicine by the Ministry of Health in China. The nondegree curriculum for diagnostic imaging of infections and infectious diseases has been approved as a national continuing
education program by the Chinese Medical Association for 5 years since 2008. Radiology of
Infectious Diseases encapsulates clinical application and basic research in the field of radiology of infectious diseases, which fills the blank in systematic theories about radiology of infectious diseases and further develops the theoretical system of medical radiology. The publication

of this book is therefore significant in preventing and controlling human infectious diseases.
The book is about relevant theoretic researches of the complication spectrum of infectious
diseases regarding their radiological findings, clinical managements, pathogens, pathology,
and anatomy. The book is composed of 3 parts, including 59 chapters in about 2 million bytes.
The detailed case descriptions, data, and 3,000 high-quality figures demonstrate the recent
development of the field to readers. Several chapters and sections incorporate registrations of
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Preface

morphological and molecular imaging, which include extended data for the imaging diagnosis.
The book will definitely facilitate the early diagnosis of infectious diseases, especially their
early noninvasive diagnosis with standardized technological guidelines and practical clinical
routes. In addition, the book incorporates format styles of both Chinese and Western books,
which highlights key points with brief arguments, citations from classics, as well as text along
with abundant pictures. The book also includes large quantities of classical cases, which is
highly practical and consultative for medical professionals of advanced, intermediate, and
junior level. Many rare and precious images from clinical cases are seldom encountered in
clinical practice or might be omitted due to misdiagnosis. Some imaging data are rarely found
in China which are therefore cited from relevant foreign literature. These data enriches the
content of this book. As most of the imaging data are presented for the first time, we hope this
book provides readers a refreshing perspective for expertise.
To complete this book, we have set up an advisory committee and an experts committee for
scientific design and penetrating argumentation. The composition of this book has spanned
over 4 years from its outline design and writing training to the finished manuscript, which
ultimately passed the peer-reviewing procedures by People’s Medical Publishing House and
has been published as a practical blue-cover treatise. Meanwhile, the author received invitation

for its international publication by Germany Springer Press. After the signing of the transfer of
copyright, its English version is to be published. Therefore, the editorial board has committed
tremendous endeavors to the book, with 3 trainings on composition standards. In addition, a
total of 63 medical institutions and 213 professionals contributed to the manuscript compilation, data collection, and case elaboration. Several professionals were pointed to specifically
organize auditing, modification, and supplementation. As designers, advocators, and participants, I would like to express my heartfelt thanks to all the scholars and professionals who
significantly contributed to the compilation of this book. I would also like to extend my sincere
thanks to the senior radiologists such as academician Yuqing Liu, academician Jianping Dai
(American Academy of Medical Sciences), Prof. Ji Qi, Prof. Qiyong Guo, Prof. Xiaoyuan
Feng, Prof. Ke Xu, Prof. Guozhen Zhang, Prof. Xiangsheng Xiao, Prof. Jiaxing Xu, Prof.
Jingxia Xie, and Prof. Daqing Ma for their persistent devotion to the field of radiology of infectious diseases. I would also like to thank the nationwide team and the team at the Department
of Radiology, Beijing You’an Hospital, Capital Medical University, for their efforts and persistent contributions. Especially, I bestow my thanks to Ning Li, president of Beijing You’an
Hospital of Capital Medical University, and other hospital leaders for their substantial supports. My thanks also go to those contributors for the publication and compilation of this book.
Academician Yuqing Liu, a forerunner in the field of radiology in China, is really excited at
witnessing the serial publications of the treatise in both Chinese and English, such as Radiology
of HIV/AIDS and Radiology of Influenza A (H1N1) as well as the manuscript of Radiology of
Infectious Diseases, which record and signify the recent advance in medical radiology in China.
He praised that our works marked a new area of medical radiology in China and enriched the
theoretical system of medical radiology. When visiting China in 2011, the president of the British
Science Academy acclaimed that Prof. Hongjun Li and his team at Beijing You’an Hospital had
achieved significant contributions to both the Chinese people and the whole human race.
This book also covers extremely rare and even eliminated infectious diseases, with citations
of pictures from domestic and foreign precious literature. The original authors of these citations have been identified, and we have requested for citations by written letters or e-mails.
Hereby, I would like to express my sincere thanks to these authors for their approval and support. In light of the spread and sporadic prevalence of H7N9, this treatise will provide another
powerful weapon for the battle against infectious diseases and will play a mighty role in eradicating infectious diseases that endanger human health.
There definitely exist some errors in this book. Your kindly comments are highly appreciated for the improvement of this book.
Beijing, China

Hongjun Li

Acknowledgment to Contributing
Institutions

Affiliated Beijing You’an Hospital, Capital Medical University, Beijing, China
University College Cork (UCC), Cork, Ireland
Department of Pathology, Capital Medical University, Beijing, China
Affiliated Beijing Ditan Hospital, Capital Medical University, Beijing, China
Affiliated Beijing Chest Hospital, Capital Medical University, Beijing, China
Affiliated Beijing Shijitan Hospital, Capital Medical University, Beijing, China
Affiliated Beijing Tiantan Hospital, Capital Medical University, Beijing, China
Affiliated Luhe Hospital, Capital Medical University, Beijing, China
The Third Affiliated Hospital, Suzhou University, Suzhou, Jiangsu, China
The Second Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang, China
Public Health and Clinical Center, Chengdu, Sichuan, China
Affiliated Huashan Hospital, Fudan University, Shanghai, China
The Eighth People’s Hospital, Guangzhou, Guangdong, China
The Third People’s Hospital, Shenzhen, Guangdong, China
Longtan Hospital, Liuzhou, Guangxi Zhuang Autonomous Region, China
Department of Biochemistry, Harbin Medical University, Harbin, Heilongjiang, China
The First Affiliated Hospital, Qiqihar Medical College, Qiqihar, Heilongjiang, China
Hainan Provincial Nong Ken Hospital, Haikou, Hainan, China
The City Children’s Hospital, Hangzhou, Zhejiang, China
Cangzhou Heping Hospital, Cangzhou, Hebei, China
Cangzhou Central Hospital, Cangzhou, Hebei, China
The First Affiliated Hospital, Nanyang Medical College, Nanyang, Henan, China
Provincial Institution for Infectious Diseases Prevention and Control, Harbin,
Heilongjiang, China
Taiping People’s Hospital, Daowai District, Harbin, Heilongjiang, China
The Third People’s Hospital, Harbin, Heilongjiang, China
Yantai Yuhuangding Hospital, Shangdong, China

City Kangan Hospital (former City Hospital for Infectious Diseases), Mudanjiang,
Heilongjiang, China
Jingzhou Central Hospital, Jingzhou, Hubei, China
Affiliated Tumor Hospital, Chinese Academy of Medical Sciences, Beijing, China
Provincial Children’s Hospital, Changsha, Hunan, China
The Third People’s Hospital, Changzhou, Jiangsu, China
City Tumor Hospital, Nantong, Jiangsu, China
The First Affiliated Hospital (Xinan Hospital), the Third Military Medical University,
Chongqing, China
Affiliated Tumor Hospital, Nantong University, Nantong, Jiangsu, China
City Development District Hospital, Yantai, Shandong, China
Affiliated Fifth Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
City Public Health Medical Rescuing Center, Chongqiong, China
Peking Union Medical College Hospital, Beijing, China
The First Hospital, Shanxi Medical University, Taiyuan, Shanxi, China
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Acknowledgment to Contributing Institutions

City Public Health and Clinical Center, Fudan University, Shanghai, China
The Pulmonary Hospital, Shanghai, China
Ruijin Hospital affiliated to School of Medicine, Shanghai Jiao Tong University,
Shanghai, China
Provincial Infectious Diseases Hospital (Provincial AIDS Care Center), Kunming,
Yunnan, China
Beijing Fengtai Hospital of Integrated Traditional and Western Medicine, Beijing, China
Provincial People’s Hospital, Zhengzhou, Henan, China

Provincial Tumor Hospital, Zhengzhou, Henan, China
City TCM Hospital, Nanyang, Henan, China
Baihe Town Hospital, Nanyang, Henan, China
Family Planning Guiding Center, Wolong District, Nanyang, Henan, China
Dengzhou People’s Hospital, Dengzhou, Henan, China
No. 302 Hospital of PLA, Beijing, China
City Center for Disease Control, Shenzhen, Guangdong, China
The Third People’s Hospital, Shenzhen, Guangdong, China
The Children’s Hospital, Shenzhen, Guangdong, China
The People’s Hospital of Longhua New District, Shenzhen, Guangdong, China
City People’s Hospital, Shenzhen, Guangdong, China
City Hospital for Infectious Diseases, Tianjin, China
The First People’s Hospital, Tianjin, China
The First Central Hospital, Tianjin, China
Zhongnan Hospital, Wuhan University, Wuhan, Hubei, China
City Central Hospital, Karamay, Xinjiang Uygur Autonomous Region, China
The Second Affiliated Hospital, Xinjiang Medical University, Urumqi, Xinjiang Uygur
Autonomous Region, China
The Sixth People’s Hospital, Urumqi, Xinjiang Uygur Autonomous Region, China
Maternal and Children Health Hospital of Linxiang District, Lincang, Yunnan, China
City Central Hospital, Jinhua, Zhejiang, China
The First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan, China
City Sixth People’s Hospital, Zhengzhou, Henan, China
Department of Pathogenic Molecular Biology, Institute of Microbiological Epidemiology,
Academy of Military Medical Sciences, Beijing, China
Lahey Clinic Medical Center
Brigham and Women’s Hospital Boston
SevenHills Hospital, Mumbai
Dalin Tzu Chi General Hospital
Kaohsiung Chang Gung Memorial Hospital

Boston Children’s Hospital
Yan Chai Hospital
University Hospital Southampton NHS Foundation Trust
School of Foreign Studies, Southern Medical


Contents

Part I

Radiology of Bacterial Infections

1

Anthrax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Dongli Shi and Hongjun Li

3

2

Bacillary and Amebic Dysentery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Ruili Li, Hongjun Li, and Zheng Qi

11

3

Brucellosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yuxin Yang, Xinsheng Lv, and Bailu Liu

37

4

Cat Scratch Disease. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Qi Zhang, Hongjun Li, and Xinhua Zhang

63

5

Chlamydia pneumoniae Pneumonia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Xing Wang, Hongjun Li, and Zhenying Xia

69

6

Cholera . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Junhong Li

75

7

Diphtheria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yinglin Guo, Xue Yin, and Bailu Liu

83

8

Epidemic and Endemic Typhus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Li Li and Guiying Li

89

9

Epidemic Cerebrospinal Meningitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Mengtian Sun and Jingliang Cheng

95

10

Gonorrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
Xiaodan Wang and Yanqing Gao

11

Human Streptococcus suis Infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
Ning He, Hongjun Li, and Xinhua Zhang

12

Legionnaires’ Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
Cuiyu Jia, Dawei Zhao, and Jianan Yu

13

Leprosy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
Zhiyan Lu, Jingwei Wu, and Guangyuan Cheng

14

Leptospirosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
Ruili Li, Hongjun Li, and Aidong Zhang

15

Lyme Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
Shi Qi and Feng Chen

16

Neonatal Tetanus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167
Yinglin Guo, Lili Tang, and Bailu Liu

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Contents

17

Other Infectious Diarrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171

Li Li, Mingxiao Sun, and Jing Zhao

18

Pertussis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187
Yinglin Guo, Lili Liu, and Bailu Liu

19

Plague . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195
Ruili Li, Hong Jun Li, and Dan Wu

20

Psittacosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207
Haifeng Mi, Hongjun Li, and Jianan Yu

21

Pulmonary Tuberculosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213
Yuxin Shi, Weiren Zhang, Min Yuan, and Xinhua Zhou

22

Scarlet Fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259
Li Li, Qun Lao, and Haiyan Zhao

23

Syphilis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 267

Haifeng Mi, Yunfang Li, and Hongjun Li

24

Typhoid and Paratyphoid Fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 295
Dongli Shi, Hongjun Li, and Ailin Cheng

Part II

Radiology of Parasitic Infections

25

Filariasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 307
Jiangfeng Pan

26

Hydatidosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 315
Wenxiao Jia and Hong Wang

27

Kala-Azar. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 349
Yuxin Yang

28

Schistosomiasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 357
Jiangfeng Pan

29

Malaria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 385
Li Li and Xiaochun Zhang

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 407


Contributors

Honorary Editor
Ning Li

Editor
Hongjun Li

Associate Editors
Jingliang Cheng, Puxuan Lu, Wenxiao Jia, Bailu Liu, Yuzhong Zhang, Lianchun Liang,
Weimin An, Jinsheng Xu, Qingxia Zhao, Liyi Wang

Members of the Standing Editorial Committee
Feng Chen, Yanqing Gao, Chungang Guo, Yinglin Guo, Hong Wang, Xicheng Wang, Junhong
Li, Li Li, Ruili Li, Xueqin Li, Zhiyan Lu, Qinghua Meng, Jiangfeng Pan, Shi Qi, Haifeng Mi,
Qi Zhang, Ning He, Yanyan Zhang, Xing Wang, Cuiyu Jia, Ruichi Zhang, Yuxin Shi, Dongli
Shi, Wenyan Song, Yuxin Yang, Fuchun Zhang, Xiaochun Zhang, Chengxin Yang, Dawei
Zhao

Members of the Editorial Committee
Xinchun Chen, Guilin Yang, BoPing Zhou, Guoliang Zhang, Jian Lu, Xiaohua Yue, Yuejie

Zheng, Jikui Deng, Chengrong Li, Yanxia He, Yingying Deng, Yungen Gan, Hongwu Zeng,
Wenxian Huang, Feiqiu Wen, Jianliang Yang, Wei Zhang, Keying Zhou, Wenke Zhu, Weiye
Yu, Hanwu Ma, Shujiang Mei, Xuejun Cheng, Cheng Peng, Gendong Yang, Jing Yuan, Yusen
Zhou, Guangyu Zhao, ShipinWu, Guangping Zheng, Yi Cao, Zhaoqin Wang, Guoan Yang,
Ping Li, Deli Zhao, Lili Liu, Xue Yin, Jinling Zhang, Lili Tang, Dong Han, Mingxiao Sun,
Yang Zhao, Xuhua Yang, Han Huang, Lili Kong, Meng Huo, Guiying Li, Yungui Zhang,
Huiqin Li, Lin Mao, Pengfei Tao, Mei Liu, Jun Yang, Min Yuan, Feng Feng, Su Zhou, Shuihua
Lu, Heping Xiao, Xinhua Zhou, Weiren Zhang, Huixia Zhang, Jie Bai, Mengtian Sun, Jinhuan
Wang, Jinxin Liu, Wenxin Hong, Xinsheng Lv, Xiaodan Wang, Chao Chen, Jingwei Wu,
Guangyuan Cheng, Yuejie Yang, Bo Gao,Chunli Liu, Liucun Song, Yan Sun, Xuan Yang, Na
Zhang, Dehua Yang, Xianmin Wen, Lichong Hu, Lingbin Meng, Jinsong Shen, Jinping Wu,
Jia Yun, Liqing Kang, Jihuai Cao, Hanqiu Liu, Wenze Wu, Longhua Chen, Yu Lu, Jie Dai, Kui
Huang, Shengxiu Lv, Heping Xu, Zhi Cao, Ganlin Xia, Danlei Mou, Xiaoxi Mao, Yunfang Li,
Da Yuan, Shaohua Xu, Jinli Ding, Zhenying Xia, Shuangjun Zhao, Haiyan Zhao, Aidong
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xx

Zhang, Xinhua Zhang, Dan Wu, Ailin Cheng, Shuo Wen, Hanchen Sun, Jianan Yu, Wenqiao
Li, Yue Yin, Wei Wang, Zheng Qi, Meiji Ren, Jing Zhao, Zengxin Jiao, Xueguo Liu, Zhou
Yang, Qun Lao, Hong Li, Yonghua Tang, Li Dong, Yiqing Yang, Shuang Xia, Wei Yu, Jinpeng
Yao, Jun Ma, Wei Xing, Ruchen Peng, Lin Ai, Lu Wang, Hongyan Li, Hongchi Li, Dongying
Bao, Jinli Lou, Guizhen Sun, Haiping Xiang, Tiange Zhang, Ronghua Jin, Zhongping Duan,
Lihong Zhang, Hongchen Li, Yabin Liu, Jiaxuan Fang, Yi Xiao, Dapeng Shi, Jianbo Gao,
Hailiang Li, Yong Li, Zhiyong Zhang, Taufiek Konrad Rajab, Prashant S, Peter Hildenbrand,
Shou-Chih Chang, Seng-Kee Chuah, Ecklund K, Wai-Fu Ng, Stephen P Harden, Xu Jin,
Mingmeng Zhao , Yi Wang, Jing Ning , Zexuan Chen

Academic Advisors

Jiaxing Xu, Guozhen Zhang, Xiangshen Xiao, Xiaoyuan Feng, Ke Xu, Zhengyu Jin, Zhenchang
Wang, Shiyuan Liu, Daqing Ma, Jingxia Xie, Peiyi Gao, Jie Tian, Youmin Guo, Yi Huan, Bin
Zhao, Qiumin Li, Kuncheng Li, Xiao Wang, Hangfang Sui, Deqi Yuan, Guangjun He, Liming
Xia, Daoyu Hu, Ning Li, Yumei Li

Editorial Secretaries
Li Li, Zhen Li

Contents


Author Biography

Introduction of the Chief Editor, Hongjun Li
Hongjun Li (M.D., Prof.) is a 48-year-old radiologist with an educational background in the
UK. Currently, he is also a supervisor for the master’s degree program in radiology. Professor
Li is now offered the special government allowance from the State Council in China in recognition of his outstanding contributions to the field of medicine. He is also recognized membership in the Ten-Hundred-Thousand talent program in China at the “hundredth” level in the field
of medicine. Meanwhile, he has achieved membership as one of the 215 high-level academic
leaders in Beijing.
Research Direction: Radiology of Infectious Diseases
Prof. Li pioneers the first systematic disease spectra of legitimated 39 infectious diseases
and other 12 infectious diseases from the perspective of radiology of infectious diseases. His
contributions shed light on and improve the fundamental theories about the radiology of infectious diseases and the clinical application. In addition, his academic achievements further
enrich and advance the theoretical development of medical radiology, which paves the way for
future development of radiology of infectious diseases.

Current Positions
Director, Department of Radiology, Beijing You’an Hospital, Capital Medical University,
Beijing, China
Deputy Dean, Department of Medical Imaging and Nuclear Medicine, Capital Medical

University, Beijing, China
Chief editor, Radiology of Infectious Diseases (Elsevier platform).

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xxii

Social Affiliations
Chairman member, Specialized committee on infection affiliated to Chinese Society of
Radiology
Chinese Medical Science and Technology Award of the 3rd expert review committee
member
National Study Abroad Foundation-funded project expert review committee member
Beijing Natural Science Foundation project expert review committee member
Chairman, Chinese Association of STD/AIDS Prevention and Control
Chairman, Society of Clinical Diagnostic Imaging for AIDS
Team director, preparatory team for radiology of infectious and contagious diseases affiliated to the section of Tropical and Parasitic Diseases, Chinese Medical Association
Academic leader, specialized collaborative group for radiology of infectious diseases, affiliated to the section of Radiology, Chinese Medical Association
Committee membership, Beijing Medical Radiology Society, Chinese Medical Association
Expert membership, experts’ pool for Differential Diagnosis of Occupational Diseases in
Beijing
Director, Center for Quality Control and Supervision of Diagnostic Imaging, Fengtai
District, Beijing
Editorial board membership, Chinese Medical Journal (CMJ)
Associate editor, Practical Radiology
Editorial board membership, Journal of Clinical Hepatobiliary Diseases, Journal of
Magnetic Resonance Imaging, Chinese Journal of AIDS & STD, Beijing Medical Journal
(Infections and Research), and Journal of Hepatic Cancer

Academic Accomplishments
For 6 years, Prof. Li has directed or participated in 6 national and provincial scientific research
projects and 3 international collaborative research projects. While conducting the research projects, he has directed or contributed to 101 research papers, including 24 published in Science
Citation-Indexed journals. He also has received 17 publication fundings by the Springer and
National Natural Science and Technology Publication Foundation or the Ministry of Health, editing and publishing 12 treatises including 4 in English (5 by Springer and 1 by People’s Medical
Publishing House) and 11 in Chinese (7 by People’s Medical Publishing House, 1 by Tsinghua
University Press, 1 by Chinese Medical Science and Technology Press, and 2 by Science and
Technology Press). Of all the published treatises, 2 were published as national outstanding works
after peer-reviewing; 3 were international publications funded by China Book International (CBI)
program. Therein, within 6 months after Radiology of HIV/AIDS has been published, the global
downloads break through more than 20,000 chapters, which achieves Springer PG praise for the
work. The famous Professor Masahiro Narita from the University of Washington (American standards for infectious disease diagnosis expert of NIH) wrote a laudatory book review published in
the journal Clinical Infectious Diseases (IF: 9.416, 2014;59(12):1811), which helps Prof. Li earn
the academic status in the field of diagnostic radiology in China. In 2006, Prof. Li won the second
prize for Science and Technology Progress Award issued by the national ministry or provincial
government as the director of the research projects. In 2007, he won a prize for Science and
Technology Progress issued by the national ministry or provincial government as the leading contributor of the research project. In 2011, he won the second prize for the Chinese Medical Science
and Technology Award as the leading contributor. In 2012, he won the second prize for Beijing
Science and Technology Progress as the leading contributor. In 2013, he won the first prize for
Science and Technology Progress issued by the national ministry or provincial government as the
leading contributor. In 2013, he won the third prize for the Chinese Medical Science and
Technology Award as the leading contributor. In 2014, he won the third prize for Guangdong
Province Science and Technology Progress as the leading contributor.

Author Biography


Part I
Radiology of Bacterial Infections

Anthrax

1

Dongli Shi and Hongjun Li

Anthrax, induced by Bacillus anthracis, is an acute infectious zoonotic disease. It occurs primarily due to contact of
the bacterial spores in soil by herbivores, which causes skin
ulceration, eschar, extensive surrounding tissue edema, and
toxemia. And in some cases, even gastrointestinal anthrax,
pulmonary anthrax, or meningeal anthrax occur, all of which
can be complicated by septicemia.

1.1

Etiology

Bacillus anthracis is the pathogenic bacterium of anthrax in
both humans and animals. It is the largest Gram-positive
bacillus, with a length of 1–3 μm and a width of 5–10 μm
with flat ends. The bacillus is characterized by its bamboolike appearance arrayed in short chains, with no flagella and
no motion. In environmental conditions of sufficient oxygen
and appropriate temperature, spores can be formed that are
about 1 μm in size and ovoid in shape, with extremely strong
vitality. Bacillus anthracis can develop into capsules in bodies of both human and animals, which is characteristic of the
Bacillus anthracis strain. The antigen of Bacillus anthracis
can be divided into two parts, one as structural antigen and
the other as anthrax toxin complex. There are at least four
types of antigens in Bacillus anthracis including (1) capsular

polypeptide antigens (CPA), which, in combination with capsule, are anti-phagocytic and are related to the bacterial toxicity; (2) somatic polysaccharide antigens (SPA), which are not
related to the bacterial toxicity but are heat and decay tolerated and produce precipitation with corresponding antibodies, known as Ascoli reaction; (3) spore antigen (SA), which
is a specific antigen and has value for serological diagnosis;
and (4) protective antigens (PA), which are formed during the

D. Shi • H. Li (*)
Department of Radiology, Beijing You’an Hospital,
Capital Medical University, Beijing, China
e-mail:

growth of the bacillus and are anti-phagocytic with favorable
immunogenicity. Anthrax toxin is a complex comprised of
three different proteins, namely, PA, lethal factor (LF), and
edema factor (EF). LF or EF, when existing alone, is not bioactive. However, its combination with PA produces tissue
edema and death of laboratory animals. Anthrax toxin is antiphagocytic with immunogenicity. Bacillus anthracis, as an
aerobic or facultative anaerobic bacillus, multiplies in common culture media, and the optimal temperature for its reproduction is 37 °C. On common agar plates, rough colonies in
size of 2–4 mm can be found. But on blood agar plates, there
is no hemolysis but mucous fluid in colonies. On broth culture
media, thread-like sedimentation occurs.

1.2

Epidemiology

1.2.1

Source of Infection

The main source of infection is the infected herbivores such
as cows, horses, sheep, and camels. Sometimes, pigs and

dogs are also the source of infection. They might develop
anthrax after eating foods contaminated by the bacteria.
Direct or indirect contacts to their secretions and excretions
by human can cause the infection. However, its transmission
from person to person rarely occurs.

1.2.2

Routes of Transmission

1.2.2.1 Contact
Contact is the most common route of transmission. The
direct contact of the wound to the bacteria can cause the disease. The contact to contaminated animal by-products, soil,
and utensils can also cause the disease.

1.2.2.2 Inhalation
Inhalation of dusts and droplets carrying Bacillus anthracis
can also cause the disease.

© Springer Science+Business Media Dordrecht and People’s Medical Publishing House 2015
H. Li (ed.), Radiology of Infectious Diseases: Volume 2, DOI 10.1007/978-94-017-9876-1_1

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