Current Diagnosis & Treatment in Infectious Diseases 1st edition: by Walter R. Wilson, W. Lawrence, MD Drew, Nancy K., Phd Henry, Merle A., MD Sande, David A., MD Relman, James M., MD Steckelberg, Julie Louise, MD Gerberding Publisher: McGraw-Hill/Appleton & Lange (June 22, 2001) By OkDoKeY CURRENT DIAGNOSIS & TREATMENT IN INFECTIOUS DISEASES (2001) Front Matter 1 . Introduction — Merle A. Sande, MD Section I. Basic Principles 2 . Basic Principles of Host Defense — Donald L. Granger, MD 3 . Basic Principles of Microbial Virulence — David A. Relman, MD 4 . General Principles of Antimicrobial Therapy — Walter R. Wilson, MD 5 . Infection Prevention in Healthcare Settings — Cathryn Louise Murphy, RN, PhD, CIC, Susan A Resnik, RN, Dip IC, CIC (Syd), & Julie Louise Gerberding, MD, MPH 6 . Laboratory Diagnosis — W. Lawrence Drew, MD, PhD, Franklin R. Cockerill, III, MD, & Nancy K. Henry, PhD, MD Section II. Clinical Syndromes 7 . Infections of the Central Nervous System — Zell A. McGee, MD* 8 . Infections of the Eye & Orbit — Marlene L. Durand, MD 9 . Upper Respiratory Tract Infections — Abinash Virk, MD, & Nancy K. Henry, PhD, MD 10 . Tracheobronchitis & Lower Respiratory Tract Infections — Abinash Virk, MD, & Walter R. Wilson, MD 11 . Infective Endocarditis — James M. Steckelberg, MD, & Walter R. Wilson, MD 12 . Intra-abdominal Infections — Jeffery Loutit, MB, ChB 13 . Skin & Soft-Tissue Infections — Mark P. Wilhelm, MD, FACP, & Randall S. Edson, MD, FACP 14 . Osteomyelitis, Infectious Arthritis & Prosthetic-Joint Infection — Douglas R. Osmon, MD & James M. Steckelberg, MD 15 . Sexually Transmitted Diseases — John W. Wilson, MD & Nancy K. Henry, PhD, MD 16 . Urinary Tract Infections — Walter R. Wilson, MD & Nancy K. Henry, PhD, MD 17 . Sepsis Syndrome — Andrew D. Badley, MD & James M. Steckelberg, MD 18 . Fever of Unknown Origin — Julie Brahmer, MD & Merle A. Sande, MD 19 . Fever & Rash — Peter K. Lindenauer, MD MSc, & Merle A. Sande, MD 20 . Infectious Diarrhea — William P. Ciesla, Jr., MD, & Richard L. Guerrant, MD 21 . Hepatobiliary Infections — Paul B. Eckburg, MD & Jose G. Montoya, MD 22 . Obstetric & Gynecologic Infections — Yenjean S. Hwang, MD & Merle A. Sande, MD Section III. Special Patient Populations 23 . Patients With Aids — Dani-Margot Zavasky, MD, Julie L. Gerberding, MD, MPH & Merle A. Sande, MD, 24 . Infections in Transplant Recipients — Robin Patel, MD 25 . Patients With Neutropenia & Fever — David Dockrell, MD & Linda L. Lewis, MD 26 . Patients with Recurrent Infections and Leukocyte Abnormalities — Timothy R. La Pine, MD, & Harry R. Hill, MD Section IV. Viral Infections 27 . Enteroviruses — W. Lawrence Drew, MD, PhD 28 . Rhinoviruses — W. Lawrence Drew, MD, PhD 29 . Influenza — Lisa Danzig, MD & Keiji Fukuda, MD, MPH 30 . Parainfluenza Virus — Gregory Sonnen, MD, & Nancy Henry, MD, PhD 31 . Respiratory Syncytial Virus — Gregory Sonnen, MD, & Nancy Henry, MD, PhD 32 . Adenoviruses — W. Lawrence Drew, MD, PhD 33 . Herpesviruses — W. Lawrence Drew, MD, PhD 34 . Measles — Gregory Sonnen, MD, & Nancy Henry, MD, PhD 35 . Mumps — Gregory Sonnen, MD & Nancy Henry, MD, PhD 36 . Rubella — Gregory Sonnen, MD, & Nancy Henry, MD, PhD 37 . Rotavirus — Gregory M. Sonnen, MD & Nancy Henry, MD, PhD 38 . Other Gastrointestinal Viruses — W. Lawrence Drew, MD, PhD 39 . Hepatitis — W. Lawrence Drew, MD, PhD 40 . HIV & Other Retroviruses — W. Lawrence Drew, MD, PhD 41 . Poxviruses — W. Lawrence Drew, MD, PhD 42 . Parvoviruses — W. Lawrence Drew, MD, PhD 43 . Viral Infection of the Central Nervous System — W. Lawrence Drew, MD, PhD 44 . Miscellaneous Systemic Viral Syndromes — W. Lawrence Drew, MD, PhD 45 . Papovaviruses — W. Lawrence Drew, MD, PhD Section V. Bacterial Infections 46 . Staphylococci — Karen Bloch, MD, MPH 47 . Streptococcus pneumoniae — Jeffrey N. Martin, MD, MPH 48 . Streptococcus pyogenes — Dennis L. Stevens, PhD, MD 49 . Enterococci — Robin Patel, MD 50 . Other Gram-Positive Cocci — Robin Patel, MD 51 . Gram-Positive Aerobic Bacilli — Jeffrey Loutit, MB, ChB, & David Relman, MD 52 . Neisseria Gonorrhoeae & Neisseria Meningitidis — D. Scott Smith, MD & David A. Relman, MD 53 . Enteritis Caused by Escherichia coli & Shigella & Salmonella Species — Gary W. Procop, MD, & Franklin Cockerill III, MD 54 . Pseudomonas aeruginosa — David Dockrell, MD, & Walter Wilson, MD 55 . Helicobacter pylori — Jay V. Solnick, MD, PhD, & Javeed Siddiqui, MD, MPH 56 . Haemophilus, Bordetella, & Branhamella Species — Joseph W. St. Geme III, MD 57 . Vibrio & Campylobacter — Gary W. Procop, MD, & Frank R. Cockerill III, MD 58 . Legionella — Michael Bell, MD 59 . Important Anaerobes — Jorge Villacian, MD, & James Steckelberg, MD 60 . Brucella, Francisella, Pasteurella, Yersinia, & HACEK — Elie F. Berbari, MD, & Walter R. Wilson, MD 61 . Tuberculosis — Julie Brahmer, MD, & Merle A. Sande, MD 62 . Other Mycobacteria — Julie Brahmer, MD, Yenjean Hwang, MD & Merle A. Sande, MD 63 . Actinomycetes — Phyllis C. Tien, SM, MD & David A. Relman, MD 64 . Treponema pallidum — Fred A. Lopez, MD & David A. Relman, MD 65 . Borrelia & Leptospira Species — Sandra Chaparro, MD & Jose G. Montoya, MD 66 . Mycoplasma & Ureaplasma — Jose G. Montoya, MD 67 . Chlamydia — Jose G. Montoya, MD 68 . Coxiella, Ehrlichia, & Rickettsia — Jeffery Loutit, MB, ChB 69 . Bartonella — Phyllis C. Tien, SM, MD & Jeffery S. Loutit, MB ChB Section VI. Fungal Infections 70 . Histoplasma capsulatum — Zelalem Temesgen, MD 71 . Blastomyces dermatitidis — Zelalem Temesgen, MD 72 . Coccidioides — Caroline Milne, MD, & Merle Sande, MD 73 . Candida species — Christopher R. Fox, MD & Merle A. Sande, MD 74 . Cryptococcus neoformans — James J. Chamberlain, MD & Donald L. Granger, MD 75 . Aspergillus, Pseudallescheria, & Agents of Mucormycosis — Michael R. Keating, MD 76 . Sporothrix schenckii — Zelalem Temesgen, MD 77 . Fusarium, Penicillium, Paracoccidioides, & Agents of Chromomycosis — Michael R. Keating, MD 78 . Dermatophytes — D. Scott Smith, MS, MD & David A. Relman, MD 79 . Pneumocystis carinii — James J. Chamberlain, MD & Kristen Ries, MD Section VII. Parasitic Infections Part A. Protozoa 80 . Malaria and Babesia — Gary W. Procop, MD & David H. Persing, MD, PhD 81 . Toxoplasma gondii — Jose G. Montoya, MD 82 . Pathogenic Amebas — Christopher R. Fox, MD & Merle A. Sande, MD 83 . Cryptosporidium, Cyclospora, & Isospora Species & Microsporidia — Stephanie Boade Silas, MD, & DeVon Hale, MD 84 . Giardia — Stephanie Boade Silas, MD, & DeVon Hale, MD 85 . Leishmania & Trypanosoma — D. Scott Smith, MD & David A. Relman, MD Section VII. Parasitic Infections Part B. Helminths 86. Nematodes — James M. Steckelberg, MD & Walter R. Wilson, MD 87 . Cestodes — Andrew D. Badley, MD, James M. Steckelberg, MD & Walter R. Wilson, MD 88 . Trematodes — Walter R. Wilson, MD & James M. Steckelberg, MD Section VIII. Miscellaneous Infections 89 . Infections in Travelers — DeVon C. Hale, MD & Caroline Milne, MD 90 . Zoonotic Infections — D. Scott Smith, MD & David A. Relman, MD 91 . Ectoparasitic Infestations & Arthropod Stings & Bites — Walter R. Wilson, MD & James M. Steckelberg, MD CURRENT DIAGNOSIS & TREATMENT IN INFECTIOUS DISEASES (2001) Front Matter Title Page a LANGE medical book CURRENT Diagnosis & Treatment in INFECTIOUS DISEASES Editors Walter R. Wilson, MD Professor of Medicine Mayo Medical School Consultant Mayo Clinic, Rochester Merle A. Sande, MD Professor and Chairman The Clarence M. and Ruth N. Birrer Presidential Endowed Chair in Internal Medicine Department of Internal Medicine University of Utah, Salt Lake City Associate Editors W. Lawrence Drew, MD, PhD Professor, Laboratory Medicine and Medicine Director, Viral Diagnostic Laboratory Chief, Infectious Diseases Mt. Zion Medical Center University of California, San Francisco Nancy K. Henry, PhD, MD Associate Professor of Pediatrics Mayo Graduate School of Medicine Chair, Division of Pediatric Infectious Diseases Department of Pediatric and Adolescent Medicine Mayo Clinic, Rochester David A. Relman, MD Associate Professor of Medicine, Microbiology & Immunology Departments of Medicine, Microbiology & Immunology Stanford University School of Medicine Physician, Veterans Affairs Palo Alto Health Care System James M. Steckelberg, MD Professor of Medicine Mayo Medical School Chair, Division of Infectious Diseases Mayo Clinic and Foundation, Rochester Julie Louise Gerberding, MD, MPH Associate Professor of Medicine San Francisco General Hospital University of California, San Francisco Lange Medical Books/McGraw-Hill Medical Publishing Division New York Chicago San Francisco Lisbon London Madrid Mexico City Milan New Delhi San Juan Seoul Singapore Sydney Toronto Copyright McGraw-Hill A Division of The McGraw-Hill Companies Current Diagnosis & Treatment in Infectious Diseases Copyright © 2001 by The McGraw-Hill Companies, Inc. All rights reserved. Printed in the United States of America. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a data base or retrieval system, without the prior written permission of the publisher. 1 2 3 4 5 6 7 8 9 0 DOWDOW 0 9 8 7 6 5 4 3 2 1 ISBN: 0-8385-1494-4 (domestic) ISBN: 0-07-118185-3 (international) ISSN: 1535-1971 Notice Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy are required. The authors and the publisher of this work have checked with sources believed to be reliable in their efforts to provide information that is complete and generally in accord with the standards accepted at the time of publication. However, in view of the possibility of human error or changes in medical sciences, neither the authors nor the publisher nor any other party who has been involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete, and they disclaim all responsibility for any errors or omissions or for the results obtained from use of the information contained in this work. Readers are encouraged to confirm the information contained herein with other sources. For example and in particular, readers are advised to check the product information sheet included in the package of each drug they plan to administer to be certain that the information contained in this work is accurate and that changes have not been made in the recommended dose or in the contraindications for administration. This recommendation is of particular importance in connection with new or infrequently used drugs. This book was set in Times Roman by Pine Tree Composition. The editors were Shelley Reinhardt, Isabel Nogueira, and Peter J. Boyle. The production supervisor was Richard Ruzycka. The art manager was Charissa Baker. The illustrators were Laura Pardi Duprey and Teshin Associates. The index was prepared by Katherine Pitcoff. R.R. Donnelley and Sons, Inc. was printer and binder. This book is printed on acid-free paper. Contents Authors...xv Preface...xx 1. Introduction...1 Merle A. Sande, MD I. BASIC PRINCIPLES 2. Basic Principles of Host Defense...3 Donald L. Granger, MD Innate Host Defenses 4 Defense Mechanisms at the Physiologic Level 4 Innate Defense Mechanisms at the Cellular Level 5 Defense Mechanisms at the Level of Protein Molecules 10 Adaptive Immune Responses 11 Humoral Immunity 11 Cell-Mediated Immunity 15 3. Basic Principles of Microbial Virulence...20 David A. Relman, MD Microorganisms as Pathogens 20 Regulation of Virulence 22 Adherence & Colonization 22 Toxins 24 Entry Into & Life within Host Cells 24 Manipulation or Avoidance of the Host Immune Response 25 Transmission & Life Outside the Mammalian Host 26 4. General Principles of Antimicrobial Therapy...28 Walter R. Wilson, MD Etiologic Agent & Susceptibility Testing 28 Dosage & Route of Administration 29 Underlying Host Factors 30 Monitoring the Response to Antimicrobial Therapy 32 5. Infection Prevention in Healthcare Settings...33 Cathryn Louise Murphy, RN, PhD, CIC, Susan A Resnik, RN, Dip IC, CIC (Syd), & Julie Louise Gerberding, MD, MPH Role of the Infection Control Practitioner 33 Role of the Healthcare Epidemiologist 34 The Infection Control Committee 34 Infection Control Policies & Procedures 34 Infection Monitoring & Prevention 35 Patient Isolation 35 Preventing Antimicrobial-Agent-Resistant Infections 36 Hand Hygiene 36 Asepsis 38 Occupational Health Issues 39 Infectious Conditions of Concern 39 Blood-Borne Pathogens 39 Tuberculosis 40 Vaccine-Preventable Diseases 40 New & Emerging Agents 41 6. Laboratory Diagnosis...43 W. Lawrence Drew, MD, PhD, Franklin R. Cockerill, III, MD, & Nancy K. Henry, PhD, MD Diagnosis of Bacterial, Fungal, & Parasitic Infections 43 Rapid, Direct Test Methods & Culture-Based Methods 51 Serologic Test Methods 55 Diagnosis of Viral Infections 57 Detection of Viral Antigens 61 Molecular Test Methods 55 Susceptibility Testing of Bacterial & Fungal Isolates to Antimicrobial Agents 55 Cytology 57 Culture-Based Methods 57 Serologic Test Methods 61 Molecular Test Methods 63 II. Clinical Syndromes 7. Infections of the Central Nervous System...65 Zell A. McGee, MD Acute Bacterial Meningitis 65 Aseptic Meningitis Syndrome 73 Infectious Disorders With Dementia as a Dominant Feature 76 Infections Presenting as Stroke Syndromes 77 Infections Presenting as Spinal Cord Syndromes 77 Infectious Disorders with Focal Disturbances as a Dominant Feature 78 Infectious Disorders Involving Cranial Nerves 82 Infectious Disorders with Dysphagia & Dysarthria as Dominant Features 82 8. Infections of the Eye & Orbit...85 Marlene L. Durand, MD Eyelid Infections 85 Hordeolum 85 Chalazion 85 Blepharitis 85 Preseptal Cellulitis 85 The Tear Film 86 Lacrimal System Infections 86 Dacryocystitis 87 Canaliculitis 87 Dacryoadenitis 87 Orbital Infections 87 Orbital Cellulitis 89 Orbital Abscess 89 Subperiosteal Abscess 89 Cavernous Sinus Thrombosis 89 Conjunctivitis 89 Hyperacute Conjunctivitis 90 Acute Conjunctivitis 90 Chronic Conjunctivitis 91 Keratitis (Corneal Ulcer) 92 Bacterial Keratitis 92 Interstitial Keratitis 93 Viral Keratitis 93 Parasitic Keratitis 93 Fungal Keratitis 93 Endophthalmitis 94 Postcataract Endophthalmitis 94 Bleb-Related Endophthalmitis 94 Post-Traumatic Endophthalmitis 94 Endogenous Endophthalmitis 94 Uveitis & Retinitis 96 Anterior Uveitis 96 Posterior Uveitis 96 Toxoplasma 96