Bacterial Infections of Humans: Epidemiology and Control

Description

In Memoriam of Alfred S. Evans The third edition of Bacterial Infections of Humans is dedicated to Alfred Spring Evans, who died on January 21, 1996, 2 ½ years after a diagnosis of cancer. Al was the senior editor of this textbook, which he founded with Harry Feldman in 1982. Al was a clinician, epidemiologist, educator, ca- lyst for biomedical research, historian, author, speaker, seeker of the truth, sincere friend of students, sports enthusiast, traveler, and truly a man of all seasons. He was a devoted husband to Brigette Klug Evans, father of three children, and grandfather of four. Al was born in Buffalo, New York, on August 21, 1917, to Ellen Spring and John H. Evans, M. D. , one of the United States’s ?rst anesthesiologists and an early researcher in the ?eld of oxygen therapy. He received his undergraduate training at the University of Michigan; was awarded an M. D. degree in 1943 from the University of Buffalo; interned in Pittsburgh, Pe- sylvania; and performed his medical residency at the Goldwater Hospital in New York City. He was in the United States Army from 1944 to 1946, assigned as a public health of?cer to a base in Okinawa, Japan. It was there that he met Drs. Albert Sabin and John R. Paul, who came to Okinawa to test a new Japanese encepha- tis vaccine. Al was invited by Dr. Paul to come to Yale Alfred S. Cover Bacterial Infections of Humans, 4th Edition (Springer, 2009) ISBN 978-0-387-09842-5 Contributors Biographical Sketch – Elias Abrutyn Preface Contents Chapter 1 Epidemiological Concepts 1.1 Introduction 1.2 Definitions and Methods 2.1. Definitions 2.2. Methods 2.2.0. Types of Epidemiological Studies. 2.2.1. Experimental Epidemiology. 2.2.2. Serological Epidemiology. 1.3 Epidemics and Their Investigation 3.1. Pathogenesis of an Outbreak 3.2. Investigation of an Outbreak 3.2.0. Determination of the Presence of an Epidemic. 3.2.1. Determination of the Circumstances Under Which the Outbreak Occurred. 3.3. Example of Investigating a Foodborne Outbreak 1.4 Agent 4.1. Characteristics of Organisms That are Involved in Spread Through the Environment 4.2. Characteristics of Organisms That are Involved in Production of Infection 4.3. Characteristics of Organisms That are Involved in Production of Disease 1.5 Environment 1.6 Host 1.7 Routes of Transmission 7.1. Respiratory or Airborne 7.2. Contact 7.3. Genital or Sexually Transmitted 7.4. Gastrointestinal or Fecal--Oral 7.5. Urinary 7.6. Perinatal 7.7. Insect Vectors 1.8 Pathogenesis 8.1. Localized or Superficial Infections 8.2. Systemic Infections 1.9 Incubation Period 1.10 Immune Response 10.1. Nonspecific Immunity 10.2. Humoral Immunity 10.3. Cell-Mediated Immunity 10.4. Cellular Interaction in Immune Responses 10.5. The Generation of Diversity in Antigen Recognition 1.11 Patterns of Host Response 11.1. Biological Gradient 11.2. Clinical Syndromes 11.2.0. Infections of the CNS. 11.2.1. Acute Respiratory Infections. 11.2.2. Acute Otitis Media. 11.2.3. Intestinal Infections and Intoxications. 11.2.4. Acute Urinary Tract Infections. 11.2.5. Sexually Transmitted Diseases. 11.2.6. Hospital (Nosocomial) Infections. 1.12 Diagnosis of Bacterial Infections 12.1. Collection of Specimens 12.2. Requests for Testing 12.3. Tests Employed 12.4. Interpretation of Tests 1.13 Proof of Causation 1.14 Control and Prevention 14.1. Environmental Control 14.1.0. Air. 14.1.1. Water. 14.1.2. Sewage and Garbage. 14.1.3. Milk and Food. 14.1.4. Animals and Insect Vectors. 14.2. Host Factors 14.2.0. Quarantine and Isolation. 14.2.1. Hygiene. 14.2.2. Immunization. 14.2.3. Antibiotic Prophylaxis. Chapter 2 Public Health Surveillance 2.1 Introduction 2.2 History 2.3 Use of Surveillance 2.4 Data Sources 4.1. Mortality Data 4.2. Morbidity Data 4.3. Individual Case Reports 4.4. Epidemic Reporting 4.5. Epidemic Field Investigation 4.6. Laboratory Reporting 4.7. Hospital Reporting 4.8. Surveys 4.9. Animal Reservoir and Vector Distribution 4.10. Biologics and Drug Distribution 4.11. Demographic and Environmental Data 4.12. News Media 2.5 Routine Surveillance 2.6 Reporting 6.1. Motivation 6.2. Ease of Reporting 6.3. Case Definition 6.4. Passive Reporting 6.5. Active Reporting 6.6. Sentinel Physician Reporting 6.7. Laboratory Surveillance 6.8. Hospital Surveillance 6.9. Absenteeism Surveillance 6.10. Syndromic Surveillance 2.7 Special Surveillance 7.1. Influenza 7.2. Gastroenteritis 7.3. GuillainéBarré Syndrome 7.4. Reye's Syndrome 7.5. Infant Botulism 7.6. Legionnaires' Disease 7.7. Hospital Infections 7.8. Arbovirus Diseases 7.9. High-Risk Population 7.10. Emerging Infections 7.11. Serosurveillance 2.8 Data Analysis 8.1. Frequency of Review 8.2. Time 8.3. Place 8.4. Person 2.9 Reports 2.10 Evaluation 2.11 Limitations of Surveillance Chapter 3 Molecular Epidemiology 3.1 Introduction 3.2 Definitions 3.3 Methodology 3.1. Phenotyping Methods 3.1.0. Differentiation by Growth and Morphologic Characteristics. 3.1.1. Typing Based on Biochemical Characteristics. 3.1.2. Typing by Serologic Characteristics. 3.1.3. Typing by Functional or Physiologic Characteristics . 3.2. Genotyping Methods 3.2.0. Extrachromosomal DNA Genotyping Methods. 3.2.1. Genome-Based Typing Methods. 3.2.2. Restriction Endonuclease Analysis (REA). 3.2.3. Southern Blot Hybridization. 3.2.4. Pulsed Field Gel Electrophoresis (PFGE). 3.2.5. Whole-Genome Sequence Comparison. 3.2.6. Microarray Comparisons. 3.2.7. PCR-Based Genotyping Methods. 3.2.8. Overview of PCR. 3.2.9. PCR-Based Strain Typing Methods. 3.2.10. PCR Typing Methods Based on Sequence Polymorphism in the Whole Genome. 3.2.11. PCR-Restriction Enzyme Analysis. 3.2.12. PCR Typing Methods Based on DNA Repetitive Elements. 3.2.13. Insertion Sequence (IS)-Based PCR. 3.2.14. Multilocus Sequence Typing (MLST). 3.4 Epidemiologic Problems Addressed by Genotyping Techniques 4.1. Studying Dynamics of Disease Transmission in Geographically Widespread Areas 4.2. Identifying and Quantitating Risk in Sporadic Occurrence of Infectious Diseases 4.3. Stratifying Data to Refine Epidemiologic Study Designs 4.4. Distinguishing Pathovars from Nonpathovars 4.5. Addressing Hospital and Institutional Infectious Disease Problems 4.6. Identifying Genetic Determinants of Disease Transmission 3.5 Summary Chapter 4 The Epidemiology of Bacterial Resistance to Antimicrobial Agents 4.1 Introduction 4.2 Historical Background 2.1. Importance of Changes in Resistance Epidemiology 4.3 Mechanisms of Resistance 3.1. Intrinsic Resistance 3.2. Acquired Resistance 3.3. Molecular Mechanisms 3.4. Epidemiologic Pathways 3.4.0. Introduction from Outside. 3.4.1. Exchange of Resistance Determinants. 3.4.2. Emergence or Selection. 3.4.3. Clonal Dissemination. 3.4.4. Combinations of Pathways. 3.5. Examples of Resistance Mechanisms for Various Classes of Antimicrobial Agents 3.5.0. -Lactam Agents. 3.5.1. Macrolides, Azalides, Lincosamides, and Streptogramins. 3.5.2. Aminoglycosides. 3.5.3. Tetracycline. 3.5.4. Trimethoprim and Sulfonamides. 3.5.5. Glycopeptides. 3.5.6. Fluoroquinolones. 3.5.7. Oxalidinones. 3.6. Key Factors in the Development of Resistant Microorganisms 3.6.0. Selection of Resistant Mutations. 3.6.1. Genetic Exchange Among Bacteria. 3.6.2. Selective Pressure Arising from Antimicrobial Use. 3.7. Mechanisms of Gene Dissemination 4.4 Epidemiology of Antimicrobial Resistance 4.1. Resistance in Health Care Contrasted with Community Settings 4.2. New Challenges Related to Resistance Epidemiology 4.2.0. Alteration of Antimicrobial Use Patterns. 4.2.1. Interference with Effective Treatment. 4.2.2. Complexity of Diagnosis. 4.2.3. Altering Requirements for Surveillance. 4.5 Organisms of Special Importance 5.1. Health-Care-Associated Pathogens 5.2. Community-Acquired Pathogens 4.6 Unresolved Problems Chapter 5 Anthrax 5.1 Introduction 5.2 Historical Background 5.3 Methodology 3.1. Sources of Mortality and Morbidity Data 3.2. Surveys 3.3. Laboratory Diagnosis 3.3.0. Isolation and Identification 3.3.1. Serological and Immunologic Diagnostic Methods. 3.3.2. Pathology. 5.4 Biological Characteristics of the Organism 5.5 Descriptive Epidemiology 5.1. Prevalence and Incidence 5.2. Epidemic Behavior and Contagiousness 5.3. Geographic Distribution 5.4. Temporal Distribution 5.5. Age 5.6. Sex 5.7. Race 5.8. Occupation 5.9. Cases Related to Commercial Products 5.10. Socioeconomic and Other Factors 5.6 Mechanisms and Routes of Transmission 5.7 Pathogenesis and Immunity 7.1. Pathogenesis 7.1.0. Cutaneous Anthrax. 7.1.1. Inhalational Anthrax. 7.1.2. Gastrointestinal Anthrax. 7.2. Immunity 5.8 Patterns of Host Responses 8.1. Clinical Features 8.1.0. Cutaneous Anthrax. 8.1.1. Inhalational Anthrax. 8.1.2. Gastrointestinal Anthrax. 8.1.3. Other Forms. 8.2. Diagnosis 5.9 Control and Prevention 9.1. General Concepts 9.2. Antibiotic Prophylaxis and Chemotherapeutics 9.3. Immunization 9.4. Immune Serum 5.10 Unresolved Problems Chapter 6 Bacterial Foodborne Disease 6.1 Introduction 6.2 Historical Background 6.3 Foodborne Disease Outbreak Surveillance 3.1. Surveillance of Sporadic Diarrheal Illness 6.4 Etiologic Patterns 6.5 Staphylococcus aureus 5.1. Historical Background 5.2. Microbiology 5.2.0. Biological Characteristics of the Organism. 5.2.1. Laboratory Diagnosis. 5.3. Descriptive Epidemiology 5.3.0. Prevalence and Incidence. 5.3.1. Epidemic Behavior and Contagiousness. 5.3.2. Geographic Distribution. 5.3.3. Temporal Distribution. 5.3.4. Age, Gender, Race, and Occupation. 5.3.5. Occurrence in Different Settings. 5.3.6. Foods Implicated in Outbreaks. 5.4. Mechanisms and Routes of Transmission 5.5. Pathogenesis and Immunity 5.5.0. Pathogenesis. 5.5.1. Immunity. 5.6. Patterns of Host Response 5.6.0. Clinical Features. 5.6.1. Diagnosis. 6.6 Bacillus cereus 6.1. Historical Background 6.2. Microbiology 6.2.0. Biological Characteristics of the Organism. 6.2.1. Laboratory Diagnosis. 6.3. Descriptive Epidemiology 6.3.0. Prevalence and Incidence. 6.3.1. Epidemic Behavior and Contagiousness. 6.3.2. Geographic, Temporal, Age, Gender, Racial, and Occupational Distribution. 6.3.3. Occurrence in Different Settings. 6.3.4. Other Factors. 6.4. Mechanisms and Routes of Transmission 6.5. Pathogenesis and Immunity 6.5.0. Pathogenesis. 6.5.1. Immunity. 6.6. Patterns of Host Response 6.6.0. Clinical Features. 6.6.1. Diagnosis. 6.7 Clostridium perfringens 7.1. Historical Background 7.2. Microbiology 7.2.0. Biological Characteristics of the Organism. 7.2.1. Laboratory Diagnosis. 7.3. Descriptive Epidemiology 7.3.0. Prevalence and Incidence. 7.3.1. Epidemic Behavior and Contagiousness. 7.3.2. Geographic, Age, Gender, Racial, and Occupational Distribution. 7.3.3. Temporal Distribution. 7.3.4. Occurrence in Different Settings. 7.3.5. Nutritional Factors. 7.4. Mechanisms and Routes of Transmission 7.5. Pathogenesis and Immunity 7.5.0. Pathogenesis. 7.5.1. Immunity. 7.6. Patterns of Host Response 7.6.0. Clinical Features. 7.6.1. Diagnosis. 7.7. Enteritis Necroticans 6.8 Noncholera Vibrio Species 8.1. Historical Background 8.2. Microbiology 8.2.0. Biological Characteristics of the Organisms. 8.2.1. Laboratory Diagnosis. 8.3. Descriptive Epidemiology 8.3.0. Prevalence and Incidence. 8.3.1. Epidemic Behavior and Contagiousness. 8.3.2. Geographic and Temporal Distribution. 8.3.3. Age, Gender, Race, and Other Host Factors. 8.4. Mechanisms and Routes of Transmission 8.5. Pathogenesis and Immunity 8.5.0. Pathogenesis 8.5.1. Immunity. 8.6. Patterns of Host Response 8.6.0. Nonepidemic V. cholerae . 8.6.1. V. parahaemolyticus. 8.6.2. Other Pathogenic Vibrio Species. 6.9 Aeromonas Species 9.1. History 9.2. Microbiology 9.2.0. Biological Characteristics of the Organism. 9.2.1. Laboratory Diagnosis. 9.3. Descriptive Epidemiology 9.4. Mechanisms and Routes of Transmission 9.5. Pathogenesis and Immunity 9.6. Patterns of Host Response 6.10 Plesiomonas 10.1. History 10.2. Microbiology 10.2.0. Biological Characteristics of the Organism. 10.2.1. Laboratory Diagnosis. 10.3. Descriptive Epidemiology 10.4. Mechanisms and Routes of Transmission 10.5. Pathogenesis and Immunity 10.6. Patterns of Host Response 6.11 Control and Prevention 11.1. General Concepts 11.1.0. Food Safety Regulation in the United States. 11.1.1. Methods to Further Reduce Foodborne Bacterial Disease 11.2. Antibiotics and Chemotherapeutics 11.3. Immunizations 6.12 Unresolved Problems Chapter 7 Botulism 7.1 Introduction 7.2 Historical Background 7.3 Methodology 3.1. Sources of Mortality and Morbidity Data 3.2. Laboratory Confirmation 7.4 Biological Characteristics of the Organism 7.5 Descriptive Epidemiology 5.1. Foodborne Botulism 5.2. Infant Botulism 5.3. Wound Botulism 5.4. Child or Adult Botulism from Intestinal Colonization 5.5. Iatrogenic Botulism 7.6 Mechanisms and Routes of Transmission 6.1. Foodborne Botulism 6.2. Infant, Wound, and Child or Adult Botulism from Intestinal Colonization 7.7 Pathogenesis and Immunity 7.8 Patterns of Host Response 8.1. Clinical Features 8.2. Diagnosis 7.9 Prevention, Control, and Treatment 9.1. Prevention and Control 9.2. Treatment 7.10 Bioterrorism 7.11 Unresolved Problems Chapter 8 Brucellosis 8.1 Introduction 8.2 Historical Background 8.3 Methodology 3.1. Sources of Data 3.2. Surveys 3.3. Laboratory Diagnosis 3.3.0. Isolation and Identification of the Organism. 3.3.1. Serological and Immunological Tests. 8.4 Biological Characteristics of the Organism 8.5 Descriptive Epidemiology 5.1. Prevalence and Incidence 5.1.0. High-Risk Categories. 5.2. Epidemic Behavior and Contagiousness 5.3. Geographic Distribution 5.4. Temporal Distribution 5.5. Age and Sex Distribution 5.6. Brucellosis During Pregnancy 5.7. Innate Immunity 8.6 Mechanisms and Routes of Infection 6.1. Brucellosis in Wildlife 8.7 Pathogenesis and Immunity 8.8 Patterns of Host Response 8.1. Clinical Features 8.2. Diagnosis 8.9 Control and Prevention 9.1. General Concepts 9.2. Chemotherapy and Prophylaxis 9.3. Immunization 8.10 Unresolved Problems Chapter 9 Campylobacter Infections 9.1 Introduction 9.2 Historical Background 9.3 Methodology 3.1. Sources of Mortality Data 3.2. Sources of Morbidity Data 3.3. Serological Surveys 3.4. Laboratory Diagnosis 9.4 Proof of Causation and Biological Characteristics of the Organism that Affect the Epidemiological Pattern 9.5 Descriptive Epidemiology 5.1. Prevalence and Incidence 5.2. Epidemic Behavior 5.3. Geographic Distribution 5.4. Temporal Distribution 5.5. Age and Sex 5.6. Occupation 5.7. Other Factors 5.8. Atypical Campylobacter Species 9.6 Mechanisms and Routes of Transmission 9.7 Pathogenesis and Immunity 9.8 Patterns of Host Response 8.1. Clinical Features 8.2. Diagnosis 9.9 Control and Prevention 9.10 Unresolved Problems Chapter 10 Chancroid 10.1 Introduction 10.2 Historical Background 10.3 Methodology 3.1. Sources of Morbidity and Mortality Data 3.2. Surveys 10.4 Etiologic Patterns 10.5 Descriptive Epidemiology 5.1. Prevalence and Incidence 5.2. The Roles of Race and Gender in Chancroid 10.6 Mechanisms and Routes of Transmission 10.7 Pathogenesis and Immunity 7.1. Pathogenesis 7.2. Immunity 10.8 Patterns of Host Response 8.1. Clinical Features 8.2. Diagnosis 10.9 Prevention, Control, and Treatment 9.1. Prevention and Control 9.2. Treatment 10.10 Unresolved Problems Chapter 11 Chlamydial Infections 11.1 Introduction 11.2 Historical Background Historical Background 11.3 Methodology Methodology 3.1. Sources of Mortality Data Sources of Mortality Data 3.2. Sources of Morbidity Data Sources of Morbidity Data 3.3. Surveys Surveys 3.4. Laboratory Diagnosis Laboratory Diagnosis 3.4.0. Cytological Identification. 3.4.1. Isolation 3.4.2. Antigen and Nucleic Acid Probes. 3.4.3. Serological and Immunological Diagnostic Methods. 11.4 Biological Characteristics of the Organism Biological Characteristics of the Organism 11.5 Descriptive Epidemiology Descriptive Epidemiology 5.1. Trachoma Trachoma 5.1.0. Prevalence and Incidence. 5.1.1. Epidemic Behavior and Contagiousness. 5.1.2. Geographic Distribution. 5.1.3. Temporal Distribution. 5.1.4. Age. 5.1.5. Sex. 5.1.6. Race. 5.1.7. Occupation. 5.1.8. Socioeconomic Factors. 5.1.9. Other Factors. 5.2. Oculogenital Diseases Oculogenital Diseases 5.2.0. Prevalence and Incidence. 5.2.1. Epidemic Behavior and Contagiousness. 5.2.2. Geographic Distribution. 5.2.3. Temporal Distribution. 5.2.4. Age, Sex, Race, Occupation, Occurrence in Different Settings, Socioeconomic Factors, and Other Factors. 5.3. Lymphogranuloma Venereum Lymphogranuloma Venereum 5.3.0. Prevalence and Incidence. 5.3.1. Epidemic Behavior and Contagiousness. 5.3.2. Geographic Distribution. 5.3.3. Temporal Distribution. 5.3.4. Age and Sex. 5.3.5. Race. 5.3.6. Other Factors. 5.4. Psittacosis Psittacosis 5.4.0. Prevalence and Incidence. 5.4.1. Epidemic Behavior and Contagiousness. 5.4.2. Geographic Distribution. 5.4.3. Temporal Distribution. 5.4.4. Age, Sex, Race, and Occupation. 5.4.5. Socioeconomic Factors. 5.5. Chlamydia pneumoniae Infections C. pneumoniae Infections 5.5.0. Prevalence and Incidence. 5.5.1. Epidemic Behavior and Contagiousness. 5.5.2. Geographic Distribution. 5.5.3. Temporal Distribution. 5.5.4. Age and Sex. 5.5.5. Race, Occupation, Occurrence in Different Settings, and Socioeconomic Factors. 11.6 Mechanism and Routes of Transmission Mechanisms and Routes of Transmission 6.1. Trachoma Trachoma 6.2. Oculogenital Diseases Oculogenital Diseases 6.3. Lymphogranuloma Venereum Lymphogranuloma Venereum 6.4. Psittacosis Psittacosis 6.5. Chlamydia pneumoniae Infections C. pneumoniae Infections C. pneumoniae Infections 11.7 Pathogenesis and Immunity Pathogenesis and Immunity 7.1. Trachoma Trachoma 7.2. Oculogenital Diseases Oculogenital Diseases 7.3. Lymphogranuloma Venereum Lymphogranuloma Venereum 7.4. Psittacosis Psittacosis 7.5. Chlamydia pneumoniae Infections C. pneumoniae Infections C. pneumoniae Infections 11.8 Patterns of Host Response Patterns of Host Response 8.1. Trachoma Trachoma 8.1.0. Clinical Features. 8.1.1. Diagnosis. 8.2. Oculogenital Diseases 8.2.0. Clinical Features (see Table 1 ) 8.2.1. Diagnosis. 8.3. Lymphogranuloma Venereum Lymphogranuloma Venereum 8.3.0. Clinical Features. 8.3.1. Diagnosis. 8.4. Psittacosis Psittacosis 8.4.0. Clinical Features. 8.4.1. Diagnosis. 8.5. Chlamydia pneumoniae Infections C. pneumoniae Infections 8.5.0. Clinical Features. 8.5.1. Diagnosis. 11.9 Control and Prevention Control and Prevention 9.1. Trachoma Trachoma 9.1.0. General Concepts. 9.1.1. Antibiotic and Chemotherapeutic Approaches. 9.1.2. Immunization. 9.2. Oculogenital Diseases Oculogenital Diseases 9.2.0. General Concepts. 9.2.1. Prophylaxis. 9.2.2. Immunization. 9.3. Lymphogranuloma Venereum Lymphogranuloma Venereum 9.3.0. General Concepts. 9.3.1. Prophylaxis and Immunization. 9.4. Psittacosis Psittacosis 9.4.0. General Concepts. 9.4.1. Prophylaxis and Immunization. 11.10 Unresolved Problems Unresolved Problems 10.1. Trachoma Trachoma 10.2. Oculogenital Diseases Oculogenital Diseases 10.2.0. Epidemiology and Disease Spectrum. 10.2.1. Diagnostic Tests. 10.2.2. Host Response. 10.2.3. Control. 10.3. Lymphogranuloma Venereum Lymphogranuloma Venereum 10.4. Psittacosis Psittacosis 10.5. Chlamydia pneumoniae Infections C. pneumoniae Infections Chapter 12 Cholera 12.1 Introduction 12.2 Historical Background 12.3 Methodology 3.1. Sources of Mortality Data 3.2. Sources of Morbidity Data 3.3. Surveys 3.4. Laboratory Diagnosis 3.4.0. Isolation and Identification of the Organism. 3.4.1. Serological and Immunologic Diagnostic Methods. 12.4 Biological Characteristics of the Organism 12.5 Descriptive Epidemiology 5.1. Prevalence and Incidence 5.2. Epidemic Behavior and Contagiousness 5.3. Geographic Distribution 5.4. Temporal Distribution 5.5. Age 5.6. Sex 5.7. Race 5.8. Occupation 5.9. Occurrence in Different Settings 5.10. Socioeconomic Factors 5.11. Other Factors 12.6 Mechanism and Routes of Transmission 12.7 Pathogenesis and Immunity 12.8 Patterns of Host Response 8.1. Clinical Features 8.2. Diagnosis 12.9 Control and Prevention 9.1. General Concepts 9.2. Antibiotic and Chemotherapeutic Approaches to Chemoprophylaxis 9.3. Immunization 12.10 Unresolved Problems Chapter 13 Clostridium difficile 13.1 Introduction 13.2 Historical Background 13.3 Methodology 3.1. Sources of Mortality Data 3.2. Sources of Morbidity Data 3.3. Surveys 3.4. Laboratory Diagnosis 3.4.0. Toxin Detection. 3.4.1. Organism Detection. 3.4.2. Detection of Pseudomembranous Colitis. 3.4.3. Pathology. 13.4 Biological Characteristics of the Organism (Etiologic Patterns) 13.5 Descriptive Epidemiology 5.1. Prevalence and Incidence 5.2. Epidemic Behavior and Contagiousness 5.3. Geographic Distribution 5.4. Temporal Distribution 5.5. Age 5.6. Gender 5.7. Race 5.8. Occupation 13.6 Mechanisms and Routes of Transmission 13.7 Pathogenesis and Immunity 13.8 Patterns of Host Response 8.1. Clinical Features 8.2. Diagnosis 13.9 Control and Prevention 9.1. General Concepts 9.2. Prophylaxis 9.3. Immunizations 13.10 Unresolved Problems 10.1. Epidemiology 10.2. Control and Prevention Chapter 14 Diphtheria 14.1 Introduction 14.2 Historical Background 14.3 Methodology 3.1. Sources of Morbidity and Mortality Data 3.2. Surveys 3.3. Laboratory Diagnosis 3.3.0. Isolation and Identification of the Organism. 3.3.1. Serological and Immunologic Diagnostic Methods. 14.4 Biological Characteristics of the Organism 14.5 Descriptive Epidemiology 5.1. Prevalence and Incidence 5.2. Epidemic Behavior and Contagiousness 5.3. Geographic Distribution 5.4. Temporal Distribution 5.5. Age 5.6. Sex 5.7. Race 5.8. Occupation 5.9. Occurrence in Different Settings 5.10. Socioeconomic Factors 14.6 Mechanism and Routes of Transmission 14.7 Pathogenesis and Immunity 14.8 Patterns of Host Response 8.1. Clinical Features 8.1.0. Carrier State. 8.1.1. Respiratory Diphtheria. 8.1.2. Cutaneous Diphtheria. 8.1.3. Other Sites. 8.1.4. Invasive Disease. 8.2. Diagnosis 8.3. Treatment 14.9 Control and Prevention 9.1. General Concepts 9.2. Antibiotic and Chemotherapeutic Approaches to Prophylaxis 9.3. Immunization 14.10 Unresolved Problems Chapter 15 Escherichia coli Diarrhea 15.1 Introduction 15.2 Historical Background 15.3 Methodology 3.1. Sources of Mortality Data 3.2. Sources of Morbidity Data 3.3. Surveys 3.4. Laboratory Diagnosis 3.4.0. Isolation and Identification of Organisms. 15.4 Biological Characteristics of the Organisms 15.5 Descriptive Epidemiology 5.1. Prevalence and Incidence 5.2. Epidemic Behavior and Contagiousness 5.3. Geographic Distribution 5.4. Temporal Distribution 5.5. Age 5.6. Sex 5.7. Race 5.8. Occupation 5.9. Occurrence in Different Settings 5.10. Socioeconomic Factors 15.6 Mechanisms, Routes of Transmission and Reservoirs 15.7 Pathogenesis and Immunity 15.8 Patterns of Host Response 8.1. Clinical Features 8.2. Diagnosis 15.9 Control and Prevention 9.1. General Concepts 9.2. Antibiotic and Chemotherapeutic Approaches to Prophylaxis 9.3. Immunization 15.10 Unresolved Problems Chapter 16 Gonococcal Infections 16.1 Introduction 16.2 Historical Background 16.3 Methodology 3.1. Sources of Mortality Data 3.2. Sources of Morbidity Data 3.3. Surveys 3.4. Laboratory Diagnosis 3.4.0. Isolation of the Organism. 3.4.1. Immunologic and Molecular Diagnostic Methods. 16.4 Biological Characteristics of the Organism 16.5 Descriptive Epidemiology 5.1. Prevalence and Incidence 5.2. Epidemic Behavior and Contagiousness 5.3. Geographic Distribution 5.4. Temporal Distribution 5.5. Age and Sex 5.6. Race 5.7. Occupational and Socioeconomic Factors 5.8. Homosexuality 5.9. Gonorrhea and HIV 5.10. Antimicrobial Resistance 5.10.0. Penicillin and Beta-Lactam Resistance. 5.10.1. Tetracycline-Resistant Gonorrhea (TRNG). 5.10.2. Fluoroquinolones and Resistance. 16.6 Mechanisms and Routes of Transmission 16.7 Pathogenesis and Immunity 7.1. Pathogenesis 7.1.0. Pathogenesis for the Male Urethra. 7.1.1. Pathogenesis for the Female Endocervix. 7.1.2. Disseminated Gonococcal Infection (DGI). 7.2. Immunity 7.2.0. Protein Antibodies. 7.2.1. Lipooligosaccharide (LOS) Antibodies. 16.8 Patterns of Host Response 8.1. Clinical Features 8.1.0. Urethritis in Men. 8.1.1. Endocervicitis. 8.1.2. Upper Genital Tract Infection and PID. 8.1.3. Anorectal Infections. 8.1.4. Pharyngeal Infection. 8.1.5. Disseminated Gonococcal Infection. 8.1.6. Gonococcal Ophthalmia. 8.1.7. Pediatric Gonorrhea. 8.2. Diagnosis 16.9 Control and Prevention 9.1. Principles of Control 9.1.0. Clinical Services. 9.1.1. Epidemiological Process. 9.1.2. Transmitters or Nontransmitters. 9.1.3. Diagnostic Screening. 9.1.4. Epidemiological Treatment. 9.1.5. Health Education. 9.1.6. Partner Management. 9.2. Macro-Level Epidemiological Approaches 9.2.0. Social Networks. 9.3. Personal Prophylaxis 9.4. Possibilities of Immunization 16.10 Unresolved Problems Chapter 17 Haemophilus influenzae 17.1 Introduction 17.2 Historical Background 17.3 Methodology 3.1. Epidemiologic Reporting 3.2. H. influenzae Typing Methods 3.2.0. Phenotype-Based Typing Methods 3.2.1. Molecular-Based Genotyping Methods. 3.3. Laboratory Diagnosis of H. influenzae Infection 3.3.0. Culture. 3.3.1. Identification of H. influenzae . 3.3.2. Antigen Detection. 3.3.3. Polymerase Chain Reaction (PCR). 3.3.4. Serology. 17.4 Biological Characteristics of H. influenzae 4.1. Growth Requirements 4.2. Natural Competency 4.3. Genetic Variability 4.3.0. Genome Sequence. 4.3.1. Mechanisms of Genetic Diversity. 4.4. Antibiotic Resistance 17.5 Descriptive Epidemiology 5.1. Epidemiology of Infections Caused by Type b H. influenzae (Hib) 5.1.0. Classical Hib Epidemiology in Non-immune Individuals. 5.1.1. Current Hib Epidemiology, US Children. 5.1.2. Current Hib Epidemiology, US Adults. 5.1.3. Hib Epidemiology Worldwide. 5.1.4. Risk Factors for Hib Infections. 5.2. Epidemiology of Infections Caused by Types a, c0f H. influenzae 5.3. Epidemiology of Infections Caused by Non-typeable H. influenzae 17.6 Mechanisms and Routes of Transmission 17.7 Pathogenesis and Immunity 7.1. H. influenzae Colonization 7.1.0. Colonization with H. influenzae Type b (Hib). 7.1.1. Colonization with Non-typeable H. influenzae (NTHi). 7.1.2. H. influenzae and Biofilms. 7.2. H. influenzae Virulence Factors 7.2.0. Polysaccharide Capsule. 7.2.1. Attachment Factors. 7.2.2. Lipooligosaccharide (LOS). 7.2.3. Iron and Heme Uptake. 7.2.4. IgA Protease. 7.2.5. Other Virulence Factors. 7.3. Immunity 7.3.0. Immunity Against the Type b Capsule. 7.3.1. Immunity Against Non-capsular Antigens. 17.8 Patterns of Host Response 8.1. Infections with Typeable H. influenzae 8.1.0. Diseases Caused by Encapsulated H. influenzae . 8.1.1. Mechanisms of Disease Caused by Encapsulated H. influenzae . 8.2. Infections with Non-typeable H. influenzae (NTHi) 8.2.0. Diseases Caused by NTHi. 8.2.1. Mechanisms of Disease Caused by NTHi. 8.3. Infections Caused by Unique H. influenzae Strains 8.3.0. Conjunctival Infections. 8.3.1. Brazilian Purpuric Fever. 8.3.2. Genital Infections. 17.9 Control and Prevention of H. influenzae Infections 9.1. Prevention of Type b Infections 9.1.0. Hib Vaccines. 9.1.1. Antibiotic Prophylaxis Against Hib Infection. 9.2. Vaccines Against NTHi 17.10 Unresolved Problems Chapter 18 Helicobacter pylori 18.1 Introduction 18.2 Historical Background 18.3 Methodology 3.1. Sources of Mortality Data 3.2. Sources of Morbidity Data 3.3. Surveys 3.4. Laboratory Diagnosis 3.4.0. Isolation and Identification. 3.4.1. Other Endoscopic Methods of Diagnosis. 3.4.2. Nonendoscopic Diagnostic Tests. 18.4 Biological Characteristics of the Organism 18.5 Descriptive Epidemiology 5.1. Prevalence and Incidence 5.2. Age and Birth Cohort 5.3. Gender 5.4. Race--Ethnicity 5.5. Socioeconomic Status 18.6 Mechanisms and Routes of Transmission 6.1. Person-to-Person Transmission 6.2. Transmission from a Common Environmental Source 6.3. Iatrogenic Transmission 18.7 Pathogenesis and Immunity 18.8 Patterns of Host Response 8.1. Clinical Spectrum of Disease 8.1.0. Acute Symptomatic Gastritis. 8.1.1. Non-ulcer Dyspepsia. 8.1.2. Peptic Ulcer Disease. 8.1.3. Gastric Adenocarcinoma. 8.1.4. Gastric Lymphoma. 8.1.5. Esophageal Diseases. 8.2. Diagnosis 18.9 Control and Prevention 9.1. General Concepts 9.2. Antibiotic and Chemotherapeutic Approaches to Disease Prevention 9.3. Immunization 18.10 Unresolved Problems Chapter 19 Legionellosis 19.1 Introduction 19.2 Historical Background 19.3 Methodology 3.1. Sources of Mortality Data 3.2. Sources of Morbidity Data 3.3. Surveys 3.4. Laboratory Diagnosis 3.4.0. Isolation and Identification. 3.4.1. Serological Diagnostic Methods. 3.4.2. Urine Antigen Detection. 3.4.3. Nucleic Acid Detection. 3.4.4. Biological Characteristics of the Organism. 19.4 Descriptive Epidemiology 4.1. Incidence and Prevalence 4.2. Epidemic Behavior and Contagiousness 4.3. Geographic Distribution 4.4. Seasonal Distribution 4.5. Age 4.6. Sex 4.7. Race 4.8. Occupation 4.9. Occurrence in Special Settings 4.9.0. Health Care-Associated Infection. 4.9.1. Disease among Travelers. 4.10. Socioeconomic Factors 4.11. Other Factors 4.11.0. Cigarette Smoking. 4.11.1. Alcohol Consumption. 4.11.2. Underlying Medical Conditions. 19.5 Mechanism and Routes of Transmission 19.6 Pathogenesis and Immunity 19.7 Patterns of Host Response 7.1. Clinical Features 19.8 Control and Prevention 8.1. General Concepts 8.2. Antibiotic and Chemotherapeutic Approaches to Prophylaxis 8.3. Immunization 19.9 Unresolved Issues 9.1. Rapid Diagnostic Tests 9.2. Risk Assessment 9.3. Prevention Chapter 20 Leprosy 20.1 Introduction 20.2 Historical Background 20.3 Methodology 3.1. Sources of Data 3.1.0. Sources of Mortality Data. 3.1.1. Sources of Morbidity Data. 3.2. Surveys 3.3. Laboratory Diagnosis 3.3.0. Isolation and Identification of Organism. 3.3.1. Serological and Immunological Tests. 20.4 Biological Characteristics of the Organism 20.5 Descriptive Epidemiology 5.1. Prevalence and Incidence 5.2. Epidemic Behavior and Contagiousness 5.3. Geographic Distribution 5.4. Temporal Distribution 5.5. Age 5.6. Sex 5.7. Race 5.8. Occupation 5.9. Occurrence in Different Settings 5.10. Socioeconomic Factors 5.11. Other Factors 20.6 Mechanisms and Routes of Transmission 20.7 Pathogenesis and Immunity 20.8 Patterns of Host Response 20.9 Control and Prevention 9.1. General Concepts 9.2. Antimicrobial Chemotherapy of Leprosy 9.3. Follow-Up after Antimicrobial Therapy 9.4. Follow-Up of Contacts 9.5. Chemotherapeutic Approaches to Prophylaxis 9.6. Immunization 20.10 Unresolved Problems Chapter 21 Leptospirosis 21.1 Introduction 21.2 Historical Background 21.3 Methodology 3.1. Sources of Data 3.2. Surveys 3.3. Laboratory Diagnosis 3.3.0. Isolation and Identification of Leptospires 3.3.1. Serological Tests. 21.4 Biological Characteristics of the Organism 21.5 Descriptive Epidemiology 5.1. Prevalence and Incidence 5.2. Epidemic Behavior and Contagiousness 5.3. Geographical Distribution 5.4. Temporal Distribution 5.5. Age 5.6. Sex 5.7. Race 5.8. Occupation 5.9. Occurrence in Different Settings 5.10. Socioeconomic Factors 21.6 Mechanisms and Routes of Transmission 21.7 Pathogenesis and Immunity 7.1. Incubation Period 7.2. Virulence and Its Attributes 7.3. The Course of Events in Infection 7.3.0. Entry. 7.3.1. Spread. 7.3.2. Lesions. 7.3.3. Transplacental Spread. 7.3.4. Recovery. 7.3.5. Carrier State. 7.3.6. Autoimmunity and Hypersensitivity. 7.4. Immunity 7.4.0. Specific and Nonspecific Immunity. 7.4.1. Antibodies. 7.4.2. Antigens Related to Pathogenesis and Immunity. 7.4.3. Vaccines. 21.8 Patterns of Host Response 8.1. Clinical Features 8.1.0. Congenital Leptospirosis. 8.1.1. Clinical Laboratory Findings. 8.1.2. Prognosis. 8.1.3. Treatment. 8.2. Diagnosis 8.2.0. Clinical Diagnosis. 8.2.1. Laboratory Bacteriologic Diagnosis. 8.2.2. Differential Diagnosis. 21.9 Control and Prevention 9.1. General Concepts 9.1.0. Education, Laboratory Services, and Notification. 9.1.1. Control Measures in Animals 9.1.2. Treatment of the Carrier State. 9.1.3. Occupational Hygiene. 9.2. Antimicrobial Prophylaxis 9.3. Immunization 21.10 Unresolved Problems Chapter 22 Listeria monocytogenes Infections 22.1 Introduction 22.2 Historical Background 22.3 Methodology 3.1. Sources of Mortality Data 3.2. Sources of Morbidity Data 3.3. Surveys 3.4. Laboratory Diagnosis 3.4.0. Isolation and Identification of the Organism. 3.4.1. Serological and Immunological Diagnostic Methods. 22.4 Biological Characteristics of the Organism 22.5 Descriptive Epidemiology 5.1. Prevalence and Incidence 5.1.0. Asymptomatic Carriage. 5.1.1. Gastroenteritis. 5.1.2. Invasive Infection. 5.2. Epidemic Behavior and Contagiousness 5.3. Geographic Distribution 5.4. Temporal Distribution 5.5. Age 5.6. Sex 5.7. Race 5.8. Occupation 5.9. Occurrence in Different Settings 5.10. Socioeconomic Factors 5.11. Other Factors 22.6 Mechanisms and Routes of Transmission 22.7 Pathogenesis and Immunity 22.8 Patterns of Host Response Please note that heading level 8 and 8.1 are the same. Please check. 8.1. Patterns of Host Response 8.1.0. Non-perinatal Listeriosis. 8.1.1. Perinatal Listeriosis. 8.2. Diagnosis 8.3. Differential Diagnosis 22.9 Control and Prevention 9.1. General Concepts 9.2. Antibiotic and Chemotherapeutic Approaches to Prophylaxis and Treatment 9.3. Immunization 22.10 Unresolved Problems Chapter 23 Lyme Disease 23.1 Historical Perspective 23.2 Microbiology 23.3 Life Cycle 23.4 Epidemiology 23.5 Pathophysiology: HostPathogen Interactions 23.6 Spectrum of Disease/Clinical Manifestations 6.1. Cutaneous 6.2. Cardiac 6.3. Neurologic 6.4. Musculoskeletal 23.7 Possible New Borrelial Syndromes 23.8 Diagnosis 23.9 Special Considerations 9.1. Pregnancy 9.2. Immunosuppression 9.3. Co-infection 23.10 Prevention 23.11 Treatment 23.12 Conclusion Chapter 24 Meningococcal Infections 24.1 Introduction 24.2 Historical Background 24.3 Methodology 3.1. Sources of Mortality Data 3.2. Sources of Morbidity Data 3.3. Surveys 3.4. Laboratory Diagnosis 3.4.0. Isolation and Identification of the Organism. 3.4.1. Serological and Immunologic Diagnostic Methods. 24.4 Biological Characteristics of the Organism 4.1. Serotypes and Serogroups 4.2. Antibiotic Susceptibility 24.5 Descriptive Epidemiology 5.1. Prevalence and Incidence 5.2. Epidemic Behavior and Contagiousness 5.3. Geographic Distribution 5.4. Temporal Distribution 5.5. Age 5.6. Sex 5.7. Race 5.8. Occupation 5.9. Occurrence in Different Settings 5.10. Socioeconomic Factors 5.11. Other Factors 24.6 Mechanisms and Routes of Transmission 6.1. Secondary Attack Rate 24.7 Pathogenesis and Immunity 24.8 Patterns of Host Response 8.1. Clinical Features 8.1.0. Genetic Determinants of Meningococcal Disease: Complement Deficiency. 8.1.1. Other Genetic Determinants of Meningococcal Disease. 8.2. Diagnosis 24.9 Control and Prevention 9.1. General Concepts 9.2. Antibiotic and Chemotherapeutic Approaches to Prophylaxis: Suggestions for the Management of Outbreaks 9.3. Immunization 9.3.0. Application. 24.10 Unresolved Problems Chapter 25 Mycoplasma pneumoniae and Other Human Mycoplasmas 25.1 Introduction 25.2 Historical Background 25.3 Methodology 3.1. Clinical Diagnosis 3.2. Laboratory Diagnosis 3.2.0. Clinical Laboratory Diagnosis. 3.3. In Vitro Antibiotic Susceptibility Testing 25.4 Etiologic Patterns 4.1. M. pneumoniae Syndromes 4.1.0. Pneumonia. 4.1.1. Asthma. 4.1.2. Extrapulmonary Syndromes. 25.5 Descriptive Epidemiology 5.1. Geographic Distribution 5.2. Age Distribution 5.3. Transmission in Families 25.6 Mechanisms and Routes of Transmission 25.7 Pathogenesis and Immunity 7.1. Incubation Period 7.2. Pathogenesis 7.3. Immunity 25.8 Patterns of Host Response 8.1. Clinical Features 8.2. Diagnosis 25.9 Control and Prevention 9.1. Treatment 9.2. Vaccines 25.10 Unresolved Problems 25.11 Other Human Mycoplasmas 11.1. Background, Classification, and Disease Associations 11.2. Pathogenesis and Immunity 11.3. Transmission 11.4. Laboratory Detection 11.5. Treatment 11.6. Unresolved Problems Chapter 26 Healthcare-Acquired Bacterial Infections 26.1 Introduction 26.2 Historical Background 26.3 Methodology 3.1. Criteria for Infection 3.2. Sources of Mortality Data 3.3. Sources of Morbidity Data 3.4. Surveillance 3.4.0. Microbiological Surveys. 3.4.1. Prevalence Surveys. 3.4.2. Surveillance Studies. 3.5. Laboratory Diagnosis 3.5.0. Isolation and Identification of Organisms. 3.5.1. Evaluation of Specimens: Initial Screening. 3.5.2. In Vitro Susceptibility Testing. 3.5.3. Quality Control in the Laboratory. 3.5.4. Special Studies for Examining the Relatedness of Isolates. 26.4 Biological Characteristics of Nosocomial Organisms 4.1. Infecting Normal Flora 4.2. Antimicrobial Resistance 26.5 Descriptive Epidemiology 5.1. Prevalence and Incidence 5.1.0. Mortality Data. 5.1.1. Prevalence Studies. 5.1.2. Incidence Studies. 5.1.3. Site-Pathogen Analysis. 5.2. Epidemic Behavior and Contagiousness 5.3. Geographic Distribution 5.4. Temporal Distribution 5.5. Age 5.6. Sex 5.7. Race 5.8. Occupation 5.9. Occurrence in Different Settings 5.10. Socioeconomic Factors 5.11. Other Host Factors 5.12. Treatment Factors 5.12.0. Antibiotics. 5.12.1. Other Drugs. 5.12.2. Device- and Procedure-Related Infections. 26.6 Mechanisms and Routes of Transmission 6.1. Inanimate Reservoirs 6.1.0. Structural or Engineering Reservoirs. 6.1.1. Equipment Reservoirs. 6.2. Animate Reservoirs 26.7 Pathogenesis and Immunity 26.8 Patterns of Host Response: Clinical Features and Diagnosis 8.1. Urinary Tract Infection 8.2. Nosocomial Pneumonia 8.3. Surgical Site Infection 8.4. Bacteremia 8.5. Infection at Other Sites 26.9 Control and Prevention 9.1. General Concepts 9.1.0. Preventive Engineering. 9.1.1. Equipment Control. 9.1.2. Personnel Programs. 9.2. Special Control Programs 9.2.0. Hand Washing. 9.2.1. Standard Precautions and Isolation Control. 9.2.2. Epidemic Investigation and Control. 9.2.3. Nosocomial Urinary Tract Infection. 9.2.4. Nosocomial Surgical Site Infection. 9.2.5. Nosocomial Respiratory Infections. 9.2.6. Nosocomial Intravascular Infection. 9.2.7. Antimicrobial Prophylaxis. 9.2.8. Immunization. 9.2.9. Cellular and Transplantation Methods. 26.10 Unresolved Problems 10.1. Efficacy and Cost--Benefit Evaluation: Acute Care 10.2. Coordinated Programs 10.3. Need and Efficacy in Developing Countries 10.4. Efficacy in Nonacute Care 10.5. Public Reporting of Hospital Infections Chapter 27 Pertussis 27.1 Introduction 27.2 Historical Background 27.3 Methodology 3.1. Sources of Mortality Data 3.2. Sources of Morbidity Data 3.3. Surveys 3.4. Laboratory Diagnosis 27.4 Biological Characteristics of the Organism 27.5 Descriptive Epidemiology 5.1. Prevalence and Incidence 5.1.0. High-Risk Groups. 5.2. Epidemic Behavior and Contagiousness 5.3. Geographic Distribution 5.4. Temporal Distribution 5.5. Age 5.6. Sex 5.7. Race/Ethnicity 5.8. Other Factors 27.6 Mechanisms and Routes of Transmission 27.7 Pathogenesis and Immunity 7.1. Pathogenesis 7.2. Immunity 27.8 Patterns of Host Response 8.1. Clinical Features 8.2. Diagnosis 27.9 Control and Prevention 9.1. Isolation 9.2. Antibiotics 9.3. Passive Immunization 9.4. Active Immunization 27.10 Unresolved Problems Chapter 28 Plague 28.1 Introduction 28.2 Historical Background 28.3 Methodology 3.1. Sources of Morbidity and Mortality Data 3.2. Surveys 28.4 Biological Characteristics of the Organism 4.1. Etiologic Agent, Yersinia pestis 4.2. Virulence Factors 4.3. Geographic Biotypes 4.4. Flea Vectors 4.5. Rodent Reservoirs 28.5 Epidemiology 5.1. Occurrence of Human Plague 5.2. Contagiousness 5.3. Geographic Distribution 5.4. Environmental Factors 5.5. Demographic Factors 5.6. Occupation and Recreation 5.7. Occurrence in Different Settings 5.8. Socioeconomic Factors 28.6 Mechanisms and Routes of Transmission 28.7 Pathogenesis and Immunity 7.1. Pathogenesis 7.2. Incubation Period 7.3. Immunity 28.8 Patterns of Host Response 8.1. Clinical Features 8.2. Differential Diagnosis 8.3. Laboratory Diagnosis 8.3.0. Clinical Specimen Collection and Staining. 8.3.1. Cultural Isolation of Y. pestis . 8.3.2. Serological Diagnostic Methods. 8.3.3. Rapid Detection Tests. 8.3.4. Reference Diagnostic Testing. 8.3.5. Diagnostic Categories. 28.9 Control and Prevention 9.1. General Concepts 9.2. Antibiotic Treatment 9.3. Antibiotic Prophylaxis 9.4. Immunization 9.5. Public Health Management of the Use of Plague as a Weapon of Terrorism 28.10 Unresolved Problems Chapter 29 Pneumococcal Infections 29.1 Introduction 29.2 Historical Background 29.3 Methodology 3.1. Sources of Epidemiological Data 3.2. Surveys 3.3. Laboratory Diagnosis 3.3.0. Isolation and Identification of the Organism. 3.3.1. Serological Methods. 29.4 Biological Characteristics of the Organism 29.5 Descriptive Epidemiology 5.1. Prevalence and Incidence 5.1.0. Occurrence of Penicillin-Resistant Pneumococci. 5.1.1. Distribution of Pneumococcal Types. 5.1.2. Occurrence in Carriers. 5.2. Epidemic Behavior and Contagiousness 5.3. Geographic Distribution 5.4. Temporal Distribution 5.5. Age 5.6. Gender 5.7. Race 5.8. HIV Infection 5.9. Cigarette Smoking 5.10. Occupation 5.11. Occurrence in Families 5.12. Occurrence in Animals 5.13. Laboratory Infections 5.14. Nutrition 5.15. Alcoholism 5.16. Association with Viral Infections 29.6 Mechanisms and Routes of Transmission 29.7 Pathogenesis and Immunity 7.1. Pathogenesis 7.1.0. Virulence Factors. 7.1.1. Host Defenses. 7.2. Immunity 29.8 Patterns of Host Response 8.1. Clinical Features 29.9 Control and Prevention 9.1. Antibiotic Treatment 9.2. Prevention 9.3. Pneumococcal Polysaccharide Vaccine 9.4. Pneumococcal Conjugate Vaccines 29.10 Unresolved Problems Chapter 30 Q fever 30.1 Introduction 30.2 Historical Aspects 30.3 Methodology 3.1. Sources of Data 3.2. Surveys 3.3. Laboratory Diagnosis 30.4 Biological Characteristics of the Organism 30.5 Descriptive Epidemiology 5.1. Epidemiology of Q Fever in Selected Countries 5.1.0. United States. 5.1.1. Germany. 5.1.2. Australia Including Post Q Fever Fatigue Syndrome (QFFS). 5.1.3. France Including Age and Sex Distribution. 5.1.4. United Kingdom. 5.1.5. Q Fever in Other Countries. 5.2. Q Fever, the Military and Bioterrorism -- Including Contagiousness 5.3. Epidemiology of Q Fever at the Community Level 5.4. Q Fever in Animals 30.6 Routes of Transmission 6.1. Inhalation of Contaminated Aerosols 6.2. Oral Route 6.3. Percutaneous Route 6.4. Vertical Transmission 6.5. Person-to-Person Transmission 6.6. Sexual Transmission 30.7 Biological Characteristics of the Organism: Pathogenesis and Immunity 30.8 Patterns of Host Response 8.1. Acute Q Fever 8.1.0. A Self-Limited Febrile Illness. 8.1.1. Pneumonia. 8.1.2. Hepatitis. 8.1.3. Miscellaneous Manifestations. 8.1.4. Q Fever in Immunocompromised Host. 8.2. Chronic Q Fever 30.9 Control and Prevention 9.1. General Concepts 9.2. Chemotherapy and Prophylaxis 9.3. Immunization 30.10 Unresolved Issues Chapter 31 Rocky Mountain Spotted Fever 31.1 Introduction 31.2 Historical Background 31.3 Methodology 3.1. Sources of Mortality Data 3.2. Sources of Morbidity Data 3.3. Laboratory Diagnosis 3.3.0. Isolation and Identification of R. rickettsii . 3.3.1. Serological Tests. 31.4 Biological Characteristics of the Organism 31.5 Descriptive Epidemiology 5.1. Prevalence and Incidence 5.2. Epidemic Behavior and Contagiousness 5.3. Geographic Distribution 5.4. Temporal Distribution 5.5. Age, Sex, and Occupational Factors 31.6 Mechanisms and Routes of Transmission 31.7 Pathogenesis and Immunity 7.1. Pathogenesis 7.2. Immunity 31.8 Patterns of Host Response 8.1. Common Clinical Features 8.1.0. Fever. 8.1.1. Headache. 8.1.2. Rash. 8.1.3. Cardiovascular and Respiratory Signs. 8.1.4. Hepatic and Renal Signs. 8.1.5. Gastrointestinal Signs. 8.1.6. Neurological Signs. 8.2. Clinical Course and Complications 8.3. Diagnosis 31.9 Control and Prevention 9.1. Vector Control 9.2. Chemotherapy and Prophylaxis 9.3. Immunization 31.10 Unresolved Problems Chapter 32 Salmonellosis: Nontyphoidal 32.1 Introduction 32.2 Historical Background 32.3 Methodology 3.1. Sources of Mortality Data 3.2. Sources of Morbidity Data 3.3. Surveys and Investigations 3.4. Laboratory Diagnosis 3.4.0. Isolation and Identification. 3.4.1. Serological Diagnostic Methods. 32.4 Biological Characteristics of the Organism 4.1. Antimicrobial Resistance 32.5 Descriptive Epidemiology 5.1. Prevalence and Incidence 5.2. Epidemic Behavior and Contagiousness 5.3. Geographic Distribution 5.4. Temporal Distribution 5.5. Age and Sex 5.6. Race 5.7. Occupation 5.8. Occurrence in Different Settings 5.9. Salmonella Infections in the Compromised Host 5.10. Salmonella Infections and AIDS 32.6 Mechanisms and Routes of Transmission 32.7 Pathogenesis and Immunity 32.8 Patterns of Host Response 8.1. Clinical Features 8.2. Diagnosis 32.9 Control and Prevention 32.10 Unresolved Problems Chapter 33 Shigellosis 33.1 Introduction 33.2 Historical Background 33.3 Methodology 3.1. Sources of Mortality and Morbidity Data 3.2. Surveys 3.3. Laboratory Diagnosis, Isolation, and Identification of the Organism 33.4 Biological Characteristics of the Organism 4.1. Invasiveness and Intercellular Spread 4.1.0. Invasion. 4.1.1. Vesicle Lysis and Intracellular Multiplication. 4.1.2. Intra- and Intercellular Spread. 4.1.3. Cell Death. 4.2. Acid Resistance 4.3. Other Virulence Determinants 4.4. Toxins 4.5. Antimicrobial Resistance 33.5 Descriptive Epidemiology 5.1. Prevalence and Incidence 5.2. Epidemic Behavior 5.3. Geographic Distribution 5.4. Seasonal Transmission 5.5. Age 5.6. Gender and Sexual Practices 5.7. Race 5.8. Occupation 5.9. Occurrence in Different Settings 5.10. Socioeconomic Factors 33.6 Mechanisms and Routes of Transmission 33.7 Pathogenesis and Immunity 7.1. Pathogenesis 7.2. Immunity 33.8 Patterns of Host Response 8.1. Clinical Features 8.2. Diagnosis 33.9 Control and Prevention 9.1. General Concepts 9.2. Antibiotic and Chemotherapeutic Approaches to Prophylaxis and Treatment 9.3. Immunization 33.10 Unresolved Problems 10.1. Epidemiology 10.2. Pathogenesis 10.3. Antimicrobial Resistance 10.4. Clinical Complications 10.5. Vaccines Chapter 34 Evans' Infections of Humans: Staphylococcal Infections 34.1 Introduction 34.2 Historical Background 34.3 Methodology 3.1. Sources of Mortality Data 3.2. Sources of Morbidity Data 3.3. Surveys 3.4. Laboratory Diagnosis 34.4 Biological Characteristics of the Organism 34.5 Descriptive Epidemiology 5.1. Prevalence and Incidence 5.2. Nasal Carriage 5.3. Epidemic Behavior and Contagiousness 5.4. Geographic Distribution 5.5. Age 5.6. Sex 5.7. Race 5.8. Occupation 5.9. Socioeconomic Factors 5.10. Other Factors 34.6 Mechanisms and Routes of Transmission 34.7 Pathogenesis and Immunity 7.1. Pathogenesis 7.2. Immunity 34.8 Patterns of Host Response 8.1. Clinical Features 8.1.0. Boils, Furuncles, and Carbuncles. 8.1.1. Wound Infections. 8.1.2. Breast Infections. 8.1.3. Pneumonia. 8.1.4. Endocarditis. 8.1.5. Skin Infections. 8.1.6. Intravenous Catheter-Related Infections. 8.1.7. Bacteremia. 8.1.8. Osteomyelitis. 8.1.9. Septic Arthritis. 8.1.10. Food Poisoning. 8.1.11. Parotitis. 8.1.12. Toxic Shock Syndrome. 8.1.13. Peritonitis. 8.1.14. Urinary Tract Infection. 8.1.15. CSF Shunt Infection. 8.1.16. Pyomyositis. 8.1.17. Meningitis. 8.2. Diagnosis 34.9 Control and Prevention 34.10 Unresolved Problems Chapter 35 Streptococcal Infections 35.1 Introduction 35.2 Historical Background 35.3 Methodology 3.1. Sources of Mortality Data 3.2. Sources of Morbidity Data 3.3. Surveys 3.4. Laboratory Diagnosis 3.4.0. Isolation and Identification. 3.4.1. Serologic and Immunologic Diagnostic Methods. 35.4 Biological Characteristics of the Organisms 4.1. Cellular Antigens and Enzymes 4.1.0. Group A Streptococcal Cellular Antigens and Enzymes. 4.1.1. Group B Streptococcal Cellular Antigens and Enzymes. 4.1.2. Pneumococcal Cellular Antigens and Enzymes. 4.1.3. Components of Other Streptococci. 4.2. Antibiotic Susceptibility 35.5 Descriptive Epidemiology 5.1. Prevalence and Incidence 5.2. Epidemiology and Contagiousness 5.3. Geographic Distribution 5.4. Temporal Distribution 5.5. Age 5.6. Sex 5.7. Race and Genetic Factors 5.8. Occupation 5.9. Other Settings and Predisposing Factors 35.6 Mechanisms and Routes of Transmission 35.7 Pathogenesis and Immunity 7.1. Pathogenesis 7.2. Immunity 35.8 Patterns of Host Response 8.1. Clinical Features 35.9 Control and Prevention 9.1. General Preventive Measures 9.2. Antibiotics in Treatment and Prevention of Group A Streptococcal Disease 9.3. Surgical Approaches to Recurrent Group A Streptococcal Disease 9.4. Antibiotics in Treatment and Prevention of Endocarditis 9.5. Intrapartum Chemoprophylaxis Against Group B Streptococcal Disease 9.6. Passive Immune Prophylaxis Against Streptococcal Infections 9.7. Immunization Against Streptococcal Infections 9.8. Prevention of Dental Caries 35.10 Unresolved Problems Chapter 36 Syphilis 36.1 Introduction 36.2 Historical Aspects 2.1. Early History 2.2. Social Attitudes 2.3. Control Programs 2.4. Funding Levels and Syphilis Incidence 2.5. The National Plan to Eliminate Syphilis from the United States 36.3 Methodology 3.1. Sources of Mortality and Morbidity Data 3.2. Serological Surveys 3.3. Laboratory Diagnosis 3.3.0. Identification of the Organism. 3.3.1. Serology. 36.4 Biological Characteristics of the Organism 36.5 Descriptive Epidemiology 5.1. Prevalence and Incidence 5.2. Contagiousness 5.3. Geographic Distribution 5.4. Temporal Distribution 5.5. Age and Gender 5.6. Race 5.7. Occupation 5.8. Occurrence in High-Risk Environments 5.9. Socioeconomic Factors 36.6 Mechanisms and Routes of Transmission 36.7 Pathogenesis and Immunity 36.8 Patterns of Host Response 8.1. Clinical Features 8.1.0. Primary Stage. 8.1.1. Secondary Stage. 8.1.2. Clinical (Infectious) Secondary Relapse. 8.1.3. Late Benign Syphilis. 8.1.4. Cardiovascular Syphilis. 8.1.5. Neurosyphilis. 8.2. Diagnosis 36.9 Control and Prevention 9.1. Epidemiological Basis for Syphilis Control Activities 9.1.0. Transmission Dynamics. 9.1.1. Core Populations. 9.2. Control and Prevention 9.2.0. Screening. 9.2.1. Clinical Diagnosis as a Tool for Disease Control. 9.2.2. The Role of Treatment. 9.2.3. Partner Notification. 9.2.4. Health Education. 9.2.5. Immunization. 36.10 Unresolved Problems Chapter 37 Nonvenereal Treponematoses 37.1 Introduction 37.2 Historical Background 37.3 Methodology 3.1. Sources of Mortality Data 3.2. Sources of Morbidity Data 3.3. Surveys 3.4. Laboratory Diagnosis 3.4.0. Isolation and Identification of the Organisms. 3.4.1. Serological and Diagnostic Methods. 37.4 Biological Characteristics of the Organism 37.5 Descriptive Epidemiology 5.1. Prevalence and Incidence 5.2. Epidemic Behavior and Contagiousness 5.3. Geographic Distribution 5.4. Temporal Distribution 5.5. Age 5.6. Sex 5.7. Race 5.8. Occupation 5.9. Occurrence in Different Settings 5.10. Socioeconomic Factors 37.6 Mechanisms and Routes of Transmission 37.7 Pathogenesis and Immunity 37.8 Patterns of Host Response 8.1. Clinical Features 8.1.0. Pinta. 8.1.1. Yaws. 8.1.2. Endemic Syphilis. 8.2. Diagnosis 37.9 Control and Prevention 9.1. Antibiotic and Chemotherapeutic Approaches to Prophylaxis 9.2. Immunization 37.10 Unresolved Problems Chapter 38 Tetanus 38.1 Introduction 38.2 Historical Background 38.3 Methodology 3.1. Sources of Mortality Data 3.2. Sources of Morbidity Data 3.3. Serological Surveys 3.4. Laboratory Diagnosis 38.4 Biological Characteristics of the Organism 38.5 Descriptive Epidemiology 5.1. Prevalence and Incidence 5.2. Epidemic Behavior 5.3. Geographic Distribution 5.4. Temporal Distribution 5.5. Age 5.6. Sex 5.7. Race 5.8. Occupation and Location 5.9. Occurrence in Different Settings 5.10. Socioeconomic Factors 38.6 Mechanisms and Routes of Transmission 6.1. Children and Adults 6.2. Neonates 38.7 Pathogenesis and Immunity 7.1. Pathogenesis 7.2. Immunity 38.8 Patterns of Host Response 8.1. Clinical Features in Children and Adults 8.2. Clinical Features in Neonatal Tetanus 8.3. Diagnosis 38.9 Control and Prevention 9.1. Passive Immunization 9.2. Active Immunization 9.2.0. Production and Testing of Tetanus Toxoid. 9.2.1. Use of Tetanus Toxoid. 9.2.2. Adverse Events. 9.2.3. Wound Management. 9.3. Antimicrobials 9.4. Summary 38.10 Unresolved Problems Chapter 39 Toxic Shock Syndrome (Staphylococcal) 39.1 Introduction 39.2 Historical Background 39.3 Methodology 3.1. Sources of Mortality Data 3.2. Sources of Morbidity Data 3.3. Surveys 3.4. Laboratory Diagnosis 3.4.0. Isolation and Identification of the Organism. 3.4.1. Serological and Immunologic Diagnostic Methods. 39.4 Biological Characteristics of the Organism 39.5 Descriptive Epidemiology 5.1. Prevalence and Incidence 5.2. Epidemic Behavior and Contagiousness 5.3. Geographic Distribution 5.3.0. United States. 5.3.1. Other Countries. 5.4. Temporal Distribution 5.5. Age 5.6. Sex 5.7. Race 5.8. Occupation 5.9. Occurrence in Different Settings 5.10. Socioeconomic Factors 5.11. Other Factors 5.11.0. Menstrual TSS. 5.11.1. Postpartum TSS. 5.11.2. Postoperative TSS. 5.11.3. Other Nonmenstrual TSS. 39.6 Mechanisms and Routes of Transmission 39.7 Pathogenesis and Immunity 39.8 Patterns of Host Response 8.1. Clinical Features 8.2. Diagnosis 39.9 Control and Prevention 9.1. General Concepts 9.1.0. Menstrual TSS. 9.1.1. Postpartum TSS. 9.1.2. Hospital-Acquired TSS. 9.2. Antibiotic and Chemotherapeutic Approaches to Prophylaxis 9.3. Immunization 39.10 Unresolved Problems Chapter 40 Tuberculosis 40.1 Introduction 40.2 Historical Background 40.3 Methodology 3.1. Sources of Mortality Data 3.2. Sources of Morbidity Data 3.3. Surveys 3.4. Laboratory Diagnosis 3.4.0. Isolation and Identification of the Organism. 3.4.1. Serological and Immunologic Diagnostic Methods. 40.4 Biological Characteristics of the Organism 40.5 Descriptive Epidemiology 5.1. Prevalence and Incidence 5.1.0. Infection. 5.1.1. Disease. 5.2. Epidemic Behavior and Contagiousness 5.3. Geographic Distribution 5.4. Temporal Distribution 5.5. Age 5.6. Sex 5.7. Genetic Factors and Race 5.8. Occupation 5.9. Socioeconomic Factors 5.10. Smoking 5.11. Nutrition 5.12. Human Immunodeficiency Virus---HIV 5.13. Size of Tuberculin Reaction 40.6 Mechanisms and Routes of Transmission 40.7 Pathogenesis and Immunity 40.8 Patterns of Host Response 40.9 Control and Prevention 9.1. General Concepts 9.2. Decontamination of Air and Milk 9.3. Case-Finding and Chemotherapy 9.4. Preventive Therapy 9.5. Immunization 40.10 Unresolved Problems Chapter 41 Nontuberculous Mycobacterial Infections 41.1 Introduction 41.2 Historical Background 41.3 Methodology 3.1. Sources of Data 3.2. Laboratory Diagnosis 3.2.0. Isolation and Identification of NTM. 3.2.1. Drug Susceptibility Testing. 3.2.2. Serological and Immunologic Tests. 41.4 Biological Characteristics of the Nontuberculous Mycobacteria 41.5 Descriptive Epidemiology 5.1. Prevalence and Incidence 5.1.0. Risk Factors for Infection and Disease. 5.2. Epidemic Behavior and Contagiousness 5.3. Geographic Distribution 5.4. Temporal Distribution 5.5. Age and Sex Distribution 41.6 Mechanisms and Routes of Transmission 6.1. Nontuberculous Mycobacteria in the Environment 41.7 Pathogenesis and Immunity 41.8 Patterns of Host Response 8.1. Clinical Features 8.1.0. Pulmonary Disease. 8.1.1. Lymphadenitis. 8.1.2. Soft Tissue, Skin, and Bone Infection. 8.1.3. Disseminated Infections. 8.2. Diagnosis 8.2.0. Pulmonary Disease. 8.2.1. Lymphadenitis. 8.2.2. Soft Tissue. 8.2.3. Disseminated Disease. 41.9 Control and Prevention of NTM Infections 9.1. General Concepts 9.2. Chemotherapy 9.2.0. Chemotherapy of Pulmonary Infections. 9.2.1. Chemotherapy of Lymphadenitis. 9.2.2. Chemotherapy of Skin, Soft Tissue, and Bone/Joint Infections. 9.2.3. Chemotherapy for Disseminated Infections. 9.3. Prophylaxis of NTM Infections 9.4. Immunization 41.10 Unresolved Problems Chapter 42 Tularemia 42.1 Introduction 42.2 Historical Background 42.3 Methodology 3.1. Sources of Data 3.2. Surveys 42.4 Biological Characteristics 4.1. Bacteriology 4.2. Ecology 42.5 Descriptive Epidemiology 5.1. Prevalence and Incidence 5.2. Epidemic Behavior 5.3. Geographic Distribution 5.4. Seasonal Distribution 5.5. Age and Sex Distribution 5.6. Occupation and Recreation 5.7. Other Factors 5.8. Occurrence in Different Settings 42.6 Transmission to Humans 42.7 Pathogenesis and Immunity 7.1. Pathogenesis 7.2. Immunity 42.8 Patterns of Host Response 8.1. Clinical Features 8.2. Laboratory Diagnosis 8.2.0. Isolation and Identification of the Organism. 8.2.1. Serological and Immunological Tests. 8.3. Prognosis 42.9 Control and Prevention 9.1. General Concepts 9.2. Chemotherapeutic Approaches to Prophylaxis 9.3. Immunization 42.10 Unresolved Issues Chapter 43 Typhoid Fever 43.1 Introduction 43.2 Historical Background 43.3 Methodology 3.1. Sources of Mortality Data 3.2. Sources of Morbidity Data 3.3. Surveys 3.4. Laboratory Diagnosis 3.4.0. Isolation and Identification of the Organism. 3.4.1. Serological Diagnostic Methods. 3.4.2. Rapid Immunoassays. 43.4 Biological Characteristics of the Organism 43.5 Descriptive Epidemiology 5.1. Prevalence and Incidence 5.1.0. In the United States. 5.1.1. Worldwide. 5.1.2. Prevalence of Carriers. 5.1.3. Prevalence of Antibody. 5.2. Epidemic Behavior and Contagiousness 5.3. Geographic Distribution 5.4. Temporal Distribution 5.5. Age 5.6. Sex 5.7. Race 5.8. Occupation 5.9. Occurrence in Different Settings 5.10. Socioeconomic Factors 5.11. Other Factors 43.6 Mechanisms and Routes of Transmission 43.7 Pathogenesis and Immunity 7.1. Pathogenesis 7.2. Immunity 43.8 Patterns of Host Response 8.1. Clinical Features 8.2. Diagnosis 43.9 Control and Prevention 9.1. General Concepts 9.2. Antibiotic and Chemotherapeutic Approaches to Prophylaxis 9.3. Immunization 9.3.0. Ty21a. 9.3.1. Vi Polysaccharide Vaccine. 9.3.2. New Generation Typhoid Vaccines. 43.10 Unresolved Problems Chapter 44 Yersinia enterocolitica Infections 44.1 Introduction 44.2 Historical Background 44.3 Methodology 3.1. Sources of Mortality Data 3.2. Sources of Morbidity Data 3.3. Surveys and Investigations 3.4. Laboratory Diagnosis 3.4.0. Isolation and Identification of the Organism. 3.4.1. Serological Diagnostic Methods. 44.4 Biological Characteristics of the Organism 44.5 Descriptive Epidemiology 5.1. Prevalence and Incidence 5.2. Epidemic Behavior and Contagiousness 5.3. Geographic Distribution 5.4. Temporal Distribution 5.5. Age 5.6. Sex 5.7. Occupation 5.8. Race and Ethnicity 5.9. Occurrence in Different Settings 5.10. Socioeconomic Factors 44.6 Mechanisms and Routes of Transmission 44.7 Pathogenesis and Immunity 44.8 Patterns of Host Response 8.1. Clinical Features 8.2. Diagnosis 44.9 Control and Prevention 9.1. General Concepts 9.2. Antibiotic and Chemotherapeutic Approaches to Prophylaxis 9.3. Immunization. 44.10 Unresolved Problems Index