Chapter 12 : The Emerging Role of Pathology in Infectious Diseases

MyBook is a cheap paperback edition of the original book and will be sold at uniform, low price.

Preview this chapter:
Zoom in

The Emerging Role of Pathology in Infectious Diseases, Page 1 of 2

| /docserver/preview/fulltext/10.1128/9781555818418/9781555811686_Chap12-1.gif /docserver/preview/fulltext/10.1128/9781555818418/9781555811686_Chap12-2.gif


Due to increased awareness of infectious diseases, there has been renewed interest and revitalization in infectious disease pathology. Recent experience at the Centers for Disease Control and Prevention (CDC) and other institutions has shown that use of a combination of traditional morphology with immunologic and molecular pathology techniques is an extremely useful approach for the confirmation of diagnoses for patients with otherwise unexplained illnesses. Visualization of microbial antigens or nucleic acids in the context of pathology allows the pathologist to assess the clinical significance of serologic test results or microbial isolation. By comparison, the use of molecular pathology techniques offers several distinct advantages over traditional microbiologic methods, including speed, sensitivity, reduced risk of exposure of laboratory personnel to the agent, and tissue localization of pathogens. Epidemiologic, clinical, and histopathologic findings enable CDC pathologists to use the most appropriate initial immunologic and molecular pathology tests. The chapter highlights some of the contributions of CDC pathologists in addressing some of the challenges posed by new, emerging, and reemerging infectious diseases. Historically, pathologists and the discipline of pathology have played pivotal roles in the discovery and characterization of the rickettsioses and, more recently, the ehrlichioses. Disease recognition by infectious disease pathologists can play a key role in the study of emerging infectious diseases. The chapter provides several examples of the frontline role of pathology in guiding the early phases of epidemiologic investigations of infectious diseases.

Citation: Zaki S, Paddock C. 1999. The Emerging Role of Pathology in Infectious Diseases, p 181-200. In Scheld W, Craig W, Hughes J (ed), Emerging Infections 3. ASM Press, Washington, DC. doi: 10.1128/9781555818418.ch12

Key Concept Ranking

Rocky Mountain Spotted Fever
Infectious Diseases
Sin nombre virus
Simian immunodeficiency virus
Highlighted Text: Show | Hide
Loading full text...

Full text loading...


Image of Color Plate 1
Color Plate 1

Emerging infectious diseases. Immunostaining of viral and rickettsial antigens in patient tissues by IHC is shown. (A) Hantavirus pulmonary syndrome, lung. Viral antigens are localized within the pulmonary microvasculature. (B) Leptospirosis, kidney. Intact and granular staining of leptospires within renal interstitium is shown. (C) Epidemic typhus, cerebral cortex. Staining of within a characteristic glial nodule is shown. (D) Rocky Mountain spotted fever, leptomeninges. Spotted fever group rickettsiae are localized within the endothelia of medium-sized vessels. (E) Ehrlichiosis, bone marrow. Morulae of are stained within mononuclear cells. (F) Ebola hemorrhagic fever, skin. Abundant viral antigens in connective tissue surrounding a sweat gland in dermis are shown. (G) Enterovirus 71 encephalitis, central nervous system. Immunostaining of viral antigens within a neuron is shown. (H) Nipah virus encephalitis, cerebral cortex. Viral antigens are present within neurons and glial cells. Note the abundant extracellular antigen.

Citation: Zaki S, Paddock C. 1999. The Emerging Role of Pathology in Infectious Diseases, p 181-200. In Scheld W, Craig W, Hughes J (ed), Emerging Infections 3. ASM Press, Washington, DC. doi: 10.1128/9781555818418.ch12
Permissions and Reprints Request Permissions
Download as Powerpoint


1. Anderson, B.,, K. Sims,, R. Regnery,, L. Robinson,, M. J. Schmidt,, S. Goral,, C. Hager,, and K. Edward. 1994. Detection of Rochalimaea henselae DNA in specimens from cat scratch disease patients by PCR. J. Clin. Microbial. 32:942948.
2. Bakken, J. S.,, J. S. Dumler,, S.-M. Chen,, M. R. Eckman,, L. L. Van Etta,, and D. H. Walker. 1994. Human granulocytic ehrlichiosis in the upper Midwest United States. A new species emerging? JAMA 272:212218.
3. Blayney, D. W.,, E. S. Jaffe,, W. A. Blattner,, J. Crossman,, M. Robert-Guroff,, D. L. Longo,, P. A. Bunn,, and R. C. Gallo. 1983. The human T-cell leukemia/lymphoma virus associated with American adult T-cell leukemia/lymphoma. Blood 62:401405.
4. Boshoff, c.,, T. F. Schultz,, and M. M. Kennedy. 1995. Kaposi's sarcoma-associated herpesvirus infects endothelial and spindle cells. Nature 1:12741278.
5. Brynes, R. K.,, W. C. Chan,, T. J. Spira,, E. P. Ewing,, and F. W. Chandler. 1983. Value of lymph node biopsy in unexplained lymphadenopathy in homosexual men. JAMA 250:13131317.
6. Bwaka, M. A.,, M.-J. Bonnet,, P. Calain,, R. Colebunders,, A. De Roo,, Y. Guimard,, K. R. Katwiki,, K. Kibadi,, M. A. Kipasa,, K. J. Kuvula,, B. B. Mapanda,, M. Massamba,, K. D. Mupapa,, J.-J. Tamfun-Muyembe,, E. Ndaberey,, C. J. Peters,, P. E. Rollin,, and E. V. Enden. 1999. Ebola hemorrhagic fever in Kikwit. Democratic Republic of Congo; clinical observations in 103 patients. J. Infect. Dis. 179:SIS7.
7. Cali, A.,, D. P. Kotler,, and J. M. Orenstein. 1993. Septata intestinalis. ng. nsp, an intestinal microsporidian associated with chronic diarrhea and dissemination in AlDS patients.. J. Eukaryot Microbial. 40:101112.
8.Centers for Disease Control and Prevention. 1993. Outbreak of acute illness-southwestern United States, 1993. Morbid. Mortal. Weekly Rep. 42:421424.
9.Centers for Disease Control and Prevention. 1994. Addressing Emerging Infectious Disease Threats: a Prevention Strategy for the United States. U.S. Department of Health and Human Services, Atlanta, Ga.
10.Centers for Disease Control and Prevention. 1995. Hantavirus pulmonary syndrome-Chile. Morbid. Mortal, Weekly Rep. 46:949951.
11.Centers for Disease Control and Prevention. 1995. Outbreak of Ebola viral hemorrhagic fever- Zaire, 1995. Morbid. Mortal, Weekly Rep. 44:381382.
12.Centers for Disease Control and Prevention. 1998. African tick-bite fever among international travelers—Oregon 1998. Morbid. Mortal. Weekly Rep. 47:950952.
13.Centers for Disease Control and Prevention. 1998. Death among children during an outbreak of hand, foot, and mouth disease—Taiwan, Republic of China. Morbid, Mortal. Weekly Rep. 47:2932.
14.Centers for Disease Control and Prevention. 1998. Outbreak of acute febrile illness among athletes participating in triathlons-Wisconsin and Illinois, 1998. Morbid. Mortal. Weekly Rep. 47:585588.
15.Centers for Disease Control and Prevention. 1998. Preventing Emerging Infectious Diseases. A Strategy for the 21st Century. U.S. Department of Health and Human Services, Atlanta, Ga.
16.Centers for Disease Control and Prevention. 1999. Outbreak of acute febrile illness and pulmonary hemorrhage—Nicaragua, 1995. Morbid. Mortal. Weekly Rep. 44:841843.
17.Centers for Disease Control and Prevention. 1999. Outbreak of Hendra-like virus-Malaysia and Singapore, 1998-1999. Morbid. Mortal. Weekly Rep. 48:265269.
18.Centers for Disease Control and Prevention. 1999. Update: outbreak of Nipah virus-Malaysia and Singapore, 1999. Morbid. Mortal Weekly Rep. 48:335337.
19. Chadburn, A.,, C. Metrka,, and J. Mouradian. 1989. Progressive lymph node histology and its prognostic value in patients with acquired immunodeficiency syndrome and AIDS-related complex. Hum. Pathol. 20:579587.
20. Chang, Y.,, E. Cesarman,, M. S. Pessin,, F. Lee,, J. Culpepper,, D. M. Knowles,, and P. S. Moore. 1994. Identification of herpesvirus-like DNA sequences in AIDS-associated Kaposi's sarcoma. Science 266:18651869.
21. Connor, B. A.,, D. R. Shlim,, J. V. Scholes,, J. L. Rayburn,, J. Reidy,, and R. Rajah. 1993. Pathologic changes in the small bowe1 in nine patients. with diarrhea associated with a coccidia-like body. Ann. Intern. Med. 119:377382.
22. Dawson, J. E.,, C. K. Warner,, C. D. Paddock,, U. G. Munderloh,, J. H. Bartlett,, P. W. Greer,, and S. R. Zaki. Unpublished data.
23. Dumler, J. S.,, P. Brouqui,, J. Aronson,, J. P. Taylor,, and D. H. Walker. 1991. Identification of ehrlichia in human tissue. N. Engl. J. Med. 325: 11091110.
24. Dumler, J. S.,, J. E. Dawson,, and D. H. Walker. 1993. Human ehrlichiosis: hematopathology and immunohistologic detection of Ehrlichia chaffeensis. Hum. Pathol. 24:391396.
25. Elliott, L. H.,, T. G. Ksiazek,, P. E. Rollin,, C. F. Spiropoulou,, S. Morzunov,, M. Monroe,, C. S. Goldsmith,, C. D. Humphrey,, S. R. Zaki,, and J. W. Krebs. 1994. Isolation of the causative agent of hantavirus pulmonary syndrome. Am. J. Trop. Med. Hyg. 51:102108.
26. Foucar, K.,, K. B. Nolte,, R. M. Feddersen,, B. Hjelle,, S. Jenison,, J. McLaughlin,, D. A. Madar,, S. A. Young,, S. R. Zaki,, and L. Hughes. 1994. Outbreak of hantavirus pulmonary syndrome in the southwestern United States. Response of pathologists and other laboratorians. Am. J. Clin. Pathol. 101:S1S5.
27. Georges-Courbot, M. c.,, A. Sanchez,, C. Y. Lu,, S. Baize,, E. Leroy,, J. Lansout-Soukate,, C. Tevi-Benissan,, A. J. Georges,, S. G. Trappier,, S. R. Zaki,, R. Swanepoel,, P. A. Leman,, P. E. Rollin,, C. J. Peters,, S. T. Nichol,, and T. G. Ksiazek. 1997. Isolation and phylogenetic characterization of Ebola viruses causing different outbreaks in Gabon, Emerg. Infect. Dis. 3:5962.
28. Goldsmith, C. S.,, L. H. Elliott,, C. J. Peters,, and S. R. Zaki. 1995. Ultrastructural characteristics of Sin Nombre virus, causative agent of hantavirus pulmonary syndrome, Arch. Virol. 140:21072122.
29. Guarda, L. A.,, S. A. Stein,, K. A. Cleary,, and N. G. Ordonez. 1983. Human cryptosporidiosis in the acquired immune deficiency syndrome. Arch. Pathol. Lab. Med. 107:562566.
30. Hooper, P. T.,, A. R. Gould,, G. M. Russell,, J. A. Kattenbelt,, and G. Mitchell. 1996. The retrospective diagnosis of a second outbreak of equine morbillivirus infection. Aust. Vet J. 74:244245.
31. Hughes, J. M., 1999. Addressing the challenges of emerging infectious diseases: implementation of the strategy of the Centers for Disease Control and Prevention, p. 261269. In W. M. Scheld,, D. Armstrong,, and J. M. Hughes (ed.). Emerging Infections 1 . ASM Press, Washington, D.C
32.Institute of Medicine. 1988. The Future of Public Health. National Academy Press, Washington. D.C.
33. Kelly, P. J.,, L. Beati,, L. A. Matthewman,, P. R. Manson,, G. A. Dasch,, and D. Raoult. 1994. A new pathogenic spotted fever group rickettsia from Africa .. Am. J. Trap. Med. Hyg. 97:129137.
34.. Khan, A. S.,, R .F. Khabbaz,, L. R. Armstrong,, R. C. Holman,, S. P. Bauer,, J. Graber,, T. Strine,, G. Miller,, S. Reef,, J. Tappero,, P. E. Rollin,, S. T. Nichol,, S. R. Zaki,, R. T. Bryan,, L. E. Chapman,, C. J. Peters,, and T. G. Ksiazek. 1996. Hantavirus pulmonary syndrome: the first 100 US cases. J. Infect. Dis. 173:12971303.
35. 35 Khan, A. S.,, T. F. Kweteminga,, D. H. Heymann,, B. LeGuenno,, P. Nabeth,, B. Kersteins,, Y. Fleerackers,, P. H. Kilmarx,, G. R. Rodier,, O. Nkuku,, P. E. Rollin,, A. Sanchez,, S. R. Zaki,, R. Swanepoel,, O. Tomori,, S. T. Nichol,, C. J. Peters,, T. Muyembe,, and T. G. Ksiazek. 1999. The reemergence of Ebola hemorrhagic fever, Zaire, 1995. J. Infect. Dis. 179:S76S86.
36.. Ksiazek, T. G.,, P. E. Rollin,, A. J. Williams,, D. S. Bressler,, M. L. Martin,, R. Swanepoel,, F. J. Burt,, P. A. Leman,, A. S. Khan,, A. K. Rowe,, R. R. Mukunu,, A. Sanchez,, and C. J. Peters. 1999. Clinical virology of Ebola hemorrhagic fever (EHF): virus, virus antigen, and IgG and IgM antibody findings among EHF patients in Kikwit, Democratic Republic of the Congo, 1995. J. Infect. Dis. 179:S177S187.
37. LeBoit, P. E.,, B. M. Egbert,, M. H. Stoler,, J. A. Strauchen,, T. G. Berger,, T. S. B. Yen,, T. A. Bonfiglio,, C. K. English,, and D. J. Wear. 1988. Epithelioid haemangioma-like vascular proliferation in AIDS: manifestation of cat scratch disease bacillus infection? Lancet i:960963.
38. Lefkowitch, J. H.,, S. Krumholz,, K. Fengehen,, P. Grifin,, D. Despommier,, and T. A. Brasitus. 1984. Cryptosporidiosis of the human small intestine: a light and electron microscope study. Hum. Pathol. 15:746752.
39. Lloyd, E. S.,, S. R. Zaki,, P. E. Rollin,, T. G. Ksiazek,, P. Calain,, M. K. Konde,, K. Tchioko,, M. A. Bwaka,, E. Verchueren,, J. Kabwau,, R. Ndambe,, and C. J. Peters. 1999. Long-term disease surveillance in Bandundu Region, Democratic Republic of the Congo: a model for early detection and prevention of Ebola hemorrhagic fever. J. Infect. Dis. 179:S274S280.
40. Moolenaar, R. L.,, C. Dalton,, H. B. Lipman,, E. T. Umland,, M. Gallaher,, J. S. Duchin,, L. Chapman,, S. R. Zakl,, T. G. Ksiazek,, and P. E. Rollin. 1995. Clinical features that differentiate hantavirus pulmonary syndrome from three other acute respiratory illnesses. Clin. Infect. Dis, 21:643649.
41. Murray, P. K. 1996. The evolving story of the equine morbillivirus. Aust. Vet. J. 74:214.
42. Nolte, K. B.,, R. M. Feddersen,, K. Foucar,, S. R. Zaki,, F. T. Koster,, D. Madar,, T. L. Merlin,, P. J. McFeeley,, E. T. Umland,, and R. E. Zumwalt. 1995. Hantavirus pulmonary syndrome in the United States: a pathological description of a disease caused by a new agent. Hum. Pathol. 26:110l20.
43. Orenstein, J. M.,, J. Chiang,, W. Steinberg,, P. D. Smith,, H. Rotterdam,, and D. P. Kotler. 1990. Intestinal microsporidiosis as a cause of diarrhea in human immunodeficiency virus-infected patients: a report of 20 cases. Hum. Pathol. 21:475481.
44. O'Sullivan, J. D.,, A. M. Allworth,, D. L. Paterson,, T. M. Snow,, R. Boots,, L. J. Gleeson,, A. R. Gould,, A. D. Hyatt,, and J. Bradfield. 1997. Fatal encephalitis due to novel paramyxovirus transmitted from horses. Lancet 349:9395.
45. Paddock, C. D.,, P. W. Greer,, T. L. Ferebee,, J. Singleton,, D. B. McKechnie,, T. A. Treadwell,, J. W. Krebs,, M. J. Clarke,, R. C. Holman,, J. G. Olson,, J. E. Childs,, and S. R. Zaki. 1999. Hidden mortality attributable to Rocky Mountain spotted fever: immunohistochemical detection of fatal, serologically unconfirmed disease, J. Infect. Dis. 179:14691476.
46. Paddock, C. D.,, D. M. Suchard,, K. L. Grumbach,, W. K. Hadley,, R. L. Kerschmann,, N. W. Abbey,, J. E. Dawson,, K. Sims,, J. Dumler,, and B. Herndier. 1993. Brief report: fatal seronegative ehrlichiosis in a patient with HIV infection, N. Engl. J. Med. 329:11641167.
47. Parsonnet, J.,, G. D. Friedman,, and D. P. Vandersteen. 1991. Helicobacter pylori infection and the risk of gastric carcinoma. N. Engl. J. Med. 325:11271131.
48. Paton, J. I.,, Y. S. Leo,, S. R. Zaki,, M. C. Wong,, K. E. Lee,, A. E. Ling,, S. K. Chew,, B. Ang,, P. E. Rollin,, T. G. Ksiazek,, A. P. Auchus,, T. Umapathi,, I. Sng,, C. C. Lee,, E. Lim,, A. Kurup,, M. S. Lam,, and S. Y. Wong. Outbreak of Nipah virus infection among abbattoir workers in Sin- gapore: description of a new infectious disease. Lancet, in press.
49. Perkins, B. A.,, J. M. Flood,, R. Danila,, R. C. Holman,, A. L. Reingold,, L. A. Klug,, M. Virata,, P. R. Ciesiak,, S. R. Zaki,, R. W. Pinner,, and R. F. Khabbaz. 1996. Unexplained deaths due to possibly infectious causes in the United States: defining the problem and designing surveillance and laboratory approaches, The Unexplained Deaths Working Group. Emerg. Infect. Dis. 2:4753.
50. Perkocha, L. A.,, S. M. Geaghan,, T. S. Yen,, S. L. Nishimura,, S. P. Chan,, R. Garcia-Kennedy,, G. Honda,, A. C. Stoloff,, H. Z. Klein,, R. L. Goldman,, S. V. Meter,, L. D. Ferrell,, and P. E. LeBoit. 1990. Clinical and pathological features of bacillary peliosis hepatis in association with human immunodeficiency virus infection. N. Engl. J. Med.323:15811586.
51. Peters, C. J.,, and S. R. Zaki,. Viral hemorrhagic fevers: overview. In R. L. Guerrant,, D. J. Krogstad,, J. A. Maguire,, D. H. Walker,, and P. F. Weller (ed.). Tropical Infectious Diseases, in press. Churchill Livingstone, Inc., New York. N.Y.
52. Raoult, D.,, J. B. Ndihokubwayo,, H. Tissot-Dupont,, V. Roux,, B. Faugere,, R. Abegbinni,, and R. J. Birtles. 1998. Outbreak of epidemic typhus associated with trench fever in Burundi. Lancet 352:353358.
53. Ripoll, C. M.,, C. E. Remondegui,, G. Ordonez,, R. Arazamendi,, H. Fusaro,, M. J. Hyman,, C. D. Paddock,, S. R. Zaki,, J. G. Olson,, and C. A. Santos-Buch. 1999. Evidence of rickettsial spotted fever and ehrlichial infections in a subtropical territory of Jujuy, Argentina. Am. J. Trop. Med. Hyg. 61:350354.
54. Rogers, R. J.,, I. C. Douglas,, F. C. Baldock,, R. J. Glanville,, K. T. Seppanen,, L. J. Gleeson,, P. N. Selleck,, and K. J. Dunn. 1996. Investigation of a second focus of equine morbillivirus infection in coastal Queensland, Aust. Vet. J. 74:243244.
55. Rosenblum, M. K. 1990, Infection of the central nervous system by the human immunodeficiency virus type 1; morphology and relation to syndromes of progressive encephalopathy and myelopathy in patients with AIDS, Pathol Annu. 1:117169.
56. Sanchez, A.,, T. G. Ksiazek,, P. E. Rollin,, C. J. Peters,, S. T. Nichol,, A. S. Khan,, and B. W. J. Mahy. 1995. Reemergence of Ebola virus in Africa, Emerg. Infect. Dis. 1:9697.
57. Schwartz, D. A. 1997. Emerging and reemerging infections: progress and challenges in the subspecialty of infectious disease pathology. Arch. Pathol. Lab. Med. 121:776784.
58. Schwartz, D. A.,, R. T. Bryan,, and K. O. Hewan-Lowe. 1992. Disseminated microsporidiosis (Encephalitozoon hellem) and acquired immunodeficiency syndrome. Autopsy evidence for respiratory acquisition. Arch. Pathol. Lab. Med. 116:660668.
59. Schwartz, D. A.,, R. T. Bryan,, and J. M. Hughes. 1995. Pathology and emerging infections-quo vadimus? Am. J. Pathol. 147:15251533.
60. Schwartz, D. A.,, and C. J. Herman. 1996. The importance of the autopsy in emerging and reemerging infectious diseases. Clin. Infect. Dis. 23:248254.
61. Scott, M. A.,, T. L. McCurley,, C. L. Vnencak-Jones,, C. Hager,, J. A. McCoy,, B. Anderson,, R. D. Collins,, and K. M. Edwards. 1996. Cat scratch disease: detection of Bartonella henselae DNA in archival biopsies from patients with clinically. serologically. and histologically defined disease. Am. J Pathol. 149:21612167.
62. Selvey, L. A.,, R. M. Wells,, J. G. McCormack,, A. J. Ansford,, K. Murray,, R. J. Rogers,, P. S. Lavercombe,, P. Selleck,, and J. W. Sheridan. 1995. Infection of humans and horses by a newly described morbillivirus. Med. J. Aust. 162:642645.
63. Sexton, D. J.,, P. E. Rollin,, E. B. Breitschwerdt,, G. R. Corey,, S. A. :Myers,, M. R. Dumais,, M. D. Bowen,, C. S. Goldsmith,, S. R. Zaki,, S. T. Nichol,, C. J. Peters,, and T. G. Ksiazek. 1997. Life-threatening Cache Valley virus infection. N. Engl. J. Med. 336:547549.
64. Shefer, A. M.,, J. W. Tappero,, J. S. Bresee,, C. J. Peters,, M. S. Ascher,, S. R. Zaki,, R. J. Jackson,, S. B. Werner,, P. E. Rollin,, and T. G. Ksiazek. 1994. Hantavirus pulmonary syndrome in California: report of two cases and investigation. Clin. Infect. Dis. 19: 11051109.
65. Shieh, W. J.,, S.-M. Jung,, C. Hsueh,, T.-T. Kuo,, and S. R. Zaki, for the Epidemic Working Group. Pathologic studies on two fatal cases from an outbreak of hand-foot-and-mouth disease in Taiwan, 1998. Submitted for publication.
66. Stoler, M. H.,, T. A. Bonfiglio,, R. T. Steigbigel,, and M. Pereira. 1983. An atypical subcutaneous infection associated with acquired immune deficiency syndrome, Am. J. Clin. Pathol. 80:714718.
67. Sun, T.,, C. F. Hardi,, D. Asnis,, A. R. Bresciani,, B. Roberts,, and S. Teichberg. 1996. Light and electron microscopic identification of Cyclospora species in smal1 intestine: evidence of the presence of asexual life cycle in (he human host. Am. J. Clin. Pathol. 105:216220.
68. Toro, J.,, J. D. Vega,, A. L. Khan,, K. J. Mills,, P. Padula,, W. Terry,, Z. Yadon,, R. Valderrama,, B. A. Ellis,, C. Pavletic,, R. Cerda,, S. R. Zaki,, W. J. Shieh,, R. Meyer,, M. Tapia,, C. Mansilla,, M. Baro,, J. A. Vergara,, M. Concha,, G. Calderon,, D. Enria,, C. J. Peters,, and T. G. Ksiazek. 1998. An outbreak of hantavirus pulmonary syndrome, Chile 1997. Emerg. Infect. Dis. 4:687694.
69. Travejo, R. T.,, J. G. Rigau-Perez,, D. A. Ashford,, E. M. M~Clure,, C. Jarquin-Gonzalez,, J. J. Amadore,, J. O. De Los Reyes,, A. Gonzales,, S. R. Zaki,, W. J. Shieh,, R. G. McLean,, R. S. Nasci,, R. S. Weyant,, C. A. Bolin,, S. L. Bragg,, B. A. Perkin,, and R. A. Spiegel. 1998. Epidemic leptospirosis associated with pulmonary hemorrhage-Nicaragua, 1995. J. Infect. Dis. 178:14571463.
70. Visvesvara, G. S.,, F. L. Schuster,, and A. J. Martinez. 1993. Balamuthia mandrillaris, ng. nsp. agent of amebic memngoencephalitis in humans and other animals, J. Eukaryot. Microbiol. 40:504514.
71. Walker, D. H., and J, S. Dumler. 1995. Will pathologists play as important a role in the future as they have in the past against the challenge of infectious diseases? Infect. Agents Dis. 4:167170.
72. Walker, D. H., and J, S. Dumler. 1997. Human monocytic and granulocytic ehrlichioses. Discovery and diagnosis of emerging tick-borne infections and the critical role of the pathologist. Arch. Pathol. Lab. Med. 121:785791.
73. Wang, L. F. , W. P. Michalski,, M. Yu,, L. I. Pritchard,, G. Crameri,, B. Shiell,, and R. T. Eaton. 1998. A novel P/V/C gene in a new member of the Paramyxoviridae family, which causes lethal infection in humans, horses, and other animals. J. Viral. 72:14821490.
74. Warren, J. R. 1983. Unidentified curved bacilli on gastric epithelium in active chronic gastritis. Lancet i:12731275.
75. Wear, D. J.,, A. M. Margileth,, T. L. Hadfield,, G. W. Fischer,, C. J. Schlagel,, and F. M. King. 1983. Cat scratch disease: a bacterial infection. Science 221:14031405.
76. Wells, R. M.,, S. S. Estani,, Z. E. Yadon,, D. Enria,, P. Padula,, N. Pini,, J. N. Mills,, C. J. Peters,, E. L. Segura, and The Hantavirus Pulmonary Syndrome Study Group for Patagonia. 1997. An unusual hantavirus outbreak in southern Argentina: person-to-person transmission? Emerg. Infect. Dis. 3:171174.
77. Will, R. G.,, J. W. Ironside,, M. Zeidler,, S. N. Cousens,, K. Estibeiro,, A. Alperovitch,, S. Poser,, M. Poochiari,, and A. Hofman. 1996. A new variant of Creutzfeldt-Jakob disease in the UK. Lancet 347:921925.
78. Williams, R. J.,, R.T. Bryan,, J. N. Mills,, R. E. Palma,, I. Vera,, V. F. De,, E. Baez,, W. E. Schmidt,, R. E. Figueroa,, C. J. Peters,, S. R. Zaki,, A. S. Khan,, and T. G. Ksiazek. 1997. An outbreak of hantavirus pulmonary syndrome in western Paraguay. Am. J. Trop. Med. Hyg. 57:274282.
79. Winn, W. C., and R. L. Myerowitz. 1981. The pathology of the Legionella pneumonias. Hum. Pathol. 12:401422.
80.World Health Organization. 1992. Global Health Situations and Projections, Estimates 1992. World Health Organization, Geneva, Switzerland.
81. Wotherspoon, A.,, C. Ortiz-Hidalgo,, T. Diss,, M. R. Falzon,, and P. G. Isaacson. 1991. Helicobacter pylori-associated gastritis and primary B-cell gastric lymphoma. Lancet 338:11751176.
82. Zaki, S. R., 1997. Hantavirus-associated diseases, p. 125136. In D. H. Connor,, F. W. Chandler,, D. A. Schwartz,, H. J. Manz,, and E. E. Lack (ed.), Pathology of Infectious Diseases. Appleton & Lange, Stamford, Conn.
83. Zaki, S. R.,, R. C. Albers,, P. W. Greer,, L. M. Coffield,, L. R. Armstrong,, A. S. Khan,, R. Khabbaz,. and C. J. Peters. 1994. Retrospective diagnosis of a 1983 case of fatal hantavirus pulmonary syndrome. Lancet 343:10371038. (Letter.)
84. Zaki, S. R.,, and C. S. Goldsmith. 1999. Pathologic features of filovirus infections in humans. Curr: Top. Microbial. Immunol. 235:97116.
85. Zaki, S. R.,, P. W. Greer,, L. M. Coffield,, C. S. Goldsmith,, K. B. Nolte,, K. Foucar,, R. M. Feddersen,, R. E. Zumwalt,, G. L. Miller,, and A. S. Khan. 1995. Hantavirus pulmonary syndrome. Pathogenesis of an emerging infectious disease. Am. J. Pathol. 146:552579.
86. Zaki, S. R.,, A. S. Khan,, R. A. Goodman,, L. R. Armstrong,, P. W. Greer,, L.M. Comeld,, T. G. Ksiazek,, P. E. Rollin,, C. J. Peters,, and R. F. Khabbaz. 1996. Retrospective diagnosis of hantavirus pulmonary syndrome, 1978-1993: implications for emerging infectious diseases. Arch. Pathol. Lab. Med. 120:134139.
87. Zaki, S. R.,, and P. H. Kilmarx,. 1997. Ebola virus hemorrhagic fever, p. 299312. In C. Horsburgh, Jr.,, and A. M. Nelson (ed.), Pathology of Emerging Infections. ASM Press, Washington, D.C.
88. Zaki, S. R.,, and A. M. Marty,. 1995. New technology for the diagnosis of infectious diseases, p. 127154. In G. Seifert, and W. Doerr (ed.), Tropical Pathology. Springer-Verlag, Berlin, Germany.
89. Zaki, S. R.,, and C.J. Peters,. 1997. Viral hemorrhagic fevers, p. 347364. In D. H. Connor,, F. W. Chandler,, D. A. Schwartz,, H. J. Manz,, and E. E. Lack (ed.). Diagnostic Pathology of Infectious Diseases. Appleton & Lange, Stamford, Conn.
90. Zaki, S. R.,, W. J. Shieh,, P. W. Greer, , C. S. Goldsmith,, T. Ferebee,, J. Katsbilski,, K. Tehioko,, M. A. Bwaka,, R. Swanepoel,, P. Calain,, A. S. Khan,, E. Lloyd,, P. E. Rollin,, T. G. Ksiazek,, C. J. Peters, and the EHF Study Group. 1999. A novel immunohistochemical assay for detection of Ebola virus in skin: implications for diagnosis, spread and surveillance of Ebola hemorrhagic fever. J. Infect. Dis. 179:S36S47.
91. Zaki, S. R.,, W. J. Shieh, and The Epidemic Working Group at Ministry of Health in Nicaragua. 1996. Leptospirosis associated with outbreak of acute febrile illness and pulmonary haemorrhage, Nicaragua, 1995. Lancet 347:535536.
92. Zanetti, G.,, P. FrancioIi,, D. Tagan,, C. D. Paddock,, and S. R. Zaki. 1998. Imported epidemic typhus. Lancet 352:1709. (Letter.)


Generic image for table
Table 1

Selected examples of emerging infectious diseases with significant contributions by pathology

Citation: Zaki S, Paddock C. 1999. The Emerging Role of Pathology in Infectious Diseases, p 181-200. In Scheld W, Craig W, Hughes J (ed), Emerging Infections 3. ASM Press, Washington, DC. doi: 10.1128/9781555818418.ch12
Generic image for table
Table 2

IHC and ISH tests used by IDPA, CDC, for diagnosis of infectious disease agents

Citation: Zaki S, Paddock C. 1999. The Emerging Role of Pathology in Infectious Diseases, p 181-200. In Scheld W, Craig W, Hughes J (ed), Emerging Infections 3. ASM Press, Washington, DC. doi: 10.1128/9781555818418.ch12

This is a required field
Please enter a valid email address
Please check the format of the address you have entered.
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error