Student Consult Study smart with Searchable full text online Register and activate this title today at studentconsult.com • Access the full text online • Download images Activation Code • Add your own notes and bookmarks • Search across all the Student Consult resources you own online in one place ALREADY REGISTERED? FIRST-TIME USER? 1. Go to studentconsult.com; sign in 1. REGISTER 2. Click the “Activate Another Book” • Go to studentconsult.com; click “Register Now” button • Fill in your user information and click “Activate your 3. Gently scratch off the surface of account” the sticker with the edge of a coin 2. ACTIVATE YOUR BOOK to reveal your Pin code • Click the “Activate Another Book” button 4. Enter it into the “Pin code” box; • Gently scratch off the surface of the sticker with the select the title you’ve activated edge of a coin to reveal your Pin code from the drop-down menu • Enter it into the “Pin code” box; select the title 5. Click the “Activate Book” button you’ve activated from the drop-down menu • Click the “Activate Book” button Access to, and online use of, content through the Student Consult website is for individual use only; library and institutional access and use are strictly prohibited. For information on products and services available for institutional access, please contact our Account Support Center at (+1) 877-857-1047. Important note: Purchase of this product includes access to the online version of this edition for use exclusively by the individual purchaser from the launch of the site. This license and access to the online version operates strictly on the basis of a single user per PIN number. The sharing of passwords is strictly prohibited, and any attempt to do so will invalidate the password. Access may not be shared, resold, or otherwise circulated, and will terminate 12 months after publication of the next edition of this product. Full details and terms of use are available upon registration, and access will be subject to your acceptance of these terms of use. For technical assistance: email [email protected] call 800-401-9962 (inside the US) / call +1-314-995-3200 (outside the US) Medical Microbiology This page intentionally left blank Medical Microbiology Patrick R. Murray, PhD Worldwide Director, Scientific Affairs BD Diagnostics Systems Sparks, Maryland; Adjunct Professor, Department of Pathology University of Maryland School of Medicine Baltimore, Maryland Ken S. Rosenthal, PhD Professor, Department of Integrated Medical Sciences Northeast Ohio Medical University Rootstown, Ohio; Adjunct Professor, Herbert Wertheim College of Medicine Florida International University Miami, Florida Michael A. Pfaller, MD JMI Laboratories North Liberty, Iowa; Professor Emeritus, Pathology and Epidemiology University of Iowa College of Medicine and College of Public Health Iowa City, Iowa 7th Edition 1600 John F. Kennedy Blvd. Ste 1800 Philadelphia, PA 19103-2899 MEDICAL MICROBIOLOGY, SEVENTH EDITION ISBN: 978-0-323-08692-9 Copyright © 2013 by Saunders, an imprint of Elsevier Inc. Copyright © 2009, 2005, 2002, 1998, 1994, 1990 by Mosby, Inc. an affiliate of Elsevier Inc. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). Notices Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary. Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility. With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. Library of Congress Cataloging-in-Publication Data Murray, Patrick R. Medical microbiology / Patrick R. Murray, Ken S. Rosenthal, Michael A. Pfaller. p. ; cm. Includes bibliographical references and index. ISBN 978-0-323-08692-9 (pbk. : alk. paper) I. Rosenthal, Ken S. II. Pfaller, Michael A. III. Title. [DNLM: 1. Microbiology. 2. Microbiological Techniques. 3. Parasitology. QW 4] 616.9′041–dc23 2012007387 Senior Content Strategist: James Merritt Senior Content Development Specialist: Kathryn DeFrancesco Publishing Services Manager: Patricia Tannian Senior Project Manager: Kristine Feeherty Design Direction: Ellen Zanolle Working together to grow libraries in developing countries Printed in China www.elsevier.com | www.bookaid.org | www.sabre.org Last digit is the print number: 9 8 7 6 5 4 3 2 1 To all who use this textbook, that they may benefit from its use as much as we did in its preparation This page intentionally left blank Preface Medical microbiology can be a bewildering field to immunology section has been extensively updated and the novice. We are faced with many questions reorganized. The immune cells and tissues are intro- when learning microbiology: How do I learn all the duced, followed by an enhanced chapter on innate names? Which infectious agents cause which diseases? immunity, and updated chapters on antigen-specific Why? When? Who is at risk? Is there a treatment? immunity, antimicrobial immunity, and vaccines. The However, all these concerns can be reduced to one essen- sections on bacteria, viruses, fungi, and parasites have tial question: What information do I need to know that also been reorganized. Each section is introduced by the will help me understand how to diagnose and treat an relevant basic science chapters and then the specific infected patient? microbial disease summary chapter before proceeding Certainly, there are a number of theories about what into descriptions of the individual microbes, “the bug a student needs to know and how to teach it, which parade.” As in previous editions, there are many summary supposedly validates the plethora of microbiology text- boxes, tables, clinical photographs, and original clinical books that have flooded the bookstores in recent years. cases. Clinical Cases are included because we believe Although we do not claim to have the one right approach students will find them particularly interesting and to teaching medical microbiology (there is truly no one instructive and they are a very efficient way to present perfect approach to medical education), we have founded this complex subject. Each chapter in the “bug parade” the revisions of this textbook on our experience gained is introduced by relevant questions to excite students through years of teaching medical students, residents, and orient them as they explore the chapter. Finally, and infectious disease fellows as well as on the work students are provided with access to the Student Consult devoted to the six previous editions. We have tried to website, which provides links to additional reference present the basic concepts of medical microbiology materials, clinical photographs, and answers to the intro- clearly and succinctly in a manner that addresses ductory and summary questions of each chapter. A very different types of learners. The text is written in a important feature on the website is access to more than straightforward manner with, it is hoped, uncomplicated 200 practice exam questions that will help students explanations of difficult concepts. Details are summa- assess their mastery of the subject matter and prepare rized in tabular format rather than in lengthy text, and for their course and Licensure exams. In essence, this there are colorful illustrations for the visual learner. edition provides an understandable text, details, ques- Clinical Cases provide the relevance that puts reality tions, examples, and a review book all in one. into the basic science. Important points are emphasized in boxes to aid students, especially in their review; and the study questions, including Clinical Cases, address TO OUR FUTURE COLLEAGUES: relevant aspects of each chapter. Each section begins THE STUDENTS with a chapter that summarizes microbial diseases, and this also provides review material. On first impression, success in medical microbiology Our understanding of microbiology and immunology would appear to depend on memorization. Microbiology is rapidly expanding with new and exciting discoveries in may seem to consist of only innumerable facts, but there all areas. Expansion of knowledge could also lead to is also a logic to microbiology and immunology. Like a expansion of the book. We used our experience as authors medical detective, the first step is to know your villain. and teachers to choose the most important information Microbes establish a niche in our bodies, and their ability and explanations for inclusion in this textbook. Each to do so and the disease that may result depends on how chapter has been carefully updated and expanded to they interact with the host and the innate and immune include new, medically relevant discoveries. In each of protective responses that ensue. these chapters, we have attempted to present the mate- There are many ways to approach learning microbiol- rial that we believe will help the student gain a clear ogy and immunology, but ultimately the more you inter- understanding of the significance of the individual act with the material using multiple senses, the better microbes and their diseases. you will build memory and learn. A fun and effective With each edition of Medical Microbiology we refine approach to learning is to think like a physician and treat and update our presentation. There are many changes to each microbe and its diseases as if it were an infection the seventh edition, including a reorganization of the in your patient. Create a patient for each microbial chapters. The book starts with a general introduction to infection, and compare and contrast the different microbiology, the techniques used by microbiologists and patients. Perform role-playing and ask the seven basic immunologists, and then the immunology section. The questions as you approach this material: Who? Where? vii viii    PREFACE When? Why? Which? What? and How? For example: property. Pretend that an imaginary patient is infected Who is at risk for disease? Where does this organism with a specific agent and create the case history. Explain cause infections (both body site and geographic area)? the diagnosis to your imaginary patient and also to your When is isolation of this organism important? Why is this future professional colleagues. In other words, do not organism able to cause disease? Which species and genera simply attempt to memorize page after page of facts; are medically important? What diagnostic tests should rather, use techniques that stimulate your mind and chal- be performed? How is this infection managed? Each lenge your understanding of the facts presented through- organism that is encountered can be systematically out the text. Use the summary chapter at the beginning examined. The essential information can be summarized of each organism section to help refine your “differential in the acronym VIRIDEPT: Know the Virulence proper- diagnosis” and classify organisms into logical “boxes.” ties of the organism; how to Identify the microbial cause Our knowledge about microbiology and immunology of disease; the specific conditions or mechanisms for is constantly growing, and by building a good foundation Replicating the microbe; the helpful and harmful aspects of understanding in the beginning, it will be much easier of the Innate and Immune response to the infection; the to understand with the advances of the future. Disease signs and consequences; the Epidemiology of No textbook of this magnitude would be successful infections; how to Prevent its disease; and its Treatment. without the contributions of numerous individuals. We Learn three to five words or phrases that are associated are grateful for the valuable professional help and support with the microbe—words that will stimulate your provided by the staff at Elsevier, particularly Jim Merritt, memory (trigger words) and organize the diverse facts William Schmitt, Katie DeFrancesco, and Kristine Fee- into a logical picture. Develop alternative associations. herty. We also want to thank the many students and For example, this textbook presents organisms in the professional colleagues who have offered their advice and systematic taxonomic structure (frequently called a “bug constructive criticism throughout the development of parade,” but which the authors think is the easiest this sixth edition of Medical Microbiology. way to introduce the organisms). Take a given virulence property (e.g., toxin production) or type of disease Patrick R. Murray, PhD; Ken S. Rosenthal, PhD; (e.g., meningitis) and list the organisms that share this and Michael A. Pfaller, MD