Ebook Sherris medical microbiology (6th edition): Part 2

(BQ) Part 2 book Sherris medical microbiology presentation of content: Fungi—Basic concepts, pathogenesis and diagnosis of fungal infection, antifungal agents and resistance, pathogenesis and diagnosis of parasitic infection, intestinal nematodes, tissue nematodes, cestodes, trematodes,... and other contents.

PART Pathogenic Fungi IV Kenneth J Ryan Fungi—Basic Concepts CHAPTER 42 Pathogenesis and Diagnosis of Fungal Infection CHAPTER 43 Antifungal Agents and Resistance CHAPTER 44 Dermatophytes, Sporothrix, and Other Superficial and Subcutaneous Fungi CHAPTER 45 Candida, Aspergillus, Pneumocystis, and Other Opportunistic Fungi CHAPTER 46 Cryptococcus, Histoplasma, Coccidioides, and Other Systemic Fungal Pathogens CHAPTER 47 This page intentionally left blank Chapter 42 Fungi—Basic Concepts F ungi or the Eumycota are a distinct class of microorganisms, most of which are freeliving in nature where they function as decomposers in the energy cycle Of the more than 90 000 known species, fewer than 200 have been reported to produce disease in humans These diseases have unique clinical and microbiologic features and are increasing in immunocompromised patients MYCOLOGY Fungi are eukaryotes with a higher level of biologic complexity than bacteria They are spore bearing; reproducing both sexually and asexually Fungi may be unicellular or may differentiate and become multicellular by the development of long-branching filaments They acquire nutrients by absorption but lack the chlorophyll of plants The diseases caused by fungi are called mycoses They vary greatly in their manifestations but tend to be subacute to chronic with indolent, relapsing features Acute disease, such as that produced by many viruses and bacteria, is uncommon with fungal infections Cell organization is eukaryotic STRUCTURE The fungal cell has typical eukaryotic features, including a nucleus with a nucleolus, nuclear membrane, and linear chromosomes (Figure 42–1) The cytoplasm contains a cytoskeleton with actin microfilaments and tubulin-containing microtubules Ribosomes and organelles, such as mitochondria, endoplasmic reticulum, and the Golgi apparatus, are also present Fungal cells have a rigid cell wall external to the cytoplasmic membrane, which differs in its chemical composition from that of bacteria and plants An important difference from mammalian cells is the sterol makeup of the cytoplasmic membrane In fungi, the dominant sterol is ergosterol; in mammalian cells, it is cholesterol Fungi are usually in the haploid state, although diploid nuclei are formed through nuclear fusion in the process of sexual reproduction The chemical structure of the cell wall in fungi is markedly different from that of bacterial cells in that it does not contain peptidoglycan, glycerol, teichoic acids, or lipopolysaccharide In their place are the polysaccharides mannan, glucan, and chitin in close association with each other and with structural proteins (Figure 42–2) Mannoproteins are mannosebased polymers (mannan) found on the surface and in the structural matrix of the cell wall, where they are linked to protein They are major determinants of serologic specificity because of variations in the composition and linkages of the polymer side chains Glucans are glucosyl polymers, some of which form fibrils that increase the strength of the fungal cell wall, found to be often in close association with chitin Chitin is composed of long, unbranched chains of poly-N-acetylglucosamine It is inert, insoluble, and rigid and provides structural support in a manner analogous to the chitin in crab shells or cellulose in plants It is a major component of the cell wall of filamentous fungi In yeasts, chitin appears Presence of a nucleus, mitochondria, and endoplasmic reticulum Ergosterol, not cholesterol, makes up cell membrane Cell wall mannan linked to surface proteins Chitin and glucans give rigidity to cell wall 697 698 PART IV Pathogenic Fungi Cell wall Nucleus Cytoplasm Polar bud scar Polarbud scar Chromosome Plasma membrane FIGURE 42–1.  A yeast cell showing the cell wall and internal structures of the fungal eukaryotic cell plan (Reproduced with permission from ­Willey JM: Prescott, Harley, & Klein’s Microbiology, 7th edition McGraw-Hill, 2008.) Mitochondrion Nuclear envelope Golgi apparatus Plasma membrane to be of most importance in forming cross-septa and the channels through which nuclei pass from mother to daughter cells during cell division METABOLISM Heterotrophic metabolism uses available organic matter Fungal metabolism is heterotrophic, degrading organic substrates as an exogenous source of carbon Metabolic diversity is great, but most fungi grow with only an organic carbon source and ammonium or nitrate ions as a nitrogen source In nature, nutrients for freeliving fungi are derived from decaying organic matter A major difference between fungi and plants is that fungi lack chloroplasts and photosynthetic energy-producing mechanisms Most are strict aerobes, although some can grow under anaerobic conditions Only a few are anaerobes, none of which are human pathogens Fibrillar proteins Mannoprotein Glucan Ergosterol Chitin FIGURE 42–2.  The fungal cell wall The overlapping mannan, glucan, chitin, and protein elements are shown Proteins complexed with the mannan (mannoproteins) extend beyond the cell wall Cytoplasmic membrane FUNGI—BASIC CONCEPTS CHAPTER 42 699 REPRODUCTION Fungi may reproduce by either asexual or sexual process The asexual form is called the anamorph, and its reproductive elements are termed conidia The sexual form is called the teleomorph, and its reproductive structures are called spores (eg, ascospores, zygospores, basidiospores) Asexual reproduction involves mitotic division of the haploid nucleus and is associated with production by budding spore-like conidia or separation of hyphal elements In sexual reproduction, the haploid nuclei of donor and recipient cells fuse to form a diploid nucleus, which then divides by classic meiosis Some of the four resulting haploid nuclei may be genetic recombinants and may undergo further division by mitosis Highly complex specialized structures may be involved Detailed study of this process in fungal species, such as Neurospora crassa (brewers’ yeast), has been important in gaining an understanding of basic cellular genetic mechanisms Asexual reproduction forms conidia by mitosis Meiosis forms sexual spores in specialized structures FUNGAL MORPHOLOGY AND GROWTH The size of fungi varies immensely A single cell without transverse septa may range from bacterial size (2-4 μm) to a macroscopically visible structure The morphologic forms of growth vary from colonies superficially resembling those of bacteria to some of the most complex, multicellular, colorful, and beautiful structures seen in nature Mushrooms are an example and can be regarded as a complex organization of cells showing structural differentiation Mycology, the science devoted to the study of fungi, has various terms to describe the morphologic components that comprise these structures The terms and concepts that must be mastered can be limited by considering only the fungi of medical importance and accepting some simplification Vary from bacterial size to multicellular mushrooms YEASTS AND MOLDS Initial growth from a single cell may follow either of two courses, yeast or mold (Figure 42–3A and B) The first and simplest is the formation of a bud, which extends from a round or oblong parent, constricts, and forms a new cell, which separates from the parent These buds are called blastoconidia, and fungi that reproduce in this manner are called yeasts On plates, yeasts form colonies that resemble those of bacteria In fluids they are much more portable than molds because of the retention of a single-cell nature Fungi may also grow through the development of hyphae (singular, hypha), which are tube-like extensions of the cell with thick, parallel walls As the hyphae extend, they form an intertwined mass called a mycelium Most fungi form hyphal septa (singular, septum), A Saccharomyces cerevisiae: budding division B Yeasts produce blastoconidia by budding FIGURE 42–3.  Yeast and mold forms of fungal growth A This oval yeast cell is budding to form a blastoconidium Scars from the separation of other blastoconidia can be seen on other parts of the cell B The mold form is highly variable Here tubular stalks called condiophores arising from hyphae (not seen) bear a “Medusa head” crop of reproductive conidia (Reproduced with permission from ­Willey JM: Prescott, Harley, & Klein’s Microbiology, 7th edition McGraw-Hill, 2008.) 700 PART IV Pathogenic Fungi Nucleus A B Nucleus Septum C Pores FIGURE 42–4.  Hyphae A Nonseptate hyphae with multiple nuclei B Septate hyphae divide nuclei into separate cells C Electron micrograph of septum with a single pore D Multipore septum structure (Reproduced with permission from ­Willey JM: Prescott, Harley, & Klein’s Microbiology, 7th edition McGraw-Hill, 2008.) Molds produce septate or nonseptate hyphae Vegetative mycelium acts as a root Aerial mycelium bears reproductive conidia or spores Pseudohyphae are less rigid Morphology of reproductive conidia and spores used for identification D which are cross-walls perpendicular to the cell walls that divide the hypha into subunits (Figure 42–4) These septa vary among species and may contain pores and incomplete walls that allow movement of nutrients, organelles, and nuclei Some species are nonseptate; they form hyphae and mycelia as a single, continuous cell In both septate and nonseptate hyphae, multiple nuclei are present, with free flow of cytoplasm along the hyphae or through pores in any septum A portion of the mycelium (vegetative mycelium) usually grows into the medium or organic substrate (eg, soil) and functions like the roots of plants as a collector of nutrients and moisture The more visible surface growth may assume a fluffy character as the mycelium becomes aerial The hyphal walls are rigid so as to support this extensive, intertwining network, commonly called a mold The aerial hyphae bear the reproductive structures of this class of fungi Some fungi form structures called pseudohyphae, which differ from true hyphae in having recurring bud-like constrictions and less rigid cell walls The reproductive conidia and spores of the molds and the structures that bear them assume a variety of sizes, shapes, and relationships to the parent hyphae, and the morphology and development of these structures are the primary basis of identification of medically important molds The mycelial structure plays some role in identification, depending on whether the hyphae are septate or nonseptate, but differences are not sufficiently distinctive to identify or even suggest a fungal genus or species Exogenously formed conidia may develop directly from the hyphae or on a special stalklike structure, the conidiophore (Figure 42–3B) Occasionally, terms such as macroconidia and microconidia are used to indicate the size and complexity of these conidia Conidia that develop within the hyphae are called either chlamydoconidia or arthroconidia FUNGI—BASIC CONCEPTS CHAPTER 42 701 Terminal chlamydoconidia Arthroconidia Fragmenting hypha Chlamydoconidia within a hypha A B Sporangiospores Conidioconidia Sporangium Sporangiophore Conidiophore C D Chlamydoconidia become larger than the hypha itself; they are round, thick-walled structures that may be borne on the terminal end of the hypha or along its course Arthroconidia conform more to the shape and size of the hyphal units but are thickened or otherwise differentiated Arthroconidia may form a series of delicately attached conidia that break off and disseminate when disturbed Some of the asexual reproductive forms are illustrated in Figure 42–5A–D The most common sexual spore is termed an ascospore Four or eight ascospores may be found in a sac-like structure, the ascus FIGURE 42–5.  Asexual mold forms A Arthroconidia develop within the hyphae and eventually break off B Chlamydoconidia are larger than the hyphae and develop with the cell or terminally C Sporangiocondia are borne terminally in a sporangium sac D Simple conidia arise directly from a conidiophore (Reproduced with permission from Willey JM: Prescott, Harley, & Klein’s Microbiology, 7th edition McGraw-Hill, 2008.) Conidia and conidiophore arrangements determine names Ascospores are borne in ascus sac DIMORPHISM In general, fungi grow either as yeasts or as molds; mold forms exhibit the greatest diversity Some species can grow in either a yeast or a mold phase, depending on environmental conditions These species are known as dimorphic fungi Several human pathogens demonstrate dimorphism; they grow in the mold form in their environmental reservoir and in culture at ambient temperatures, but convert to the yeast or other forms in infected tissue For most, it is possible to manipulate the cultural conditions to demonstrate both yeast and mold phases in vitro Yeast phase growth requires conditions similar to those of the physiologic in vivo environment, such as 35°C to 37°C incubation and enriched medium Growth in yeast or mold form Temperature triggers shift between phases 702 PART IV Shift from mold to yeast begins with heat shock response Metabolic shift is toward sulfhydryl compounds in yeast form Global regulator controls process Dimorphism is reversible and linked to virulence Pathogenic Fungi Mold growth requires minimal nutrients and ambient temperatures The conidia produced in the mold phase may be infectious and serve to disseminate the fungus The morphologic and physiologic events associated with conversion from the mold to the yeast phase have been most extensively studied in the human pathogen Histoplasma capsulatum They are understandably complex, given the dramatic change of milieu encountered by the fungus when its mold conidia float from their soil habitat to the pulmonary alveoli Conversion to the yeast phase is then triggered by the host temperature (37°C) or other changes in the presence or concentration of components of the new environment (iron, pH, CO2, nitrogen) In vitro studies show that the earliest events in this shift from the mold to yeast form involve induction of the heat shock response and uncoupling of oxidative phosphorylation These are followed by a shutdown of RNA synthesis, protein synthesis, and respiratory metabolism The cells then pass through a metabolically inactive state, emerging with enhanced enzymatic capacities involving sulfhydryl compounds (eg, cysteine, cystine) that are exclusive to the yeast stage In the yeast stage, there is recovery of mitochondrial activity and synthetic capacity, but a new constellation of oxidases, polymerases, proteins, cell wall glucans, and other compounds are present In all, more than 500 genes are differentially expressed in the mold and yeast phases A global regulating gene controls mold to yeast process as well as the expression of some virulence genes Dimorphism in fungi is reversible; a feature that distinguishes it from developmental processes such as embryogenesis seen in higher eukaryotes The importance of the conversion to virulence of Histoplasma is shown by animal studies using strains biochemically blocked from converting to the yeast phase They neither produce disease nor persist in the host To the extent known, these features are similar in the other dimorphic fungi CLASSIFICATION Although conidia are more readily observed, the official classification of fungi primarily depends on the nature of the teleomorph spores and septation of hyphae as its differential characteristics On this basis, fungi have been organized into five phyla: Chlytridiomycota, Zygomycota, Glomeromycota, Ascomycota, and Basidiomycota A confusing feature in the classification of the medically important fungi is that for most species the grouping and names were established before any teleomorph form had been discovered One approach was to park these fungi in their own artificial class (Deuteromycetes, or fungi imperfecti) awaiting the discovery of their teleomorph For many, this has now been accomplished TABLE 42–1 Classification of Medically Important Fungi GENUS TYPICAL GROWTH PHYLUM MEDICAL CLASSIFICATION Aspergillus Mold + Ascomycota Opportunistic Blastomyces Candida Dimorphic + Ascomycota Systemic Dimorphic + Ascomycota Opportunistic Coccidioides Dimorphic + Ascomycota Systemic Cryptococcus Yeast Basidiomycota Systemic Epidermophyton Mold + Ascomycota Superficial Histoplasma Dimorphic + Ascomycota Systemic Microsporum Mold + Ascomycota Superficial Mucor Mold – Pneumocystis Cystsb Rhizopus Mold Sporothrix Trichophyton Zygomycota Opportunistic Ascomycota Opportunistic – Zygomycota Opportunistic Dimorphic + Ascomycota Subcutaneous Mold + Ascomycota Superficial For those that form hyphae Tissue forms but does not grow in culture a b SEPTATIONa FUNGI—BASIC CONCEPTS but the application of molecular methods such as analysis of ribosomal RNA genes has made it almost irrelevant The species can now be classified on genomic grounds without knowledge of their reproductive forms The medically important genera fall mostly into the Ascomycota, with a few in Basidiomycota, and Zygomycota, as shown in Table 42–1 Discovery of the teleomorph may not bring immediate clarity from the student’s standpoint; for instance, when the sexual stage of Trichophyton mentagrophytes, a cause of ringworm, was demonstrated, it was found to be identical with that of an already named ascomycete (Arthroderma benhamiae) The grouping of medically important fungi used in the following chapters is based on the types of tissues they parasitize and the diseases they produce, rather than on the principles of basic mycologic taxonomy The superficial fungi, such as the dermatophytes, cause indolent lesions of the skin and its appendages, commonly known as ringworm and athlete’s foot The subcutaneous pathogens characteristically cause infection through the skin, followed by subcutaneous spread, lymphatic spread, or both The opportunistic fungi are those found in the environment or in the resident flora that produce disease under certain circumstances and in the compromised host The systemic pathogens are the most virulent fungi and may cause serious progressive systemic disease in previously healthy persons They are not found in the human microbiota Although their major potential is to produce deep-seated visceral infections and systemic spread (systemic mycoses), they may also produce superficial infections as part of their disease spectrum or as the initiating event The superficial mycoses not spread to deeper tissues As with all clinical classifications, overlaps and exceptions occur In the end, the organism defines the disease, and it must be isolated or otherwise demonstrated CHAPTER 42 703 Taxonomy is based on sexual spores and septation of hyphae Asexual form is unknown for most pathogens rRNA genes are used for classification Medical grouping organized by biologic behavior in humans Systemic fungi infect previously healthy persons This page intentionally left blank 980 INDEX macrolides, 409t, 416 Borrelia burgdorferi and, 416 for Campylobacter jejuni, 572 for Mycoplasma pneumoniae, 665 resistance, 423t macrophages, 20f, 22–23, 29t, 753 alveolar, 494f apoptosis, 600 granuloma, 496 macular rash, 196 mad cow disease, 348–349 magnetic resonance imaging, 887 major histocompatibility complex (MHC), 31, 169, 239, 316 class I, 31, 32f class II, 31, 32f, 401, 435 major outer membrane protein (MOMP), 667 major surface glycoprotein (MSG), 739 malabsorption, 830 ascariasis and, 855 strongyloidiasis and, 861 malaria, 773, 775, 793–800 acute attack, termination, 798–799 anemia in, 795 antigenic variation, 797 artemisinin for, 792t central nervous system, 796f cerebral, 795 cerebral falciparum, 798 chemotherapy of, 792t chloroquine for, 792t circulatory changes in, 795 clinical aspects, 797–800 clinical capsule, 793 clinical manifestations of, 795 congenital, 795 cytokines in, 796 diagnosis, 798 endemic areas, 794 epidemiology, 793–795 erythrocytic stages of, 789, 790f fever in, 795 folate antagonists for, 792t geographic distribution of, 794f immunity, 796–797 imported, 795 manifestations, 797–798 mefloquine for, 799 morphology of, 790f mortality from, 795 nephritis in, 796 paroxysm, 797 pathogenesis, 795–796 personal protection from, 799 prevalence of, 764t prevention, 799–800 primaquine for, 792t quinine for, 792t radical cures for, 799 relapse, 797 resistance of, 764–765 serologic tests for, 798 simian, 797 sulfonamides for, 792t thrombocytopenia in, 796 treatment, 798–799 vaccines, 800 Malassezia furfur, 720t malignant otitis externa, 914 malignant pustule, 486 MALT lymphoma See mucosa-associated lymphoid tissue lymphoma mannan, 697 mannoprotein, 706 mannose, 27 Mansonia, 873 maraviroc, 157 Marburg virus, 296–298 Martin-Lewis medium, 82, 548 masseter muscle, 527 mast cells, 20f, 23 matrix proteins, 98 Maurer dots, 791t Mazzotti reaction, 877 MBC See minimum bactericidal concentration MBP See myelin basic protein MCV4 See Meningococcal Conjugate Vaccine Quadravalent MDR-TB See multidrug-resistant tuberculosis measles, 112, 189–193 antibodies, 191 chronic, 193 clinical aspects, 191–193 CNS infections and, 926t comparison, 186t complications, 192 diagnosis, 193 epidemiology, 190 German, 196 immunity, 191 immunosuppression and, 149 manifestations, 191–193 pathogenesis, 190–191 prevention, 193 rash, 192f receptors, 110t treatment, 193 vaccines, 193 virology, 189 measles, mumps, rubella, and varicella vaccine (MMRV), 189, 197, 258 mebendazole, 783 for trichinosis, 869 Medawar, Peter, 97 media indicator, 64 nutrient, 63 selective, 63 medical devices, nosocomial infections from, 51–52 mefloquine, 780, 781, 784 for malaria, 799 megacolon, 843 megaesophagus, 843 meglumine antimoniate, 783 Meister, Joseph, 306 melanin, 725, 745 melarsoprol, 782 for African trypanosomiasis, 840 melioidosis, 623 membrane attack complex (MAC), 27, 27f membrane-active exotoxins, 400 memory cells, 33, 35 men, gonorrhea in, 546f meninges, 188 meningitis, 296, 431, 482, 553 aseptic, 217, 219, 925 chronic, 925 Cryptococcus neoformans, 748f Escherichia coli, 589 Haemophilus influenzae, 555 pneumococcal, 467 purulent, 925 vaccines, 18 Meningococcal Conjugate Vaccine Quadravalent (MCV4), 541 meningococcal disease, 537–541 cellular view, 538f cephalosporins, 540 ciprofloxacin for, 541 clinical aspects, 540–541 clinical capsule, 537 diagnosis, 540 epidemiology, 537 immunity, 539–540, 539f lipooligosaccharide, 538 manifestations, 540 pathogenesis, 537–539 prevention, 541 rifampin for, 541 treatment, 540 meningococcemia, 540, 540f meningococci, 11 meningoencephalitis, 819–820, 886, 925 menstruation, 440 meropenem, 409t, 412 merozoites, in red blood cells, 789 mesophiles, 373 messenger RNA (mRNA), 16f, 114–115, 313 monocistronic, 115–118, 116f–117f pathways, 115f metabolic acidosis, 569 metacercariae, 895 Metagonimus spp., 896t metalloprotease, 181 metapneumovirus human, 161, 177 lower respiratory tract infections from, 918t metastatic infection, salmonellosis, 603 Metchnikoff, Elie, 12, 19 methicillin, 409t, 411, 425, 443 methicillin-resistant Staphylococcus aureus (MRSA), 425, 443 methylene blue stain, 60f metronidazole, 418, 782 for anaerobic infections, 520 for Bacteroides fragilis, 532 for Clostridium difficile, 530 for Entamoeba histolytica, 819 for giardiasis, 831 for Helicobacter pylori, 576 for trichomoniasis, 827 MHC See major histocompatibility complex MIC See minimal inhibitory concentration micafungin, 716 features of, 714t miconazole, 715, 724 features of, 714t microaerophilic bacteria, 367 microaerosols, 465 microbes in environment, features of, 5t relative size of, 5f microbial killing, 44 kinetics of, 44f microbiology, 4–8 microbiota, 8–12 in blood, in body fluids, carrier state, in colon, 11 diet and, 11 at different sites, 9–11 in exclusionary effect, 12 in genitourinary tract, 11 good, 12 in immune system, 12 in intestinal tract, 10–11 in mouth, 10–11 nature of, in opportunistic infection, 12 in pharynx, 10–11 potentially pathogenic, 10t residents, in respiratory tract, 11 role of, 12 samples from, 56 in skin, 9–10 stool, 11f in tissues, transients, in vagina, 11 INDEX microconidia, 700 Histoplasma capsulatum, 749 microdeletions, 378 microfilaments, 814 microfilariae, 863, 871 differentiation of, 871t hypersensitivity reaction to, 877 microhemagglutination test, 649 microinsertions, 378 microscopy dark-field, 58f, 60–61 diagnosis, 649 electron, 61, 69 fluorescence, 58f, 60–61 light, 57–61, 58f microsporidia, 766–767, 766t, 811 Microsporum, 719 classification of, 702t Microsporum audouini, 720t Microsporum canis, 720t Microsporum gypseum, 720t Microsporum mentagrophytes, 720t Microsporum rubrum, 720t Microsporum tonsurans, 720t Microsporum violaceum, 720t microwaves, 47 middle ear, 394t middle respiratory tract infection, 916–917 etiologic agents, 917t milker’s nodules, 208 Milne, A.A., 185 minimal inhibitory concentration (MIC), 420f, 467 definition, 408 minimum bactericidal concentration (MBC), 422 minocydine, for Nocardia, 513 miracidia, 895, 903f misdirected immune response, 402–403 missense mutation, 378 mite larvae, 683 mitosomes, 767 MMRV See measles, mumps, rubella, and varicella vaccine moderate virulence, 392 MOI See multiplicity of infection molds, 7–8, 699–701 asexual, 701f forms, 699f shifts from, 702 molecular assay, 125 molecular diagnostic methods, 78f molecular epidemiology, 85 molecular mimicry, 40, 148, 215, 456 molecular testing, 421 Molluscipoxvirus, 201, 202t molluscum contagiosum, 202t, 207 in AIDS, 207f of skin, 207f Molluscum contagiosum virus, 924t MOMP See major outer membrane protein monkeypox, 202t, 206–207 monobactams, 409t, 410, 411f, 412–413 monoblast, 20f monocistronic mRNA rule, 115–118, 116f–117f monoclonal antibodies, 69 monocytes, 20f in innate immunity, 22–23 mononucleosis, 924t monosaccharides, 689 monotrichous flagella, 361 Montagnier, Luc, 310 Moraxella, 10, 624, 625t Moraxella catarrhalis, 915t morbidity rotavirus, 274f tuberculosis, 493 Morganella, 580, 607 morphologic subunits, 103 mortality rates, 86f See also morbidity AIDS, 318 excess, 168 HIV and, 324f infectious diseases, 4f kala azar, 837 of malaria, 795 of neonatal herpes, 253 respiratory syncytial virus, 176 tuberculosis, 493 morulae, 683 mosquitoes anopheline, 795 eradication of, 800 lymphatic filaria and, 871 motility, 377–378 motor neuron cells, 217 motor neuron endplate, 523f mouse retrovirus (MPMV), 314f mouth, microbiota in, 10–11 moxifloxacin, 409t, 417 mRNA See messenger RNA MRSA See methicillin-resistant Staphylococcus aureus MSG See major surface glycoprotein mucin, 393 mucociliary action, 11 mucocutaneous leishmaniasis, 835–836 manifestations, 835 treatment, 835–836 Mucor, 738 classification of, 702t mucosa, in innate immunity, 21 mucosa-associated lymphoid tissue (MALT) lymphoma, 575 multicentric Castleman disease (MCD), 268 multicistronic operons, 375 multidrug-resistant tuberculosis (MDR-TB), 500 multinucleated giant cells, 250f multiple-host parasites, 770–771 multiplicity of infection (MOI), 109 mumps, 185–189 clinical aspects, 187–189 clinical capsule, 186 CNS infections and, 926t comparison, 186t complications, 188 diagnosis, 188 epidemiology, 186–187 immunity, 187 infection, 186–187 manifestations, 187–188 pathogenesis, 187 prevention, 188–189 virology, 185–186 mupirocin, 443 murine typhus, 628t, 679t mutant allele, 378 mutation, 125–127, 213 frameshift, 378, 379f herpesviruses, 159 HIV, 319 influenza A, 163 missense, 378 nonsense, 378 point, 126f types of, 378–379 mutational resistance, 427 mutations bacteria, 378–379 hepatitis C, 237 polar, 379 myc gene, 142, 263–264 mycetoma, 725, 727 mycobacteria, 373 case study, 505 cell-mediated immunity in, 491 of clinical importance, 492t 981 disease, 491 DTH and, 491 granuloma and, 491 soft tissue infections, 504 tuberculosis-like diseases caused by, 503–504 Mycobacterium, 489–505 acid-fast stain for, 490 AIDS and, 489 bacteriology, 489–491 cell wall, 490f classification of, 490–491 growth, 490 structure, 489–490 ulcers from, 912t Mycobacterium avium-intracellulare, 324t, 325, 492t, 503–504 in AIDS, 504 bacteremia from extravascular infection and, 930t Mycobacterium bovis, 492t, 628t Mycobacterium fortuitum, 492t, 504 complex, 504 Mycobacterium kansasii, 492t, 503 ethambutol for, 503 isoniazid for, 503 rifampin for, 503 Mycobacterium leprae, 492t, 501–503, 513 bacteriology, 501 tuberculoid form, 501 Mycobacterium marinum, 492t, 504 Mycobacterium scrofulaceum, 492t, 504 Mycobacterium smegmatis, 492t Mycobacterium tuberculosis, 3, 41, 51, 58, 85, 324t, 325, 356, 396, 491–500, 492t dormant, 496 eye infections from, 914t growth of, 402 lower respiratory tract infections from, 918t primary infection, 495–496 rifampin for, 418 in sputum, 490f Mycobacterium ulcerans, 492t, 504 mycolic acids, 489, 490, 491 mycology, 697–699 Mycoplasma, 411, 661–665 clinical cases, 665 electron micrograph, 662f general features, 661 tetracycline and, 415 Mycoplasma fermentans, 662t Mycoplasma genitalium, 662t, 665, 923t, 924t Mycoplasma hominis, 662t Mycoplasma pneumoniae, 661–665, 662t azithromycin for, 665 bronchiolitis, 663f clinical aspects, 664–665 clinical capsule, 662 diagnosis, 664–665 doxycycline for, 665 epidemiology, 662–663 fluoroquinolones for, 665 immunity, 664 infecting dose, 663 infecting respiratory epithelium, 663f lower respiratory tract infections from, 918t macrolides for, 665 manifestations, 664 pathogenesis, 663–664 treatment, 665 mycotoxins, 707 myelin basic protein (MBP), 148 myelitis, 664 myeloid stem cell, 20f myocarditis, 219t in American trypanosomiasis, 842f diphtheria and, 478f diphtheria toxin and, 477–478 myosin, 456 myringitis, 664, 915 982 INDEX N NAA See nucleic acid amplification N-acetylglucosamine (NAG), 356–357, 369, 370f, 652, 739 N-acetylmuramic acid (NAM), 356–357, 369 NAD See nicotinamide adenine dinucleotide NADPH See nicotinamide adenine dinucleotide phosphate Naegleria fowleri, 781, 819–820 trophozoites, 819–820 Naegleria spp., 813 nafcillin, 411 NAG See N-acetylglucosamine Nairovirus, 284 naked capsid viruses, 98 assembly of, 120–122 human, 113–114 nalidixic acid, 417, 424 NAM See N-acetylmuramic acid Napoleon, 875 narrow-spectrum agents, 408 nasopharyngeal carcinoma (NC), 265 natural immunity, 41 natural killer (NK) cells, 20f, 23, 29t, 145, 239 NC See nasopharyngeal carcinoma; nucleocapsid protein NCAM See neural cell adhesion molecule Necator americanus, 845, 846t egg structure, 856f life cycles of, 846t, 856, 857f parasitology, 855–856 structure of, 856f necrosis, caseous, 496 necrotic colonic cells, 529 necrotizing fasciitis, 519 necrotizing periodontal diseases, 693 necrotizing ulcerative gingivitis, 693 needle sharing, 238 needlestick transmission, of hepatitis B, 231 Nef protein, 315, 316 negative-sense RNA viruses, 301 Negri body, 303, 304f Neisseria, 535–549 bacteriologic features of, 536t general features, 535 lipooligosaccharide, 535 lipopolysaccharide, 535 pathogenic features of, 536t Neisseria gonorrhoeae, 15, 57, 90, 381, 396, 399, 412, 416, 429, 535, 536f, 541–549 antigenic variation, 542–543, 543f bacteriology, 541 cell wall, 538f eye infections from, 914t genital infection from, 923t, 924t lipooligosaccharide, 541, 542 Opa proteins, 399f pili, 542f plasmids, 428 porins, 541 septic arthritis from, 913t upper respiratory infection from, 916t Neisseria meningitidis, 8, 531, 535, 536–541 bacteremia from extravascular infection and, 929t bacteriology, 536 CNS infections and, 925t eye infections from, 914t genotypes, 406 in oropharynx, 10 plasmids, 428 rifampin for, 418 nelfinavir, 153t, 158 nemathelminthes, 767–768 nematodes intestinal, 845–862 case study, 862 life cycles of, 845 morphology, 845 tissue, 863–880 case study, 879 general characteristics of, 864t neomycin, 414, 443 neonatal herpes, 253, 924t nephritis, 459 in malaria, 796 nephrotoxicity, 156 neural cell adhesion molecule (NCAM), 301 neuralgia, VZV and, 257 neuraminidase, 162–163, 185, 189, 464 inhibition, 152, 153t, 171 neuromuscular junction, 523f Neurospora crassa, 699 neurosyphilis, 648 neurotoxin botulinum, 523f in clostridia, 516 neutralization, 68–69, 69–70, 146 neutrophils, 20f nevirapine, 153t, 158 nicotinamide adenine dinucleotide (NAD), 368, 551, 557, 559, 678, 780 nicotinamide adenine dinucleotide phosphate (NADPH), 367 nifurtimox, 785t for American trypanosomiasis, 843 nikkomycins, 716 action of, 715f features of, 714t Nipah virus, 299 nitazoxanide, 785t nitrate, 24, 366 nitrate reduction, 83 nitric oxide, 24 nitrite, 24 nitroimidazoles, 782 NK cells See natural killer cells NNRTIs See nonnucleoside reverse transcriptase inhibitors Nocardia, 418, 511–514, 727 amikacin for, 513 bacteriology, 511–512 cefotaxime for, 513 features, 508t imipenem for, 513 lower respiratory tract infections from, 918t minocydine for, 513 in sputum, 511f sulfonamides for, 513 trimethoprim–sulfamethoxazole for, 513 ulcers from, 912t Nocardia asteroides, 511 Nocardia brasiliensis, 511, 512 nocardiosis, 509f, 513 clinical aspects, 513 clinical capsule, 512 diagnosis, 513 epidemiology, 512 immunity, 512–513 manifestations, 513 pathogenesis, 512 treatment, 513 nonarthropod zoonotic viruses, 293–300 non-β-lactams, 409t noncommunicable infections, 87 nonconjugative plasmids, 386 noncytocidal viruses, 330 nongonococcal urethritis, 924t nonhemolytic streptococci, 460t, 468 non-Hodgkin lymphoma, 325 noninvasive luminal flagellates, 823–831 nonnucleoside reverse transcriptase inhibitors (NNRTIs), 158, 326, 327, 327f nonpermissive cells, 107, 138 nonproductive response, 107 nonpurulent otitis media, 664 nonsense mutation, 378 nonseptate hyphae, 700f, 739 nonsporulating Gram-positive bacteria, 517 nonsterile honey, 525 nonsusceptible resistance, definition, 408 nonvenereal treponemes, 660 Norovirus, 277 North American swine influenza, 167 Norwalk agent, 277 nosocomial infections, 49–50 from blood, 52 Creutzfeldt-Jakob disease, 348 environment, 51 from hospital personnel, 50–51 from medical devices, 51–52 precautions for, 54t prevention, 54 from respirators, 52 sources, 50–52 from urinary catheters, 51 from vascular catheters, 51–52 novel coronavirus 2012, 182 novobiocin, resistance, 444 nuclear inclusions, 258 nucleic acid amplification (NAA), 75, 499, 673 nucleic acid analysis, 75–80 methods, 75–78 for infectious diseases, 76–78 nucleic acid synthesis, 409t antifungals, 715–716 inhibitors, 154–155, 417–418 nucleocapsid, 98, 163, 283f assembly of, 120–122 nucleocapsid protein (NC), 310 nucleoid, 353 bacteria, 362 nucleoside reverse transcriptase inhibitors, 157–158, 326, 327, 327f nucleoside/nucleotide analog inhibitors, 159 nucleotide analogs, 155–156 nude mice, 336 nutrient broths, 82 nutrient media, 63 nystatin, 713 for Candida albicans, 735 features of, 714t for gonorrhea, 548 O O antigen, 579, 595 O antigen polysaccharide side chains, 359 obligate parasites, 763 oculoglandular tularemia, 637 oculomotor muscles, 478 ODC See ornithine decarboxylase ofloxacin, for tuberculosis, 500 oleic acid-albumin, 491 2′,5′-oligoadenylate synthetase, 145 oligosaccharides, 358 OMP See outer membrane protein Onchocerca spp., 874–877 Onchocerca volvulus, 774, 863, 871t, 874–877 general characteristics of, 864t life cycle of, 876f onchocerciasis, 777, 875–877 clinical aspects, 875–877 diagnosis, 877, 877f epidemiology, 875 ivermectin for, 877 manifestations, 875–876 prevalence of, 764t prevention, 877 treatment, 877 oncogenes, 142, 310, 330 oncogenic transformation, 107 oncogenic viruses, 140 oncogenicity of DNA viruses, 141t of RNA viruses, 141t oncoretroviruses, 309, 310, 330–331 O-nitrophenyl-β-D-galactoside, 83 ontogeny, 388 INDEX oocyst Cryptosporidium, 807 ingestion, 804 Toxoplasma gondii, 801 oophoritis, 188 Opa proteins, 399f, 542, 545 open reading frames (ORFs), 242 operating room, asepsis in, 52 operator region, 375 operon, 375, 375f ophthalmia neonatorum, 546, 914, 914t opisthorchiasis, prevalence of, 764t Opisthorchis spp characteristics, 896t infections from, 900 opportunistic anaerobes, 516t opportunistic fungi, 703 opportunistic infections in AIDS, 324t Enterobacteriaceae, 580–581 Escherichia coli, 586–586, 593 clinical capsule, 586 meningitis, 589 urinary tract infection, 586–588 flora in, 12 opportunistic pathogens, 392 opsonization, 23, 27 opsonophagocytosis, 398f optic neuritis, 914 OptiMAL, 798 Optochin, 460t, 467 OPV See oral polio vaccine oral hygiene, 689, 693 oral polio vaccine (OPV), 138, 218 Orbivirus, 285 orchitis, 188 orf, 202t, 207–208, 208f organ transplantation, 841 organogenesis, 195 Orientia tsutsugamushi, 677, 679t, 682–683 ornithine, 782 ornithine decarboxylase (ODC), 782 ornithosis, 673–674 oropharynx, 394t Neisseria meningitidis in, 10 streptococci in, 10 Oroya fever, 679t, 684 orthomyxoviruses, 162, 299 classification of, 102t Orthopoxvirus, 201, 202t oseltamivir, 152, 153t, 171 Osler, William, 3, 223 Osps See outer surface proteins osteomyelitis, 441, 913 chronic, 519 from dental caries, 691 etiologic agents, 913t otitis externa, 914, 915t otitis media, 465, 467, 556, 915, 915t outer membrane, 358 outer membrane protein (OMP), 651 Treponema pallidum, 647 outer membrane protein porins, 422 outer surface proteins (Osps), 655, 657 outpatient clinic, asepsis in, 53 ova and parasite examination, 777 overwintering, 285 oviparous, 769 owl eye cells, 258, 259f oxacillin, 411 oxazolidinones, 409t, 416 oxygen tolerance, 515 P p53, 142, 334, 336 P pili, 583 PA See protective antigen PABA See para-aminobenzoic acid packaging site, 120 PAIR See Percutaneous Aspiration Infusion of scolicidal and Reaspiration palivizumab, 177 PAMPs See pathogen-associated molecular patterns pancreatitis, 188 pandemic infections, 87, 131 antigenic shifts associated with, 167t cholera, 568 influenza, 168 Papanicolaou smear, 338, 338f papillomaviruses, 333–339 characteristics of, 334t classification of, 106t clinical aspects, 336–339 clinical capsule, 335 epidemiology, 335 genomes, 333 manifestations, 336 pathogenesis, 336 receptors, 110t STD from, 923t, 924t virology, 333–334 papovaviruses, 118, 333 incubation period, 136t para-aminobenzoic acid (PABA), 417 Paracoccidioides brasiliensis, 759–760 amphotericin B for, 760 azoles for, 760 disease, 760 features of, 746t sulfonamides for, 760 paragonimiasis, 897–900 diagnosis, 900 epidemiology, 897 manifestations, 899–900 prevalence of, 764t treatment and prevention, 900 Paragonimus africanus, 897 Paragonimus kellicotti, 897 Paragonimus mexicanus, 897 Paragonimus skrjabini, 900 Paragonimus spp., 895, 897–900 characteristics of, 896t disease caused by See paragonimiasis parasitology, 897 Paragonimus westermani, 897 lower respiratory tract infections from, 918t parainfluenza, 172–174 clinical aspects, 174 diagnosis, 174 diagram, 173f manifestations, 174 prevention, 174 treatment, 174 types, 173 upper respiratory infection and, 916t paralytic poliomyelitis, 217 paramyxoviruses, 112, 117, 147t, 172, 185, 299 classification of, 102t diagram, 173f enveloped, 172 paranasal sinuses, 394t Parapoxvirus, 201, 202t, 207 ParaSight F, 798 parasites, 6f, 8, 763–771 antigenic shifts in, 776 antigenic variation in, 776 commensalistic, 763 definition, 763 definitive hosts of, 769 diagnosis, 777–778 distribution of, 770t immune suppression by, 776 immunity, 774–777 intermediate hosts of, 769 obligate, 763 paratenic or transport hosts of, 769 983 pathogenesis of, 773–774 reservoir hosts of, 769 single-host, 770 sylvatic, 769–770 transmission of, 770t vector, 769 parasitic infections, 763–766 anthroponotic, 769 enzootic, 769 prevalence of, 764t synanthropic, 769 zoonotic, 769 parasitic stains, 59 paratenic host, 769 parechoviruses, 211 paresis, 648 paromomycin, 785t for cryptosporidiosis, 810 for giardiasis, 831 paronychia, 252 paroxysm, malarial, 797 parvovirus B19, 198–199 AIDS and, 198 erythema infectiosum, 198–199 parvoviruses, 118 classification of, 106t comparison, 186t receptors, 110t passive immunity, 41 hepatitis A, 227 Pasteur, Louis, 3–4, 301, 306, 485 Pasteurella multocida, 628t, 638 bacteremia from extravascular infection and, 929t wound infections from, 912t Pasteurella pestis, 632 pasteurellosis, 628t pasteurization, 47 See also unpasteurized dairy brucellosis and, 631 definition of, 43 for sterilization, 45t pathogen, 391 pathogen-associated molecular patterns (PAMPs), 23 manipulating, 397–398 pathogenesis, of infectious diseases, 14–15 pathogenicity, 391 bacterial, 403–406 islands, 405, 405f, 569, 582 pathogens, 12–13 opportunistic, 392 primary, 392 pathology, rubella, 196 PBPs See penicillin-binding proteins PCR See polymerase chain reaction pelvic inflammatory disease (PID), 543, 546–547, 547f, 672, 923, 924t penciclovir, 153t, 155, 254 penetration of bacteriophages, 111–114 inhibitors, 151–152 penetrin, 842 penicillin, 4, 17, 407, 408, 409t, 410, 411, 411f, 431 See also specific drugs for actinomycosis, 510–511 for anthrax, 486–487 for Bacillus anthracis, 486–487 benzyl, 408 for Clostridium perfringens, 522 for gonorrhea, 548 for group A streptococcus, 429 for group B streptococci, 463 for leptospirosis, 652 for pneumococcal disease, 467 Pseudomonas aeruginosa and, 411 resistance, 425, 622 for Streptococcus pneumoniae, 467 for tetanus, 528 for Treponema pallidum, 429, 650 984 INDEX penicillin-binding proteins (PBPs), 371, 410, 424, 425, 548 Penicillium, 408, 410, 716 penile candidiasis, 924t pentamer, 103 penton projections, 179 peplomers, 104, 181, 189 peptidoglycan, 23, 356–357, 358, 410 fragments, 438 structure, 358f synthesis, 369–371, 370f antimicrobials acting on, 410f peptidyl transferase, 415 Peptostreptococcus, 517t, 519f, 928t, 929t Percutaneous Aspiration Infusion of scolicidal and Reaspiration (PAIR), 893 perforins, 145 periapical abscess, 691 periapical granuloma, 691 pericarditis, 219t perihepatitis, 924t perinuclear inclusions, 258 periodontal abscess, 693 periodontal diseases, necrotizing, 693 periodontitis, chronic, 692–693, 692f peripheral nerves, 188 periplasm, 358, 371 periplasmic gel, 358 peritonsillar abscess, 916, 916t permissive cells, 107, 138 peroxidase, 367 persistent infection, 107, 137, 139 enterovirus, 344 viral, 139 CNS, 343–349 persistent inflammation, 402 persistent mucocutaneous herpes simplex, 324t persistent viruses, 97 pertactin, 559 pertussis, 558, 560–564 azithromycin for, 563 catarrhal phase, 562 cellular view, 561f cephalosporins for, 563 clarithromycin for, 563 clinical aspects, 562–564 clinical case, 564 convalescent phase, 562 diagnosis, 563 epidemiology, 560 erythromycin for, 563 immunity, 562 immunization, 18, 560 in lymphocytosis, 562 manifestations, 562–563 paroxysmal phase, 562 pathogenesis, 560–562 genetic regulation, 561–562 prevention, 563–564 treatment, 563 virulence, 560–561 pertussis toxin (PT), 559 pets, toxocariasis and, 866 phage genes, 130 phagocytes, 23–24 phagocytosis, 23–24, 25f, 145, 398 capsule and, 553 in protozoa, 767 phagolysosome, 23 phagosome, 396, 495, 629, 750 pharmacology acyclovir, 154 amantadine, 152 rimantadine, 152 pharyngitis, 180, 430, 477, 664, 916, 924t group A streptococci, 452–453, 457 pharyngoconjunctival fever, 180 pharynx, microbiota in, 10–11 phenanthrene, 781 phenol, 48 phenolic glycolipid [PGL-1], 501 phenolics disinfection with, 48 for sterilization, 45t phenotypic resistance, 160 pheromones, 388 Phialophora verrucosa, 720t Phlebotomus, 281, 837 Phlebovirus, 284 phospholipase, 620 photoreactivation, 43 Phthirus pubis, 924t phylogenetic relationships, 389 phylogeny, 388 physical barriers, in innate immunity, 21–22 picornaviruses, 110, 211 classification of, 102t replication cycle of, 212f PID See pelvic inflammatory disease piedra, 724 black, 722f, 724 white, 724 Piedraia hortae, 720t, 724 pilE, 542 pili, 361, 361f, 396f Bordetella pertussis, 559 Escherichia coli, 583 Neisseria gonorrhoeae, 542f P, 583 sex, 386f, 387 type I, 583, 588 pilin, 361 pilot proteins, 114 pilS, 542 pinocytosis, in protozoa, 767 pinta, 660 pinworm, 766, 846t piperacillin, 409t, 411 pityriasis versicolor, 724 plague, 431, 627–628, 628t See also Yersinia pestis clinical capsule, 631 diagnosis, 635 epidemiology, 631–632, 631f immunity, 634 manifestations, 634–635 pathogenesis, 633–634 prevention, 635 treatment, 635 plant viruses, 97 plaque, 108 See also dental plaque assay, 124, 125f plasma cells, 35 plasma membrane, 359 plasmids, 385–386 bacteria, 362 conjugative, 386 fingerprinting, 77f mobilization, 386 Neisseria gonorrhoeae, 428 Neisseria meningitidis, 428 nonconjugative, 386 R, 388 in resistance, 427–428 Plasmodium, 788–800 asexual phase of, 789 characteristics of, 791t definition, 788 growth in laboratory, 793 intrahepatic dormancy, 789 life cycle of, 788–789 morphology, 790–792 physiology, 791–792 sexual phase of, 788 Plasmodium falciparum, 764, 780, 781, 788 characteristics of, 791t distribution of, 770t growth in laboratory, 793 resistance of, 784, 799 transmission of, 770t Plasmodium knowlesi, 788 Plasmodium malariae, 788 characteristics of, 791t Plasmodium ovale, 788 characteristics of, 791t radical cure, 799 Plasmodium vivax, 788 characteristics of, 791t life cycle of, 791f radical cure, 799 platelets, 20f Plesiomonas, 624, 625t tetracycline for, 624 pleural effusion, 917 pleuritic pain, 220 PMC See pseudomembranous colitis PMN See polymorphonuclear neutrophil pneumococcal capsule, 464f pneumococcal disease capsule in, 466 clinical capsule, 464 diagnosis, 467 epidemiology, 465 GBS and, 461f group B streptococci, 464–468 immunity, 466 manifestations, 466–467 pathogenesis, 465–466 pneumolysin, 466 in polymorphonuclear leukocytes, 466 prevention, 468 treatment, 467–468 pneumococcal meningitis, 467 pneumococcal pneumonia, 466–467 pneumococcal polysaccharide vaccine (PPV), 468 pneumococci, 11, 448–449, 449t Pneumocystis carinii, 739 Pneumocystis jirovecii, 324t, 418, 739, 781 Pneumocystis spp., 739–742 AIDS and, 739, 741 classification of, 702t disease caused by See pneumocystosis immunity, 741 opportunistic, 730t pathogenesis, 741 pneumonia, 740, 740f sporocytes, 739 pneumocystosis, 740–742 in AIDS, 742 clinical aspects, 742 clinical capsule, 740 diagnosis, 742 epidemiology, 740–741 immunity, 741 manifestations, 742 pathogenesis, 741 prevention, 742 treatment, 742 trimethoprim-sulfamethoxazole for, 742 pneumolysin, 464 cilia and, 466 in pneumococcal disease, 466 Streptococcus pneumoniae, 466 pneumonia, 441, 553 acute, 917, 918t chronic, 917, 918t epidemiology of, 465 etiologic agents, 918t Haemophilus influenzae, 556 infant, 672, 924t Legionella, 611f mycoplasmal, 661–665 pneumococcal, 466–467 Pneumocystis, 740, 740f INDEX Pseudomonas aeruginosa, 620f walking, 664, 674 pneumonic plague, 633, 635 pneumonic tularemia, 637 pneumonitis, 742 diffuse, 742 pneumovirus, 174 podophyllin, 338 podophyllotoxin, 338 poikilocytosis, 338 point mutation, 126f pol, 310, 311t, 315 polar flagella, 361 polar mutations, 379 poliomyelitis, 217f abortive, 217 bulbar, 217 inactivated vaccine, 218 paralytic, 217 pathogenesis, 132f subclinical, 218 vaccine, 17 vaccine-associated, 218 polioviruses, 110, 211, 213 clinical aspects, 217–219 epidemiology, 216–217 manifestations, 217–218 pathogenesis, 217 prevention, 218–219 recombinants, 128 vaccine, 138 polyenes, 713 features of, 714t resistance, 717 polyglycan production, 691 polymerase chain reaction (PCR), 75, 125, 170, 181, 188, 199, 238, 252, 261, 271, 336, 659, 778 applications of, 80 in Chlamydia trachomatis, 673 diagnostic applications of, 79f polymerization reactions, 368–371 peptidoglycan synthesis, 369–371, 370f transcription, 368 polymorphonuclear leukocytes, 29t, 456 infiltrating, 462 in pneumococcal disease, 466 polymorphonuclear neutrophil (PMN), 23, 249, 402, 536f, 538f, 733 polymyxin B, 409t, 419 polyomaviruses, 144, 339–341 characteristics of, 334t classification of, 106t clinical aspects, 341 clinical capsule, 340 diagnosis, 341 epidemiology, 340 manifestations, 341 pathogenesis, 340 receptors, 110t virology, 339–340 polyproteins, 117 polyribitol phosphate (PRP), 552, 557 polysaccharides core, 359 O antigen, 359 Pontiac fever, 613 pore-forming exotoxins, 401f, 586 pore-forming proteins, 145, 842 pore-forming toxins, 400 in group B streptococci, 464 porins, 359, 377f Neisseria gonorrhoeae, 541 outer membrane protein, 422 pork freezing, 867 undercooked, 897 tapeworms and, 886f trichinosis and, 867 pork tapeworm, 884–887 albendazole for, 887 disease, 885–887 diagnosis, 887 epidemiology, 885 manifestations, 886–887 life cycle, 886f praziquantel for, 887 prevention, 887 treatment, 887 Porphyromonas, 517, 517t, 687, 692 Porphyromonas gingivalis, 692 posaconazole, features of, 714t poststreptococcal acute glomerulonephritis, 402 poststreptococcal sequelae, 454, 456, 459 potassium hydroxide (KOH), 709f, 723, 726, 735, 752, 754, 758 potassium iodide, 716 features of, 714t potassium tellurite, 478 Powassan virus, 292 poxviruses, 201–208 classification of, 106t electron microscopic appearance, 202f group characteristics, 201–203 human, 202t incubation period, 135t replication, 201–203, 203f virion structure, 202f PPD See purified protein derivative PPV See pneumococcal polysaccharide vaccine praziquantel, 784 for pork tapeworm, 887 for schistosomiasis treatment, 900, 902, 907 precautions airborne transmission, 53, 54t contact, 53, 54t droplet, 53, 54t for nosocomial infections, 54t standard, 53, 54t transmission-based, 53, 54t precipitation, 69 premunition, 774, 803 prevalence, 91 of viral infections, 131 prevention See also immunization; vaccines of infectious diseases, 17–18 Prevotella intermedia, 693 Prevotella melaninogenica, 517 Prevotella spp., 517, 517t, 687 primaquine, 780 for malaria, 792t primary cell culture, 66–67 primary culture, of viruses, 108 primary effusion lymphoma (PEL), 268 primary pathogens, 392 primary response, 39 primary syphilis, 646f, 647 primary tuberculosis, 494f, 497, 750 primary viremia, 136 prion(s), 97, 140, 343 biologic and physical properties, 345t protein conversion, 347f prion diseases, 344t, 345–346 proctitis, 924t progeny virions, 97 proglottids, 768, 882, 887 progressive fibrosis, 232 progressive multifocal leukoencephalopathy, 324t, 341, 344 progressive postrubella panencephalitis, 344 proguanil, 781 resistance, 784 proinflammatory cytokines, 670 prokaryotic cells, 353, 355f features of, 7t promastigote, 831 promoter region, 375 985 propagation, of viral infections, 131 prophage, 129, 384 prophylaxis, 92 with acyclovir, 154–155 antibacterial agents, 431 hepatitis B immune globulin, 234 rabies, 306 rifampin, 558 propiolactone, 306 Propionibacterium acnes, 912t Propionibacterium spp., 10, 510, 517t prostaglandin, 25 prostatitis, 921 protease inhibitors, 158, 326, 327, 327f proteases, 310, 313 coccidioidomycosis, 757 proteasome, 31 protective antigen (PA), 483 protein A, 434 protein carriers, 36 protein exotoxins, 580 protein F, 451, 454 protein secretion, transport systems, 371–373 protein synthesis inhibitors, 413–416 proteinase, 83 Proteus mirabilis, 607 Proteus spp., 580, 585t, 607, 915t osteomyelitis from, 913t protomer, 103 proton pump inhibitors, 576 proto-oncogenes, 142, 331 protoplast, 358 protozoa, 763, 766–767 classes of, 766–767, 766t ectoplasm, 767 endoplasm, 767 phagocytosis in, 767 pinocytosis in, 767 reproduction, 767 protrusion-associated proteins, 663 Providencia, 580, 607 provirus, 129, 313 PRP See polyribitol phosphate PrPc, 346 PrPsc, 348 Prusiner, Stanley, 345 pseudocowpox, 202t, 208 pseudocysts, 842 pseudohyphae, 700, 731 pseudomembranes, 476–477, 529 diphtheria, 477f pseudomembranous colitis (PMC), 529 Clostridium difficile, 529f Pseudomonas, 51, 52, 412, 421, 617–623, 921 bacteremia from extravascular infection and, 929t clinical case, 626 pneumonia from, 918t treatment, 414 Pseudomonas aeruginosa, 617–623, 625t alginate biofilm, 618, 621f amikacin for, 622 bacteriology, 617–618 cephalosporins for, 622 cystic fibrosis and, 619, 621, 622f diagnosis, 622 disease, 618–623 cellular view, 620f clinical aspects, 621–623 clinical capsule, 618 epidemiology, 618–619 manifestations, 621–622 overview, 619f pathogenesis, 619–621 ear infections, 915t eye infections, 914t folliculitis caused by, 912t gentamicin for, 622 986 INDEX Pseudomonas aeruginosa (Cont.): immunity, 621 lipopolysaccharide, 618 lower respiratory tract infections from, 918t osteomyelitis from, 913t penicillins and, 411 pigment production, 623f pneumonia, 620f prevention, 623 quinolones for, 417 ticarcillin for, 622 tobramycin for, 622 treatment, 622–623 wound infections from, 912t Pseudomonas fluoresces, 625t pseudopodia, 813 psychrophiles, 373 PT See pertussis toxin Pteropus, 300 pubic lice, 924t puerperal infections, group A streptococci, 453–454, 458 pulmonary anthrax, 486 pulmonary blastomycosis, 754 pulpitis, 691 purified protein derivative (PPD), 498, 503 purulent meningitis, 925 pyelonephritis, 921 pyocyanin, 618 pyoderma See impetigo pyogenic streptococci, 448, 449t, 463 pyrantel pamoate, 785t pyrazinamide, for tuberculosis, 499 pyrimethamine, 782, 799 resistance, 784 for toxoplasmosis, 806 pyrogenic exotoxins, group A streptococci, 458 Q Q fever, 614–615, 628t clinical aspects, 615 Qinhaosu, 781 quantitative buffy coat (QBC), 798 quaternary ammonium compounds, 48 for plaque inhibition, 689 for sterilization, 45t quinacrine hydrochloride, for giardiasis, 831 quinidine, 780–781 quinine, 780 for malaria, 792t 4-quinolinemethanols, 780 quinolones, 417 antimalarial, 780–781 for Chlamydia, 417 for Legionnaires disease, 614 for Pseudomonas aeruginosa, 417 quinones, 781 quinsy See peritonsillar abscess quinupristin, 409t, 416 quorum-sensing system, 619 in bacterial infections, 403–405 R R5, 310, 312, 319, 320, 321 R factors, 388 R plasmids, 388 RA 27/3, 197 rabies, 105f, 301–307, 305t acute neurologic stage, 305t aerosol spread of, 303 clinical aspects, 305–307 clinical capsule, 302 clinical stages of, 305t CNS infections and, 926t diagnosis, 306 electron micrograph of, 302f encephalitis in, 305 epidemiology of, 302–303 in humans, 302–303 incubation period, 303, 305t manifestations, 305 pathogenesis, 303–305 postexposure prophylaxis, 307 prevention, 306–307 prodrome stage, 305t receptors, 110t sequential steps in, 304f transmission of, 301 treatment, 306 in United States, 303f vaccine, 306 virology, 301–302 raccoons, 302, 866 radioimmunoassay, 70, 71 raltegravir, 153t, 158 rapid plasma reagin (RPR), 649 Raynaud phenomenon, 664 reactivation tuberculosis, 494f, 496–497 AIDS and, 497–498 predisposing factors, 497 reactive nitrogen intermediates, 24 reactive oxygen intermediates, 23–24 reagin, 649 reassortment, 163 RecA, 381 receptor-mediated endocytosis, 112 receptors, 109 recipient cell, 382 recombination, 127–129 antigenic variation and, 381 in bacteria, 380–381 high-frequency, 129 homologous, 380f, 381 in RNA viruses, 129 site-specific, 381 recurrent genital herpes, 252–253 red blood cells, 597 binding, 124 merozoites in, 789 trophozoites in, 789 reducing agents, 65 reduviid bug, 841 regulator protein, 375 regulatory proteins, HIV, 315–316 regulon, 375, 377 cell stress, 375–376 relapsing fever, 628t, 653–655 clinical aspects, 654–655 doxycycline for, 654 louse-borne, 653 prevention, 654–655 tetracycline for, 654 tick-borne, 653 treatment, 654 relatedness, 388 release, bacteriophages, 122 reoviruses, 115, 182–183, 282t, 284–285 case study, 183 classification of, 102t receptors, 110t replacements, 378, 379t replicative transposition, 382 repressible genes, 376f repressor, 129, 375 reproductive systems, of trematodes, 895 RES See reticuloendothelial system residents, resistance acquired, 427, 428f aminoglycosides, 423t, 470, 622 ampicillin, 557 to antibiotics, 17 antifungals, 716–717 antimicrobial, 419–431 features of, 423t mechanisms, 422–427, 424f Staphylococcus aureus, 443 antiparasitic antimicrobics, 784–785 antiviral, 159–160 atovaquone, 784 azole, 717 binding sites and, 424 cephalosporins, 425, 607 chloramphenicol, 423t chloroquine, 780, 794 clindamycin, 423t, 425 conjugation and, 427–428 definition, 716–717 echinocandins, 717 enzymatic inactivation, 425–427, 443 epidemiology of, 429 erythromycin, 470 flucytosine, 717 fluoroquinolones, 423t, 549 folate inhibitors, 423t ganciclovir, 155 genetics of, 427–429 transposition, 428 transposons, 428 genotypic, 160 glycopeptides, 423t HIV, 328 intrinsic, 427 β-lactamase, 470, 572 β-lactams, 423t macrolides, 423t of malaria, 764–765 mechanisms, 717 moderate, 419 mutational, 427 novobiocin, 444 penicillin, 425, 622 phenotypic, 160 plasmids in, 427–428 of Plasmodium falciparum, 784, 799 polyenes, 717 proguanil, 784 pyrimethamine, 784 rifampin, 423t sulfadoxine, 784 sulfonamides, 425, 470 susceptibility and, 419–420 tetracycline, 423t, 470, 532 trimethoprim, 425 vancomycin, 425 viral, 151–160 virulence, 422 respiration, 365, 366 respirators, nosocomial infections from, 52 respiratory spread, 88–89, 133t respiratory syncytial virus (RSV), 112, 161, 174–177 antigenic subgroups, 174 asthma and, 176 diagnosis, 177 epidemiology, 175 immunity, 176 inflammation in, 175f lower respiratory tract infections from, 918t manifestations, 176 mortality, 176 pathogenesis, 175 prevention, 177 treatment, 177 virology, 174 respiratory tract infections lower, 917–918 etiologic agents, 918t sputum and, 918 middle, 916–917 etiologic agents, 917t upper, 916 etiologic agents, 916t INDEX respiratory tract, microbiota in, 11 retapamulin, 416 reticulate body, 667–668 reticulocytes, 793 reticuloendothelial system (RES), 602 retinoblastoma protein, 142, 334 Retortamonas intestinalis, 824t retropharyngeal abscess, 916, 916t retrotonsillar abscesses, 916 retroviruses, 123–124, 309–331 antigenic drift of, 127 classification of, 102t diploid nature of, 129 entry, 310–312 genes, 314–315 incubation period, 136t life cycle, 312f major genes, 311t post-entry events, 312–314 replication cycle, 310–314 RNA replication, 313f structure, 310, 314f transducing, 142 transformation by, 142–143, 330–331 virology, 310–322 Rev protein, 315 reverse transcriptase, 115, 309, 310, 313 HIV, 314 reverse transcriptase PCR (RT-PCR), 216 reverse transcription, 128, 313 Rev-responsive element (RRE), 316 Reyes syndrome, 170 RGD receptors, 23 rhabditiform larve, 856 Rhabdoviridae, 117, 301 classification of, 102t disease caused by See rabies rheumatic fever, 40 rheumatic heart disease, 454, 459 rhinitis, 916, 916t rhinoviruses, 110, 180–181, 212 prevention, 181 receptors, 110t treatment, 181 upper respiratory infection from, 916t Rhipicephalus sanguineus, 680 rhizopods, case study, 821 Rhizopus, 738 classification of, 702t Rhodococcus, 513 features of, 508t ribavirin, 153t, 156–157 aerosol administration, 156–157 ribotyping, 82 rice-water stools, 570 Rickettsia, 61, 414, 628t, 677–683 bacteriology, 677–679 chloramphenicol and, 415 disease, 680–683 clinical capsule, 678 diagnosis, 680–681 epidemiology, 679 pathogenesis, 679–680 spotted fever group, 680–682 typhus group, 682–683 examples of, 679t metabolism, 677–678 structure, 677 tetracycline and, 415 vasculitis, 679f Rickettsia africae, 679t Rickettsia akari, 679t, 681–682 Rickettsia australis, 679t Rickettsia conorii, 679t Rickettsia prowazekii, 679t, 682 Rickettsia rickettsii, 292, 679t, 680–681 Rickettsia typhi, 628t, 679t, 682 rickettsial spotted fevers, 628t rickettsial zoonotic infections, 628t rickettsialpox, 679t, 681–682 doxycycline for, 682 rifampin, 368, 409t, 418, 443 for brucellosis, 631 for Haemophilus influenzae, 418, 558 for Legionnaires disease, 614 for leprosy, 503 for meningococcal disease, 541 for Mycobacterium kansasii, 503 for Mycobacterium tuberculosis, 418 for Neisseria meningitidis, 418 prophylaxis, 558 resistance, 423t for tuberculosis, 499, 500 rifamycins, 409t rifapentine, 409t rifaximin, 409t rimantadine, 151, 153t, 171 pharmacology, 152 toxicity, 152 ringworm, 720f, 721 ritonavir, 153t, 158 RNA polymerase, 368, 375 RNA synthesis inhibition, 157 RNA viruses, 120 double-stranded, 273 error rates, 126 negative-sense, 301 oncogenicity of, 141t recombination in, 129 transformation by, 143 RNase H, 314 RNase L, 145 Rocky Mountain spotted fever, 679t, 680–681, 681f, 683f diagnosis, 680–681 doxycycline for, 681 epidemiology, 680 manifestations, 680 prevention, 681 treatment, 681 Romaña sign, 842 roseola, 199, 267 comparison, 186t roseola infantum, 199 rotavirus, 12, 273–277, 920t animal, 275 clinical aspects, 277 clinical capsule, 276 diagnosis, 277 epidemiology, 276 fecal-oral spread, 274 immunity, 276–277 manifestations, 277 morbidity, 274f pathogenesis, 276 prevention, 277 receptors, 110t replication, 275f structure, 273f, 274f treatment, 277 vaccines, 275, 277 virology, 273–275 roundworms, 846t See also Ascaris lumbricoides; nematodes RPR See rapid plasma reagin RRE See Rev-responsive element RSV See respiratory syncytial virus RT-PCR See reverse transcriptase PCR rubella, 194–197 antibody response in, 195f clinical aspects, 196–197 clinical capsule, 194 comparison, 186t congenital infection, 195, 196 diagnosis, 197, 199 epidemiology, 194 987 fetal infection, 195, 197 immunity, 196 immunosuppression and, 149 infection, 194–196 isolation, 195f manifestations, 196–197 pathogenesis, 194–196 pathology, 196 persistence of, 195f prevention, 197 rash, 195, 196f, 199 treatment, 197 vaccine, 197 virology, 194 rubeola, 191 ruffles, Salmonella enterica, 600, 601f Russian flu, 167 S S phase, 118 S strand, 284 Sabouraud’s agar, 710 Saccharomyces cerevisiae, 699f saliva, 691 salivary spread, 89, 133t Salmonella, 56, 381, 392, 396, 571, 580, 599–605, 628t bacteriology, 599 enteric infections from, 920t gastroenteritis, 599–601 clinical capsule, 599 gastrointestinal infections from, 921t invasion, 596f osteomyelitis from, 913t Salmonella enterica, 585t, 599–601, 930t adherence, 600 enterotoxin, 601 epidemiology, 600 immunity, 601 pathogenesis, 600–601 ruffles, 600, 601f Salmonella serovar, 929t Salmonella typhi, 420, 599, 601–602 clinical capsule, 601 salmonellosis, 603–605, 628t ampicillin for, 604 bacteremia, 603 cefixime for, 604 ceftriaxone for, 604 chloramphenicol for, 604 ciprofloxacin for, 604 clinical aspects, 603–605 diagnosis, 604 enteric fever, 603–604 gastroenteritis, 603 manifestations, 603–604 metastatic infection, 603 prevention, 604–605 treatment, 604 salpingitis, 546, 547, 672, 924t San Joaquin Valley, 755, 756, 758 sanitization, definition of, 43 Sapovirus, 277 saquinavir, 153t, 158 sarcolemma, 456 sarcomastigophora, 766, 766t, 813–821 Sarcoptes scabiei, 924t SARS See severe acute respiratory syndrome satellite phenomenon, 551 saturated solution potassium iodide (SSKI), 727 scabies, 924t scaffolding proteins, 122 scalded skin syndrome, 439f, 441–442 scanning electron micrograph Chlamydia trachomatis, 670f Vibrio cholerae, 566f scarlet fever, 199, 452, 458 Schistosoma bovis, 908 988 INDEX Schistosoma haematobium, 774, 895 epidemiology, 905 infections, 906 life cycle, 903f parasitology, 903–904 Schistosoma intercalatum, 903 Schistosoma japonicum, 781, 895 epidemiology, 905 infections, 906 life cycle, 903f parasitology, 904 prevention, 908 Schistosoma mansoni, 777, 781, 895 eggs, 898f epidemiology, 904–905 infections, 906 larvae, 901f life cycle, 903f parasitology, 903–904 Schistosoma mekongi, 903, 905 Schistosoma spp., 895 disease caused by See schistosomiasis eggs, 898f, 904 life cycle of, 898f, 903–904 parasitology, 903–904 schistosomes, 895, 903f schistosomiasis, 765 clinical aspects, 905–907 diagnosis, 907 epidemiology, 904–905 immunity, 905 Katayama syndrome and, 906 pathogenesis, 905 prevalence of, 764t prevention, 908 stages of, 905–907 treatment, 900, 907 vaccine development for, 908 schizogony, 767, 789 exoerythrocytic, 789 schizonts, 789 Schuffner dots, 791 Schwann cells, 501 scolex, 768 scrapie, 97, 348 scrub typhus, 679t, 682–683 secondary cell culture, 66–67 secondary response, 39 secondary syphilis, 646f, 647 secondary viremia, 136 secretory component, 37 secretory IgA, 39, 276–277, 393 secretory piece, 39 selectins, 25 selective media, 63 Semmelweis, Ignaz, 13, 49–50 sensitivity definition, 408 moderate, 419 septate hyphae, 699, 700f, 735 septic arthritis, 519, 913 diagnosis of, 913t etiologic agents, 913t synovial fluid findings and, 913t sequelae, 188 serine proteases, 145 serologic classification, 72 serologic detection, 68–69 serotypes, 104, 172, 580 serous otitis media, 915t Serratia, 580, 585t, 607 serum sickness, 41 severe acute respiratory syndrome (SARS), 85, 181 sex pilus, 361, 386f, 387 sexual transmission of Chlamydia, 670 of HIV, 317 syphilis, 645 sexually transmitted infections (STDs), 922–924, 924t See also genital infections Shakespeare, 433, 436 shaking chill, 466 shellfish, undercooked, 897 Shiga toxin, 587f, 592 enterohemorrhagic Escherichia coli, 592 Escherichia coli, 586 Shigella, 597 Shigella, 22, 56, 396, 580, 593, 595–598, 602 gastrointestinal infections from, 921t immunity, 597 Shiga toxin, 597 Shigella boydii, 584t, 595 Shigella dysenteriae, 584t, 595, 596, 920t bacteremia from extravascular infection and, 929t Shigella flexneri, 584t, 595, 596 invasion, 596f Shigella sonnei, 584t, 595, 596 shigellosis, 595–598 ampicillin for, 598 azithromycin for, 598 ceftriaxone for, 598 ciprofloxacin for, 598 clinical aspects, 598 clinical capsule, 595 diagnosis, 598 epidemiology, 595–596 manifestations, 598 pathogenesis, 596–597 prevention, 598 treatment, 598 shingles, 255 sialic acid, 464, 538 sickle cell disease, 664 sickle cell trait, 793 siderophores, 365, 397 silver nitrate, 673 simian malaria, 797 simple diffusion, 364 simple transposition, 383f Simulium, 875, 877 single-host parasites, 770 single-stranded RNA, 162 singlet oxygen, 24 sinus infections, 915 etiologic agents, 915t sinusitis, 467, 556 site-specific recombination, 381 skin, 394t Candida albicans infection, 734f flora, 9–10 infections, 911–912 acne, 911, 912t cellulitis, 911, 912t erysipelas, 911 etiologic agents of, 912t folliculitis, 911, 912t furuncle, 911, 912t impetigo, 911, 912t intertrigo, 912t ulcers, 912t in innate immunity, 21 microbiota in, 9–10 skin-to-skin transfer, 90, 133t sledgehammer smallpox, 205 sleeping sickness See African trypanosomiasis slim disease, 325 slime layer, 354 slow viral diseases, 343 smallpox, 203–205 See also variola clinical aspects, 205 diagnosis, 205 epidemiology, 14 facial lesions of, 205f immunity, 206 manifestations, 205 pathogenesis, 205 prevention, 205 vaccine, 41 virology, 203 Smith, Sydney, 447 sodium stibogluconate, 783 soft palate, 477 sources, 87 Southern hybridization, 75 Southern transfer, 80 spasticity, 346 specialized transduction, 130, 385 species, 388 specific therapy, antibacterial agents, 430 specimen, 55–57 collection, 57, 922 direct examination, 57–61 direct tissue, 55–56 fluid samples, 55–56 indirect samples, 56 quality, 55 transport, 57 spectrum, of antibacterial agents, 408 spelunkers, 750 spherical architecture, 103 spherules, 754 Coccidioides immitis, 754 spikes, 98, 104, 109, 136, 139 spinal cord, 188 spiramycin, 785t, 806 spirochetes, 641–643 bacteriology, 641–643 classification, 641–643 clinical case, 659 disease, 643 features of, 643t growth, 641–643 morphology, 641, 642f shape, 354f structure, 641 spongiform changes, 345f spongiform encephalopathies, subacute, 345–350 spores bacteria, 362–363 coat, 363 cortex, 363 in fungal reproduction, 699 membrane, 363 sporocytes, Pneumocystis, 739 sporogony, 767 Sporothrix, 725–727, 912t classification of, 702t Sporothrix schenckii, 707, 720t, 725–727 sporotrichosis, 725–727, 726f clinical aspects, 726–727 clinical capsule, 725 diagnosis, 726 epidemiology, 725 immunity, 726 manifestations, 726 pathogenesis, 725 prevention, 727 treatment, 727 sporozoites, 789 sporulation, 363, 377 spotted fever group, 680–682 sputum, 918 Gram-positive bacteria in, 486 Mycobacterium tuberculosis in, 490f Nocardia in, 511f SSKI See saturated solution potassium iodide SSPE See subacute sclerosing panencephalitis St Louis encephalitis, 289, 926t stable toxin (ST), Escherichia coli, 586 staccato, 672 stains acid-fast, 58–59, 60f acridine orange, 798 crystal violet, 60f INDEX endospore, 60f flagellar, 60f fluorochrome, 59 fungal, 59 Gram, 57–58, 60f India ink capsule, 60f iodine, 61f methylene blue, 60f parasitic, 59 standard precautions, 53 for nosocomial infections, 54t StaphSAgs, 452 staphylococcal scalded skin syndrome, 439f, 441–442 staphylococcal toxic shock syndrome, 440f, 442 staphylococci, 10, 433–445 coagulase-negative, 443–445 group charecteristics, 433 superantigen toxins, 435 Staphylococcus aureus, 11, 357, 388, 392, 433–443, 434f, 444, 551 antimicrobial resistance, 443 bacteriology, 433–435 carbuncle, 439f, 440 carriers, 51 cellular view, 437f cellulitis, 912t chemoprophylaxis, 443 chronic furunculosis, 440 clinical aspects, 441–443 CNS infections and, 925t deep lesions, 440 diagnosis, 442 disease, 436f drying, 436 ear infections from, 915t enterotoxins, 435–436 epidemiology, 436–437 exfoliatin and, 435 extracellular enzymes, 434–436 eye infections from, 914t features, 434t folliculitis, 912t food poisoning, 437, 442 furuncles, 438f, 440, 912t gastrointestinal infections from, 921t hospital outbreaks, 436–437 immunity, 440 impetigo, 440, 912t infective endocarditis and, 928t influenza A and, 170 intertrigo, 912t lower respiratory tract infections from, 918t manifestations, 441–442 metabolism, 434 methicillin-resistant, 425 osteomyelitis from, 913t pathogenesis, 437–440 prevention, 443 primary infection, 437–438, 440 relapsing, 440 septic arthritis from, 913t shape, 354f sinus infections from, 915t structure, 433–434 superantigen toxins, 435–436 suppurative thrombophlebitis and, 928t toxic shock syndrome, 34 α-toxin, 434, 435f toxin-mediated disease, 439–440 toxins, 434–436, 441–442 treatment, 442 wound infections from, 912t Staphylococcus epidermidis, 444 CNS infections and, 925t Staphylococcus saprophyticus, 444 UTI from, 922 stationary phase, 373 cells, 377 stavudine, 153t, 157 STDs See sexually transmitted infections steam, 45–46 stem cells, 20f hematopoietic, 20f lymphoid, 20f myeloid, 20f Stenotrophomonas maltophilia, 625t sterile swab, 57 sterilization, 44–47 chemicals, 45t definition of, 43 ethylene oxide gas, 45t, 46 heat, 45–46, 45t ionizing radiation for, 45t, 46–47 methods, 45t radiation, 45t ultraviolet radiation for, 45t, 46–47 stillbirth, 805 stomach, 393, 394t stool, flora, 11f strep throat, 14 StrepSAgs, 452, 455 streptococcal superantigen toxins, 452 streptococcal toxic shock syndrome, 454, 456, 458–459 streptococci, 447–468 biochemical characteristics, 460t classification, 448–449, 449t cultural characteristics, 460t group A, 15, 450–460 acute, 454–456 antigenic structure of, 450f bacteriology, 450–457 cellular view of, 455f clinical capsule, 452 diagnosis, 459 disease, 453f epidemiology, 452–454 erysipelas, 458 extracellular products, 451–452 Gram stain, 448f growth, 450 immunity, 457 impetigo, 453, 457 M protein and, 450–451 manifestations, 457–459 morphology, 450 nephritogenic strains, 454 pathogenesis, 454–456 penicillin for, 429 pharyngitis, 452–453, 457 poststreptococcal sequelae, 454 prevention, 460 puerperal infections, 453–454, 458 pyrogenic exotoxins, 458 structure, 450–451 surface molecules, 451 toxic shock syndrome, 34 treatment, 460 TSS, 454 wounds, 453–454 group B, 431, 460–468 aminoglycosides for, 463 ampicillin for, 463 autolysins in, 463 bacteriology, 460–462 clinical aspects, 462–463 clinical capsule, 461 diagnosis, 462 epidemiology, 461 immunity, 462 manifestations, 462 neonatal sepsis, 461 pathogenesis, 462 penicillin for, 463 pneumococcal disease, 461f, 464–468 pore-forming toxins in, 464 989 prevention, 463 shape, 354f treatment, 463 group characteristics, 447–449 α-hemolytic, 460t β-hemolytic, 460t hemolytic reactions, 460t infective endocarditis and, 928t nonhemolytic, 460t, 468 in oropharynx, 10 plaque colonized by, 687, 689 pyogenic, 448, 449t, 463 viridans, 449, 449t, 460t Streptococcus agalactiae, 448, 449t Streptococcus bovis, 449t Streptococcus equi, 449t Streptococcus mitis, 449 Streptococcus mutans, 356, 449t, 468, 689, 691 Streptococcus pneumoniae, 8, 412, 448, 449t, 460t, 461f, 463–468, 531, 563 antibiotic selection, 467–468 bacteremia from extravascular infection and, 929t, 930t capsule, 463, 466 CNS infections and, 925t diagnosis, 467 ear infection from, 915t epidemiology, 465 extracellular products, 464 eye infections from, 914t immunity, 466 influenza A and, 170 lower respiratory tract infections from, 918t manifestations, 466–467 osteomyelitis from, 913t pathogenesis, 14, 465–466 penicillin for, 467 pneumolysin, 466 prevention, 468 septic arthritis from, 913t sinus infections from, 915t suppurative thrombophlebitis and, 928t treatment, 467–468 Streptococcus pyogenes, 448, 449t ear infections from, 915t eye infections from, 914t septic arthritis from, 913t sinus infections from, 915t Streptococcus salivarius, 391, 449, 449t Streptococcus sanguis, 449t plaque colonized by, 687 streptogramins, 409t, 416 streptokinase, 452, 456 streptolysin O, 450, 451–452, 464 streptolysin S, 450 Streptomyces, 410, 507 antibiotics, 408 features of, 508t streptomycin, 414, 424 for plague, 635 for tuberculosis, 499, 500 for tularemia, 638 Strongyloides, 773 Strongyloides stercoralis, 845, 846t, 858–862 disease caused by See strongyloidiasis life cycles of, 846t, 858–859, 860f structure of, 859f strongyloidiasis, 859–862 clinical aspects, 861–862 diagnosis, 861 epidemiology, 859–861 immunity, 861 malabsorption and, 861 manifestations, 861 pathogenesis, 861 prevalence of, 764t prevention, 862 treatment, 862 990 INDEX structural subunits, 103 subacute bacterial endocarditis, 468 subacute endocarditis, 927 subacute sclerosing panencephalitis (SSPE), 192–193, 344 subacute spongiform encephalopathies, 345–350 subclinical infection, 138 subclinical poliomyelitis, 218 subcutaneous fungi, 703, 724–725 subgingival plaque, 687–688, 692 submucosa, 544 succinate, 366 sucrose, 691 sulbactam, 413 for Bacteroides fragilis, 532 sulfadoxine, resistance, 784 sulfhydryl compounds, 702, 782 sulfonamides, 4, 407, 409t, 418, 782 for malaria, 792t for Nocardia, 513 for Paracoccidioides brasiliensis, 760 resistance, 425, 470 for toxoplasmosis, 806 sulfones, for leprosy, 503 sulfur, granule, 508, 509f superantigen exotoxins, 401, 402f superantigens in adaptive immunity, 34–35 staphylococcal, 435–436 superficial fungi, 703, 719–727 superinfection, 169, 192 in influenza A, 170 superoxide, 24 in anaerobiosis, 516 anion, 366 dismutase, 367, 516 suppurative thrombophlebitis, 927, 928t supragingival plaque, 687–688, 689f suramin, 785t surface adhesin, 753 surface proteins, 213 surfactants, disinfection with, 48 surgical wound infections, 912t susceptibility definition, 408 resistance and, 419–420 SV40, 340 receptors, 110t swine influenza virus (H1N1), 165, 167 sylvatic cycle, 286–287 echinococcosis, 891 sylvatic parasites, 769–770 sylvatic plague, 632 symmetry cubic, 121–122 helical, 120–121 icosahedral, 121–122 synapse, 523f syncytia, 139 syncytium formation, 174 synthetic or virion component production, 114 syphilis, 407, 544, 644–650, 924t cardiovascular, 648 clinical aspects, 647–650 clinical capsule, 644 congenital, 648 diagnosis, 648–650 microscopy, 648–649 nontreponemal tests, 649 serologic tests, 649, 649f treponemal, 649–650 epidemiology, 645 HIV and, 645, 649 immunity, 647 latent, 647–648 lesions, 646 manifestations, 647–648 overview, 645f pathogenesis, 645–647 primary, 646f, 647 secondary, 646f, 647 tertiary, 645, 646f, 648 transmission, 645 systemic fungi, 703 clinical case, 760 features of, 746t geographic distribution of, 750f T T antigen, 339 T cell receptors (TCR), 31 T cells, 20f, 23, 24f, 29 cytotoxic, 29t helper, 29t response, 32, 34f in adaptive immunity, 32–34 tabes dorsalis, 648, 648f tachycardia, 843 tachyzoite, Toxoplasma gondii, 801–802 Taenia saginata, 770, 882t life cycle, 881–882 parasitology, 881–882 structures, 883f Taenia solium, 765, 774, 882t acquisition of, 886f life cycle, 884–885, 885f parasitology, 884–885 structures, 883f tampons, 440 tanapox, 202t, 206 tapeworms, See also cestodes beef, 882–884 prevention, 884 treatment, 884 clinical aspects, 884 diagnosis, 884 dwarf, 893 epidemiology, 882–884 fish, 887–890 diagnosis, 890 disease, 888–890 prevention, 890 treatment, 890 intestinal, 882t manifestations, 884 pork, 884–887 albendazole for, 887 diagnosis, 887 life cycle, 886f manifestations, 886–887 praziquantel for, 887 prevention, 887 treatment, 887 undercooked meat and, 886f structures, 883f tissue, 882t target proteins, 400 Tat protein, 315, 331 Tat-acting responsive (TAR) element, 315 Tatum, E., 386 Tax protein, 331 taxonomic methods, 388–389 tazobactam, 413 3TC See lamivudine TCP See toxin-coregulated pilus TCR See T cell receptors TCT See tracheal cytotoxin T-dependent reactions, 35 tegument, 245 teichoic acid, 358 teicoplanin, 409t, 410, 413 telaprivir, 153t telavancin, 409t, 413 telbivudine, 153t, 159 telithromycin, 416 Temin, Howard, 309 temperate phages, 384 lysogenic cycles of, 385f lytic cycle of, 385f temperate viruses, 107 tenofovir, 153t, 158, 159 terbinafine, 715, 724 features of, 714t terminators, 375 tertiary syphilis, 645, 646f, 648 tetanospasmin, 526 tetanus, 41, 525–528 benzodiazepines for, 527 clinical aspects, 527–528 clinical capsule, 526 clostridial, 523f manifestations, 527 pathogenesis, 526 penicillin for, 528 prevention, 527–528 treatment, 527 vaccine, 18 tetracycline, 408, 409t, 415, 654 for Aeromonas, 624 Chlamydia and, 415 for Chlamydia psittaci, 674 for Helicobacter pylori, 576 Mycoplasma and, 415 for Plesiomonas, 624 resistance, 423t, 470, 532 Rickettsia and, 415 for tularemia, 638 tetrahydrofolic acid, 782 TH1 pathway, 32 TH2 pathway, 32–33 thiabendazole, 783 thiogycollate, 519 Thomas, Lewis, 391 thoracic actinomycosis, 509 thrombocytopenia, in malaria, 796 thrombocytopenic purpura, 192, 196 thrombophlebitis, 519, 927, 928t thrombosis, 592 thrush, 733, 734f thymidine kinase, 154 ticarcillin, 409t, 411 for Bacteroides fragilis, 532 for Pseudomonas aeruginosa, 622 tick-borne relapsing fever, 653 tigecycline, 415 T-independent reactions, 36 tinea barbae, 722 tinea capitis, 722, 723, 723f tinea corporis, 722 tinea cruris, 722 tinea manuum, 722 tinea nigra, 724 tinea pedis, 722 tinea unguium, 722 tinidazole, 782 for giardiasis, 831 Tinsdale medium, 478 tipranavir, 153t, 158 tissue culture, of viruses, 108 tissue cysts, ingestion, 804 tissue nematodes, 863–880 case study, 879 general characteristics of, 864t tissue tapeworms, 882t tissue tropism, 111 tissues, microbiota in, TLR See toll-like receptors TM See transmembrane TMP-SMX See trimethoprim-sulfamethoxazole TMV See tobacco mosaic virus TNF See tumor necrosis factor tobacco mosaic virus (TMV), 102 assembly, 121f INDEX tobramycin, 409t, 414, 623 for Pseudomonas aeruginosa, 622 togaviruses, 117, 281–282, 282t, 292 classification of, 102t enveloped, 194 toll-like receptors (TLR), 23, 397, 482, 613, 629 tonsillitis, 477, 916, 916t tooth demineralization, 691 tooth loss, 691 topoisomerase, 417 tourism, 908 toxic shock syndrome (TSS), 34 group A streptococci, 34 staphylococcal, 440f, 442 Staphylococcus aureus, 34 streptococcal, 454, 456, 458–459 toxic shock syndrome toxin (TSST), 435, 440 toxicity acyclovir, 154 amantadine, 152 of antiparasitic agents, 779, 780 rimantadine, 152 α-toxin, 434, 435f, 438 Clostridium perfringens, 520 θ-toxin, Clostridium perfringens, 520 toxin-coregulated pilus (TCP), 566 Toxocara canis, 774, 863–866, 914t disease caused by See toxocariasis eggs of, 863, 865 general characteristics of, 864t life cycle of, 864f parasitology, 863–865 transmission, 865 toxocariasis, 865–866 clinical aspects, 865–866 corticosteroids for, 866 diagnosis, 866 epidemiology, 865 manifestations, 865–866 pets and, 866 prevention, 866 treatment, 866 toxoid, 477, 526 Toxoplasma gondii, 416, 763, 774, 781, 800–807, 914t asexual cycle, 800 definitive host, 802–803 intermediate hosts, 803 life cycle, 802–803 morphology, 801–802 oocyst, 801 parasitology, 800–803 relapse, 803 sexual cycle, 800 tachyzoite, 801–802 tissue cysts, 802 trophozoites, 801–802 toxoplasmosis, 324t, 416, 766, 781, 803–807 AIDS and, 781, 805 atovaquone for, 807 clinical aspects, 805–807 clinical capsule, 803 congenital, 805 diagnosis, 806 distribution, 803 enzyme immunoassay for, 806 epidemiology, 803–804 IgG in, 806 IgM in, 806 immunity, 804–805 in immunocompromised host, 805 manifestations, 805 pathogenesis, 804–805 prevalence, 803 prevention, 806–807 pyrimethamine for, 806 sulfonamides for, 806 transmission, 803–804 congenital, 804 oocyst ingestion, 804 tissue cyst ingestion, 804 treatment, 806–807 tra, 387 tracheal cytotoxin (TCT), 559 tracheal organ culture, 562f tracheitis, 917t tracheobronchitis, 173, 916–917 trachoma, 670 Chlamydia trachomatis and, 671 transactivating, 331 retroviruses, 143 transcription in bacteria, 370f polymerization reactions, 368 viruses, 114–118 transcription factor, 375 transducing retroviruses, 142 transduction, 382, 384–385, 385f generalized, 385 specialized, 385 transferrin, 365, 538 transformation, 382, 384 artificial, 384 transient bacteremia, transient immunity, 172 transient viremia, 285 transients, translation, 368–369 in bacteria, 370f transmembrane (TM), 310 transmembrane proteins, 569 transmissible spongiform encephalopathies, 345 transmission routes, 88–90 aerosol, 301–302 bloodborne, 90, 133t common, 89t, 133t eye-to-eye, 90 fecal-oral spread, 89–90, 225, 274, 278 Entamoeba histolytica, 814 food-borne, 479 genital transmission, 90, 133t horizontal, 88, 133 human T-cell lymphotropic virus, 329 Leishmania, 833 needlestick, 231 respiratory, 88–89, 133t salivary spread, 89, 133t sexual, 317, 645, 670 skin-to-skin transfer, 90, 133t Toxocara canis, 865 toxoplasmosis, 803–804 congenital, 804 tissue cyst ingestion, 804 transplacental, 480 vertical, 88, 90, 133, 231, 285 viruses, 134t water, 651 water-borne, giardiasis, 829 zoonotic, 90, 133, 133t transmission-based precautions, 53 airborne, 53 for nosocomial infections, 54t transovarial transmission, 287 transpeptidases, 371 transpeptidation, 371f transplacental IgG, 41 transplacental transmission, listeriosis, 480 transport media, 57 transposable elements, 382f transposases, 381 transposition bacteria, 381–382 direct, 382 replicative, 382 in resistance, 428 simple, 383f 991 transposons, 378, 381, 382 in resistance, 428 traumatic wound infections, 912t traveler’s diarrhea, 594, 919 trematode(s), 767–768, 895–908 characteristics of, 896t classification of, 768t eggs, 898f, 904 hermaphrodite, 895 intestinal, 896t locomotion of, 895 reproductive systems of, 895 schistosome, 895, 903f tissue, 896t trench fever, 679t, 684 trench mouth, 643, 693 Treponema carateum, 660 Treponema denticola, 687, 692 Treponema pallidum, 60, 90, 356, 642f, 644–650, 923t, 924t bacteriology, 644 epidemiology, 645 eye infections from, 914t features of, 643t growth, 644 lipopolysaccharide, 644 outer membrane proteins, 647 penicillin for, 429, 650 prevention, 650 treatment, 650 ulcers from, 912t Treponema pallidum subspecies endemicum, 660 Treponema pallidum subspecies pertenue, 660 Trichinella nativa, 866 Trichinella spiralis, 773, 775, 863, 866–869 disease caused by See trichinosis gastrointestinal infections from, 921t general characteristics of, 864t larva, 866–867, 867f life cycle of, 868f parasitology, 866–867 trichinosis, 777, 783, 867–869 albendazole for, 869 clinical aspects, 868–869 corticosteroids for, 869 diagnosis, 869 diarrhea and, 869 epidemiology, 867–868 immunity, 868 manifestations, 868–869 mebendazole for, 869 pathogenesis, 868 prevention, 869 treatment, 869 undercooked pork and, 867 trichloroacetic acid, 338 Trichomonas hominis, 824t Trichomonas tenax, 824t Trichomonas vaginalis, 774, 823, 824–827, 824t, 924t culture, 824–825 diagnosis, 826 disease caused by See trichomoniasis distribution of, 770t HIV and, 826 immunity, 825–826 manifestations, 826 parasitology, 824–825 pathogenesis, 825–826 structure, 824f transmission of, 770t trichomoniasis, 766 clinical aspects, 826–827 clinical capsule, 825 epidemiology, 825 manifestations, 826 prevalence, 825 treatment, 827 992 INDEX Trichophyton, 719 classification of, 702t Trichophyton mentagrophytes, 703 Trichophyton rubrum, 722 Trichosporon cutaneum, 720t, 724 trichuriasis, 850–852 clinical aspects, 851–852 diagnosis, 852 epidemiology, 850 immunity, 850 manifestations, 851 pathogenesis, 850 prevalence of, 764t prevention, 852 treatment, 852 Trichuris, 765, 773 Trichuris trichiura, 845, 846t, 849–852 disease caused by See trichuriasis egg structure, 850f embryonated egg, 850f infestation, 852f life cycles of, 846t, 849–850, 851f triclosan, 689 trifluorothymidine, 154 trifluridine, 153t trimethoprim, 409t, 782 for gonorrhea, 548 resistance, 425 trimethoprim-sulfamethoxazole (TMP-SMX), 418 brucellosis for, 631 for cholera, 570 for Escherichia coli, 594 for Legionnaires disease, 614 for listeriosis, 483 for Nocardia, 513 for pneumocystosis, 742 trismus, 527 tRNA, 368 Trojan horse, 747 trophozoites Entamoeba histolytica, 814, 814f, 817, 818 Giardia lamblia, 827f, 828 multiplication of, 814 Naegleria fowleri, 819–820 in red blood cells, 789 Toxoplasma gondii, 801–802 tropical spastic paraparesis (TSP), 329 tropism, 136–137 Trypanosoma, 823, 832 life cycle, 832f Trypanosoma brucei, 765, 840f Trypanosoma brucei gambiense, 840 Trypanosoma brucei rhodesiense, 840 Trypanosoma cruzi, 765, 776 amastigotes, 842f Trypanosoma spp., 773, 782 trypanosomiasis African, 774, 837–840 anemia and, 839 antigenic shifts, 838 clinical aspects, 839–840 clinical capsule, 838 diagnosis, 839 epidemiology, 838 IgM and, 839 melarsoprol for, 840 parasitology, 837–838 pathogenesis, 839 prevalence of, 764t prevention, 840 treatment, 840 vasculitis and, 839 American, 840–844 allopurinol for, 843 benznidazole for, 843 chronic, 843 clinical aspects, 842–844 clinical capsule, 841 diagnosis, 843 epidemiology, 841 manifestations, 842–843 myocarditis in, 842f nifurtimox for, 843 pathogenesis, 841–842 prevalence of, 764t prevention, 843–844 treatment, 843 trypomastigote, 832, 838, 841 tsetse fly, 838 TSS See toxic shock syndrome TSST See toxic shock syndrome toxin tuberculate macroconidia, 749 Histoplasma capsulatum, 749 tuberculin, 491 skin test, 498, 498f tuberculoid leprosy, 501, 502 tuberculoma, 498 tuberculosis, 325, 377, 493–500 acid-fast smears, 498–499 AIDS and, 495 bovine, 628t ciprofloxacin for, 500 clinical aspects, 497–500 clinical capsule, 493 in developing countries, 493 diagnosis, 498–499 DTH and, 495 in eighteenth century, 493 epidemiology, 493–495 ethambutol for, 499, 500 extensively drug-resistant, 500 fish, 504 fluoroquinolones for, 500 granuloma, 495, 496f HIV and, 500 immunity, 497 isoniazid for, 499, 500 latent, 496 manifestations, 497–498 morbidity, 493 mortality rates, 493 multidrug-resistant, 500 in nineteenth century, 493 ofloxacin for, 500 pathogenesis, 495–497 prevention, 500 primary, 494f, 495–496, 497, 750 pyrazinamide for, 499 reactivation, 494f, 496–497 rifampin for, 499, 500 second-line agents, 500 streptomycin for, 499, 500 treatment, 499–500, 499t worldwide distribution of, 493f tubo-ovarian abscess, 547f tularemia, 636–638 aminoglycosides for, 638 clinical aspects, 637–638 diagnosis, 637–638 epidemiology, 636 gentamicin for, 638 immunity, 637 manifestations, 637 oculoglandular, 637 pathogenesis, 636–637 pneumonic, 637 prevention, 638 streptomycin for, 638 tetracyclines for, 638 treatment, 638 typhoidal, 637 ulceroglandular form, 637 tumor necrosis factor (TNF), 28, 147, 238, 401, 630, 733 Twinrix, 227 type II hypersensitivity See antibody-mediated hypersensitivity type III hypersensitivity See immune-complex hypersensitivity type IV hypersensitivity See delayed-type hypersensitivity type-specific immunity, 457 type-specific immunoglobulin G, 457 Typhimurium, 599 typhoid fever, 581, 601–602 epidemiology, 602 immunity, 602 pathogenesis, 602 typhoidal tularemia, 637 typhus, 679t typhus group, 682–683 tyrosine, 378 Tzanck test, 253 U UL54, 156 UL97, 155, 156 ulceroglandular tularemia, 637 ulcers, 912t chronic, 912t decubitus, 436, 519 genital, 922, 923t, 924t ultraviolet (UV) irradiation, 43 for sterilization, 45t, 46–47 unapparent infections, 138 uncoating of bacteriophages, 111–114 inhibitors, 151–152 United Nations, 485 United States Department of Health and Human Services (DHHS), 327 United States Preventive Service Task Force (USPSTF), 327 unpasteurized dairy, 629 UPEC See uropathogenic Escherichia coli upper respiratory infection (URI), 173, 181, 916 etiologic agents, 916t upper respiratory tract, 394t upper urinary tract, 11 urban cycle, 286, 632 Ureaplasma, general features, 661 Ureaplasma parvum, 662t Ureaplasma urealyticum, 662t urease, 745 Helicobacter pylori, 573 production, 83 urethritis, 546, 923, 923t Chlamydia trachomatis, 672 urgency, cystitis and, 921 URI See upper respiratory infection urinary catheters, nosocomial infections from, 51 urinary tract, 394t urinary tract infection (UTI), 341, 469, 921 diagnosis, 922 epidemiology, 587 Escherichia coli, 586–588 etiologic agents, 921–922 pathogenesis, 587–588 urine clean-voided midstream, 922 culture, 922, 922f uropathogenic Escherichia coli (UPEC), 584t, 588 urticaria, 873 UTI See urinary tract infection UV irradiation See ultraviolet (UV) irradiation uveitis, 914 V V factor, 557 V3 loop See variable region VacA See vacuolating cytotoxin vaccines, 41–42 anthrax, 485, 487 INDEX bacillus Calmette-Guerin, 498, 500 diphtheria, 18 diphtheria toxoid and pertussis, 527 genetically engineered, 18 hepatitis A, 227 human papilloma virus, 339 inactivated, 17 influenza A, 171–172 killed, 42 viral, 171–172 live, 17, 42 live attenuated influenza, 172 Lyme disease, 659 malaria, 800 measles, 193 meningitis, 18 MMRV, 189, 197, 258 polio, 17, 138 poliomyelitis associated with, 218 rabies, 306 rotavirus, 275, 277 rubella, 197 schistosomiasis, 908 smallpox, 41 tetanus, 18 varicella-zoster virus, 258t viral, 146t vaccinia, 202t, 205–206 immunity, 206 receptors, 110t scientific interest in, 206 vaccinia complement control protein (VCP), 138 vacuolating cytotoxin (VacA), in Helicobacter pylori, 573 vagina, 394t candidiasis of, 733 flora in, 11 vaginitis, 733, 923 valacyclovir, 153t, 155, 254 valganciclovir, 155, 262 valley fever, 758 vancomycin, 409t, 410, 413, 443, 445 for Clostridium difficile, 530 for enterococcal disease, 470 for gonorrhea, 548 for Haemophilus influenzae, 558 resistance, 425 Vaqta, 227 variable domains, 37 variable region (V3 loop), 315 variable surface glycoprotein (VSG), 838 varicella-zoster virus (VZV), 144, 245, 246t, 254–258, 324t acyclovir in, 257 in AIDS, 256 antibodies, 256 clinical aspects, 256–258 clinical capsule, 255 CNS infections and, 926t diagnosis, 257 epidemiology, 255 eye infections from, 914t immunity, 256 manifestations, 256–257 maternal, 257 neuralgia and, 257 pathogenesis, 255 prevention, 258 primary, 256f reactivation, 256 treatment, 154, 155, 257–258 vaccine, 258t virology, 254–255 variola, 202t, 203–205 See also smallpox clinical aspects, 205 diagnosis, 205 major, 203 manifestations, 205 minor, 203 pathogenesis, 205 prevention, 205 virology, 203 vascular catheters, nosocomial infections from, 51–52 vasculitis African trypanosomiasis and, 839 Rickettsia, 679f VCA See viral capsid antigen VCP See vaccinia complement control protein VDRL See Venereal Disease Research Laboratory vegetative DNA replication, 334 vegetative mycelium, 699 Veillonella, 516, 517t plaque colonized by, 687 Venereal Disease Research Laboratory (VDRL), 649 venipuncture, 929 ventriculitis, 925 verruga peruana, 679t, 684 vertical transmission, 88, 90, 133 arboviruses, 285 of hepatitis B, 231 of viruses, 134t vesicular stomatitis virus, 300 Vi antigen, 599, 602, 604, 605 Vibrio, 565–571 bacteremia from extravascular infection and, 930t shape, 354f Vibrio alginolyticus, 567t Vibrio cholerae, 565–571, 920t disease caused by See cholera growth, 565–566 O1 strain, 566 O139 strain, 566 scanning electron micrograph, 566f structure, 565–566 Vibrio mimicus, 567t Vibrio parahaemolyticus, 567t, 570, 920t gastrointestinal infections from, 921t Vibrio vulnificus, 567t, 570–571 Vietnam War, 548 Vif protein, 315, 316 Vincent infection, 643, 693 Vincent angina See fusospirochetal disease viral capsid antigen (VCA), 265 viral infections adaptive immunity, 146 CNS, 343–349 cytopathogenicity of, 137–138 disease index, 131 disseminated, 134 endemic, 131 entry, 133–134 epidemic, 131 host defenses, 144–146 host factors, 143–144 immune-mediated, 147t incidence, 131 incubation period, 133 interferons and, 144–145 localized, 134 pandemic, 131 pathogenesis, 131–149 patterns, 138–140, 140f spread in host, 134, 136 transmission, 133–134 tropism, 136–137 viral transformation, 140–143 virulence, 137–138 viral set point, 139 viral transformation, 140–143 by DNA viruses, 141–142 by retroviruses, 142–143 by RNA viruses, 143 viremia, 136, 190, 285 primary, 136 secondary, 136 transient, 285 viridans streptococci, 449, 460t, 468, 928t virulence, 468 virions, 97 Alphavirus, 283f arenaviruses, 294f attachment proteins, 109 bunyaviruses, 284f coronavirus, 182f herpes simplex 1, 246f poxvirus, 202f schematic drawing of, 99f structure, 182f viroids, 97 virokines, 138 viropexis, 113, 113f, 212 viroreceptors, 138 virulence, 13, 391 amebiasis, 816 of anaerobes, 518 Bordetella pertussis, 404f cholera, 569 of coccidioidomycosis, 757 Enterobacteriaceae, 581–582 extremely high, 392 genetic regulation of, 569 of gonorrhea, 545 high, 392 immune response and, 15 Listeria monocytogenes, 479, 482 low, 391 moderate, 392 pertussis, 560–561 plasmid, 403 regulation of, 403, 581–582 resistance, 422 of viral infections, 131, 137–138 viridans streptococci, 468 virulent phages, 384 virulent viruses, 107 viruses, 5–7, 6f See also specific viruses classification of, 105–107 growth and assay of, 108 one-step growth experiment, 108–109 quantitation of, 124–125 replication cycle, 107f, 109–111 virus-induced immunopathology, 147–148 virus-induced immunosuppression, 148–149 vitamin B12, 889 viviparous, 769 Voges-Proskauer test, 83 vomiting, 435 von Magnus phenomenon, 127 voriconazole, 715 for aspergillosis, 738 for blastomycosis, 754 features of, 714t Vpr protein, 315, 316 Vpu protein, 315, 316 Vpx protein, 316 VSG See variable surface glycoprotein vulvovaginitis, 924t VZV See varicella-zoster virus W walking pneumonia, 664, 674 walrus, 867 Warthin-Finkeldey cells, 190 warts, 333, 337f genital, 336 Washington University virus (WUV), 339 waste disposal, 902, 904, 908 water fluoridation, 692 water-borne transmission, giardiasis, 829 watery diarrhea, 581, 919, 920t, 921t Weil disease, 652 993 994 INDEX West Nile encephalitis, 926t West Nile virus, 144, 282t, 289–290 in United States, 290f Western blot immunoassay, 74 for HIV detection, 326f western equine encephalitis, 288–289, 926t whipworm, 846t white blood cells, 20f white piedra, 724 Whitewater arroyo virus, 293t Whitfield’s ointment, 724 whooping cough See pertussis wild-type allele, 378 winter gastroenteritis, 273 Wolbachia, 877 women, gonorrhea in, 546f, 547f Woolf, Virginia, 161 wool-sorter’s disease, 486 World Health Organization, 204, 558 wound botulism, 525 wound infections, 912 animal bites, 912t burns, 912t causes of, 912t etiologic agents of, 912t wounds animal bites, 912t burns, 912t group A streptococci and, 453–454 surgical, 912t Wright stains, 652, 798 Wuchereria bancrofti, 765–766, 863, 871f, 871t general characteristics of, 864t life cycle of, 872f parasitology, 870–871 X X factor, 557 XDR-TB See extensively drug-resistant tuberculosis xenodiagnosis, 843 Xenopsylla cheopis, 632, 682 xerostomia, 691 Xis proteins, 130 Y yabapox, 202t, 206 Yatapoxvirus, 201, 202t, 206 yaws, 660 yeasts, 7–8, 699–701 cell wall, 698f conversion to, 702 forms, 699f opportunistic, 730t opsonized, 733 yellow fever, 282t, 291 Yersinia, 605–606 bacteriology, 605 diseases epidemiology, 605 pathogenesis, 605–606 infections, 606 Yersinia enterocolitica, 585t, 605–606, 628t, 920t clinical aspects, 606 epidemiology, 605 pathogenesis, 605–606 Yersinia pestis, 13, 392, 580, 585t, 628t, 631–635 See also plague bacteriology, 631 ciprofloxacin for, 431 Yersinia pseudotuberculosis, 585t, 628t clinical aspects, 606 epidemiology, 605 pathogenesis, 605–606 yogurts, 12 Yops, 605, 634 Yorkston, James, 579 Z Z protein, 294 zalcitabine, 157 zanamivir, 152, 153t, 171 Zappa, Frank, 473 zidovudine, 118, 153t, 157 zoonotic diseases, 627–638 zoonotic transmission, 90, 133, 133t zoonotic viruses incubation period, 135t–136t zygomycetes, 738–739 opportunistic, 730t zygomycosis, 738–739, 739f Zygomycota, 702 ... ­Willey JM: Prescott, Harley, & Klein’s Microbiology, 7th edition McGraw-Hill, 20 08.) 700 PART IV Pathogenic Fungi Nucleus A B Nucleus Septum C Pores FIGURE 42 4.  Hyphae A Nonseptate hyphae with... are major genera Grow best at 25 °C 719 720 PART IV TABLE 45–1 Pathogenic Fungi Agents of Superficial and Subcutaneous Mycoses FUNGAL GROWTH IN LESION IN CULTURE (25 °C) INFECTION SITE DISEASE Microsporum... determines outcome Poor inflammatory response leads to chronic infection 722 PART IV Pathogenic Fungi Hair shaft Black piedra FIGURE 45 2.   Black piedra Note invasion by Piedraia hortae both within (endothrix)