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Category: Clinical Microbiology
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This new volume is the seventh in a series of books based on ICAAC Symposia on Emerging Infections. It offers an updated review of new and emerging infectious diseases, including Avian Influenza (H5N1), Severe Acute Respiratory Syndrome (SARS), West Nile fever, and many others. The editors are experts in their respective fields of research and are active in the scientific and clinical communities that deal with emerging pathogens. The Emerging Infections series is a valuable resource for a wide range of people working in microbiology, Infectious diseases, epidemiology, public health, and clinical medicine.
Electronic Only, 381 pages, illustrations, index.
Since 1997, highly pathogenic avian influenza A (H5N1) viruses have caused unprecedented widespread poultry outbreaks with high mortality in a number of Asian, European, Middle Eastern, and African countries; have infected other animal species; and have caused sporadic, severe, and fatal human infections. Influenza viruses are single-stranded, negative-sense RNA viruses with eight gene segments that encode 10 proteins and belong to the family Orthomyxoviridae. It is now known that H5N1 virus emerged in southern China in 1996 and that outbreaks of highly pathogenic avian influenza (HPAI) H5N1 among poultry have occurred in southern China for several years. Epidemiological studies conducted in Hong Kong during the 1997 H5N1 outbreak implicated avian-to-human transmission of H5N1 virus. Clinical case reports of H5N1 infection reflect surveillance for severe respiratory illness in hospitals. There are few descriptions of the clinical features of mild or atypical disease. Detection of H5N1 RNA by conventional or real-time PCR testing of respiratory specimens using H5-specific primers under biosafety level 2 (BSL2) laboratory conditions is the most common method of H5N1 diagnosis. The key to preventing human infections with H5N1 virus is to avoid unprotected direct contact with diseased and dead poultry, materials contaminated by poultry feces, and uncooked or inadequately cooked poultry or poultry products. There are several challenges to producing a pandemic influenza vaccine. Aside from the problems with production capacity and distribution, three additional challenges to creating an H5N1 vaccine are antigenic drift, immunogenicity, and vaccine pathogenicity to embryonated chicken eggs.
Severe acute respiratory syndrome (SARS) coronavirus (CoV) infection, in addition to infections originating in the laboratory, was detected in four patients with no possible laboratory exposure during December 2003 and January 2004. These four epidemiologically unrelated patients likely acquired the infection through exposure to infected animals in live-game-animal markets in Guangdong. A number of possible agents were detected in the course of investigating patients with suspected SARS, including human metapneumovirus and chlamydia. In the absence of an epidemiological history of exposure, clinical findings are not pathognomic of SARS. Therefore, a positive virological laboratory finding of SARS CoV infection is required for confirmation of the diagnosis. Evidence of SARS CoV replication in the lungs and intestine is provided by detection of virus particles through electron microscopy, by virus isolation, and by the detection of viral antigens and nucleic acid through immunohistology and in situ hybridization. Experimental infections in relevant animal models are important for understanding pathogenesis and evaluating therapeutic and vaccine strategies. The clinical management of patients with SARS includes respiratory support with intensive care when appropriate, prevention of nosocomial transmission, and the possible use of antivirals and immunomodulators. Aspects of its pathogenesis and transmission allowed the human disease outbreak to be quickly interrupted. The global response to SARS demonstrated that a rapid mobilization and coordination of relevant expertise is possible, when faced with a global emerging disease threat. It also highlighted the need for improved international regulations governing the reporting of and response to unusual infectious-disease syndromes.
Acute respiratory infections are the most common illnesses experienced by people of all ages worldwide. Based on these similarities, the virus was classified as the first mammalian member of the genus Metapneumovirus; hence its name, human metapneumovirus (hMPV). Virus neutralization assays using virus lineage-specific ferret antisera collected shortly after infection demonstrated a 12- to more than 100-fold difference in virus neutralization titers between viruses from the two main lineages. Serological tests based on prototype viruses from one lineage are less sensitive in detecting viruses with different antigenic properties, indicating that mixtures of antigens should be used in developing diagnostic tests. For RT-PCR assays, it is important to design primers based on regions that are conserved between viruses of the four genetic lineages. Like Human respiratory syncytial virus (RSV) and influenza virus infections, hMPV infections also account for respiratory tract infections (RTIs) in the elderly and in patients with underlying disease or impaired immunity. hMPV causes yearly epidemics of RTI; however, the incidences vary from year to year or between locations, as is seen for RSV epidemics. To study host responses and the virological, immunological, and pathological features of hMPV infections, several animal models are available. Only RSV, and occasionally influenza virus, was detected more frequently in the studies that included surveys for other respiratory viruses. In addition, the preliminary results on the association between asthma and hMPV infections and the possible consequences of coinfection of hMPV and RSV (and other respiratory viruses) for the severity of disease warrant further research.
Advances in the care of immunocompromised hosts have been driven by the development of a variety of increasingly potent immunosuppressive agents for use in solid-organ and hematopoietic stem cell transplant recipients. Routine prophylaxis with trimethoprim-sulfamethoxazole and antiviral agents has reduced the incidence of Pneumocystis pneumonia, nocardiosis, and respiratory, urinary, and gastrointestinal infections due to susceptible pathogens and cytomegalovirus (CMV) infection. Data from retrospective studies allow some generalizations about respiratory viral infections in transplant recipients. Direct detection of viral antigens in respiratory tract specimens using monoclonal antibodies may have increased sensitivity compared with the rapid, commercially available methods. The possibility that immune status plays a pivotal role in the transmission of severe acute respiratory syndrome (SARS) was suggested by the identification of individuals who appeared to be “super spreaders” of infection. Adenoviral disease is best described in pediatric liver transplant recipients but is also described in individuals following kidney, small bowel, lung, and heart transplantation. Vaccination is recommended annually, as much of the burden of influenza is related to secondary superinfections, graft rejection (in lung transplant recipients), or graft-versus-host disease (in HSCT recipients). Respiratory viral infections are a risk factor for graft rejection, particularly chronic graft rejection in lung transplant recipients.
This chapter focuses on epidemiologic, ecologic, and biologic observations made since the publication of Emerging Infections 4 which enhance the understanding of Human monkeypox, zoonotic disease and the pathogen that causes it. Ecologic studies, usually using convenient samples of animals collected in areas surrounding human patients in West Africa and central Africa, demonstrated orthopoxvirus- and sometimes monkeypox virus-specific seroprevalence in various members of these species, but it was not reported for Cricetomys species. In 2003, two concurrent outbreaks of disease, one in the United States and one in the Republic of the Congo, permitted additional analyses and studies which have substantially amplified the understanding of monkeypox viruses and their pathogeneses in various animal species, which in turn will allow the design of public health control measures. Gambian rats (Cricetomys sp.) and rope squirrels (Funisciurus spp.) separated from the shipment immediately on arrival in the United States, discovered moribund and later dead in Texas and New Jersey, respectively, were found positive for monkeypox virus. As the animal distribution was traced across the United States, African dormice (Graphiurus spp.) were also found moribund, and on autopsy they were positive for the presence of monkeypox virus. Monkeypox virus continues to emerge in new populations; recent reports from Sudan indicate that the virus has the capacity to cause human illness in yet another ecologically distinct environment.
This chapter highlights many aspects of the West Nile virus (WNV) that is an emerging pathogen, including its epidemiology in the Americas, new clinical syndromes, new modes of transmission and their impacts on public health, and progress in the development of therapeutics and vaccines. Virology, entomology, ecology, and pathogenesis are discussed only to the extent required to provide background for the main topics. Strains of WNV can be divided into two genetic lineages by phylogenetic analysis of the complete genome sequence or of the E protein gene sequence. The major mosquito vector in Africa and the Middle East is Culex univittatus, with Culex picilipes, Culex neavei, Culex decens, Aedes albocephalus, or Mimomyia spp. important in some areas. Further evidence that WNV could produce severe neurological disease was obtained in the early 1950s during experiments with WNV as an experimental cancer therapy. Advanced age is the most important risk factor for death. Surveillance data indicate that case fatality rates for persons with WNV neuroinvasive disease increase from 1% among persons under 40 years of age to 36% among persons 90 years old and older. Reduction of vector populations by public mosquito control programs is another mainstay of WNV prevention in North America. New clinical syndromes and new modes of transmission were identified, including transmission by transfused blood. This led to universal WNV screening of donated blood in the United States and Canada.
Until recently, Japanese encephalitis (JE) was recognized as the only encephalitis having outbreak potential in India. The clinical features described for the viral encephalitis outbreak in Raipur and Jabalpur in 1980 exactly match the typical case definition of Chandipura (CHP) encephalitis. Undoubtedly, the virus has now attained the status of an important emerging pathogen of public health significance. In this chapter, the author briefly describes the outbreaks that have led to the identification of this disease and also provides a brief description of the classical, as well as modern, virological techniques used. Other important studies that have been undertaken on the virus and disease are also summarized. An outbreak of acute encephalitis of unknown origin with a high case fatality rate (CFR) was reported in children from 11 districts of Andhra Pradesh, India, during 2003. The general clinical features of CHP encephalitis include high-grade fever of short duration, vomiting, altered sensorium, generalized convulsions, and decerebrate posture, leading to grade IV coma, acute encephalitis/encephalopathy, and death within a few to 48 hours of hospitalization. Based on the G-gene sequence of an Indian CHP virus isolate (GenBank accession number J04350), the diagnostic PCR was standardized. Genomic DNA was extracted from frozen peripheral blood mononuclear cells. For HLA A, B, and C typing, a PCR-single-strand polymorphism molecular method was followed. To overcome chance deviation in the frequency of the HLA allele, the P value was corrected by the use of the Bonferroni inequality method.
Retroviruses are a large and diverse group of enveloped RNA viruses in the family Retroviridae that replicate in a unique way, using a viral reverse transcriptase enzyme to transcribe the RNA genome into linear double-stranded DNA. Among viruses capable of causing zoonotic infections, defined for the purposes of this chapter as primary infections resulting from direct animal exposure, only some are capable of secondary spread. The approach advocated focuses on the study of individuals who are highly exposed to the blood and body fluids of primates, either through contact in laboratories and primate centers or through the hunting and butchering of wild non-human primate (NHP) game, and the detailed follow-up of individuals with zoonotic infections and their contacts for evidence of secondary transmission. The gorilla simian foamy virus (SFV)-infected persons in this study reported having received significant bite wounds from gorillas. Researchers have recently examined the diversity of human T-lymphotropic viruses (HTLVs) among primate bushmeat hunters in Cameroon who had documented SFV infections and who thus may be at risk for infection with additional simian retroviruses. Three new retroviruses previously undocumented in humans, including the simian foamy viruses, HTLV-3, and HTLV-4, have all been identified in persons exposed to the blood and body fluids of NHPs.
In the past decade, the view of methicillin-resistant Staphylococcus aureus (MRSA) epidemiology has changed. A large burden of community associated MRSA (CA-MRSA) disease was reported by prison and jail systems in California, Texas, Mississippi, and Georgia. Outbreaks have provided incentives to examine the epidemiology of CA-MRSA in closer detail. Importantly, these increases were directly translated into similar increases in the overall burden of S. aureus disease. Important genetic phenomena are believed to be responsible for the phenotypic differences observed in comparisons of CA-MRSA and hospital-associated MRSA (HA-MRSA) isolates. A survey of 16 toxin genes known to be present in genomically sequenced S. aureus strains revealed that important differences can be identified when HA-MRSA and CA-MRSA isolates are compared. Six exotoxin genes were found significantly more often among CA-MRSA isolates, and seven were found significantly more often among HA-MRSA strains. Asymptomatic colonization is the most frequent outcome of host interaction with S. aureus. The mainstay of treatment for skin abscesses is incision and drainage of the lesion. The pneumonia may be classified as ‘’necrotizing’’ if the chest CT shows a consolidative infiltrate, destruction of normal lung architecture, and loss of tissue enhancement. The CA-MRSA epidemic has complicated the selection of empirical antibiotic therapy for presumed S. aureus infections. Distinguishing HA-MRSA from CA-MRSA is useful in defining the changing epidemiology, identifying those at risk, and choosing empirical antibiotic therapy when required.
Enterobacteriaceae with reduced susceptibility to carbapenems are an emerging, worldwide problem. In most cases, the reduced carbapenem susceptibility is attributable to acquisition of one of a variety of ß-lactamases with carbapenem-hydrolyzing properties. Carbapenem resistance can be mediated by the acquisition of carbapenem-hydrolyzing ß-lactamases. In Japan, IMP enzymes have been recovered from isolates of Serratia marcescens and Enterobacter spp. and conferred resistance to ceftazidime and imipenem. Occasional isolates of Klebsiella pneumoniae carrying IMP metallo-ß-lactamases have also been recovered in Japan. Enterobacteriaceae carrying KPC ß-lactamases are emerging and pose serious challenges to therapy. Approximately 90%of KPC-possessing K. pneumoniae isolates are susceptible to polymyxin B, and the antibiotic exhibits a concentration-dependent killing effect. The addition of rifampin to polymyxin B provided bactericidal activity in 15/16 tested isolates in one report and resulted in a lower inhibitory concentration of polymyxin B. The fact that other carbapenem-hydrolyzing enzymes emerged prior to the commercial release of carbapenems also suggests that other properties of these enzymes may justify their existence or that other antibiotics in nature could be substrates and exert selection pressures. Also complicating potential antibiotic control strategies is the fact that other resistance genes often accompany the carbapenemase gene, including those for other ß-lactamases, amikacin, gentamicin, streptomycin, tobramycin, and trimethoprim-sulfamethoxazole. Due to these associations, it has been suggested that selective pressure from non-ß-lactam antibiotics (e.g., aminoglycosides) may encourage concomitant carbapenem resistance.
The majority of organisms involved in pyogenic liver abscess (PLA) originate from the gastrointestinal tract. The study by Huang et al. suggested that Klebsiella was becoming a more common pathogen in cases of PLA. Also of interest was the fact that in the majority of cases in which Klebsiella was recovered, it was the only pathogen. Therefore, the percentage of PLA cases caused by Klebsiella alone was substantially greater in this study than in any prior study from the United States. However, in recent years, bacterial virulence has been found to play an important role in the pathogenesis of the disease. A multinational prospective study revealed a global difference in clinical patterns of community-acquired Klebsiella pneumoniae bacteremia, with a distinctive form of K. pneumoniae infection causing liver abscess, endophthalmitis, and meningitis almost exclusively in Taiwan. The most common signs and symptoms of PLA are fever, right upper quadrant pain, and chills. The most common laboratory abnormalities are a low albumin level, elevated alkaline phosphatase, and an elevated white blood cell count. The majority of patients have lesions in the right lobe of the liver. While cases of pyogenic liver abscesses have been reported in the literature for many years, there have been many changes in the epidemiology of the disease. Recently, virulence factors, such as that encoded by the magA gene, have been identified. Strains with magA are also strongly associated with metastatic complications, such as endophthalmitis and meningitis.
The burden of pneumonia prevented by conjugate pneumococcal vaccine may be underestimated by consideration only of the vaccine impact against X-ray-confirmed pneumonia. An analyses of the South African data suggest that the burden of disease prevented, or vaccine-attributable reduction (VAR) in disease burden, is higher against clinically confirmed pneumonia than against X-ray-confirmed disease. The impact of Haemophilus influenzae type b (Hib) conjugate vaccine on pneumonia in HIV-infected children has not been established, although the vaccine has activity against invasive Hib disease in these children similar to that of pneumococcal conjugate. There is abundant evidence that conjugate pneumococcal vaccines reduce the carriage of vaccine serotypes and in that way reduce the burden of invasive disease in the elderly. By inference, therefore, the vaccine should prevent both bacteremic and nonbacteremic pneumococcal pneumonia by herd immunity. A consistent finding in studies of pediatric viral pneumonia has been evidence of bacterial coinfection. The mechanism of the interaction may be as varied as the synergy between the pneumococcus and the influenza virus on apoptosis of neutrophils; virus-induced interleukin-1 and tumor necrosis factor upregulation of the platelet-activating factor receptor, which mediates bacterial invasion; or the influenza virus strain neuraminidase activity, which degrades mucin and enhances secondary pneumococcal pneumonia in mice. The vaccine probe approach allows direct investigation of the concurrence of bacterial and viral pathogens in children with pneumonia. Children (and possibly adults) hospitalized with presumed viral pneumonia require antibiotics, even if the bacterial superinfection cannot be confirmed by culture.
Crohn’s disease is an idiopathic chronic granulomatous ileocolitis. Although this inflammatory bowel disease (IBD) was initially described as a segmental disease of the small intestine, it has more recently been found to be associated with the mouth, larynx, esophagus, stomach, colon, skin, muscle, synovial tissue, and bone. The only true population-based data concerning the incidence and prevalence of Crohn's disease come from Olmsted County, Minnesota. The most disturbing evidence to come out of Olmsted County concerned the increasing incidence of Crohn's disease among young children. Treatment of Crohn’s disease depends on the location and severity of disease, complications, and response to previous treatment. The most common complication is stricture of the intestine, and surgery to remove the obstructed intestinal area is often performed. Genetic factors could also be involved in intestinal-permeability defects, based on the observation that patients with quiescent Crohn's disease and two-thirds of their healthy relatives have increased permeability to inert markers. The parallels between Crohn's disease and bovine paratuberculosis infection, or Johne's disease, remain one of the best arguments for this hypothesis. A multicenter blind study aimed at analysis of blood samples from Crohn's disease patients and controls is under way. If Mycobacterium avium subsp. paratuberculosis causes Crohn’s disease, the inclination is to treat patients with antibiotics and to monitor them for clinical improvement. The problem is that mycobacteria are very difficult to treat, and M. avium is harder to treat than most due to the development of multiply drug-resistant strains.
There is now accumulating evidence that receipt of prophylaxis or treatment with voriconazole and the severity of the immunosuppression appear to work in conjunction to favor increase in the incidence of zygomycosis in hematopoietic stem cell transplantation (HSCT) recipients. This increase in zygomycosis stands in contrast to prior reports of breakthrough infections seen when fluconazole or itraconazole was used for antifungal prophylaxis in HSCT recipients. The importance of iron availability in the pathogenesis of zygomycosis is underscored by the increased incidence of zygomycosis in patients on deferoxamine therapy or with iron overload. Sinus disease is estimated that about two-thirds of the cases of sinus zygomycosis occur in diabetic patients, often in the presence of diabetic ketoacidosis. Opacification of the paranasal sinuses, fluid levels, bone destruction, and osteomyelitis are the main radiographic findings associated with sinus zygomycosis. Among the different sites, primary pulmonary infection is more frequently associated with disseminated zygomycosis. The presenting signs, symptoms, and radiographic findings of zygomycosis are nonspecific and should be interpreted with respect to the underlying condition of the patient. Despite the recent advances in antifungal therapy, zygomycosis continues to be one of the most fulminant mycoses in humans. Correction of the patient’s underlying condition that predisposes to zygomycosis is one of the cornerstones of successful management of this devastating infection. Surgical debridement is of critical importance for the successful management of zygomycosis. Zygomycetes cause disease in a number of susceptible hosts with different predisposing conditions, including surgery, burns, trauma, diabetes mellitus, and treatment with deferoxamine.
This chapter describes the most relevant features of protozoan agents of foodborne diseases and waterborne diseases, specifically, Cryptosporidium and Cyclospora, which cause diarrheal illness in humans, and Toxoplasma, which is associated with encephalitis, chorioretinitis, and abortion. In developing countries, human cryptosporidiosis and cyclosporiasis occur most frequently in children. While Cryptosporidium is common worldwide, endemic Cyclospora may be restricted to those communities that lack adequate water treatment (e.g., filtration) and sanitation (sewage treatment). Children can have multiple episodes of cryptosporidiosis and cyclosporiasis, implying that the acquired anti-Cryptosporidium or anti-Cyclospora immunity in children is short-lived or incomplete. Toxoplasmosis is one of the most common causes of primary chorioretinitis in children. In industrialized nations, the most effective treatment and prophylaxis for cryptosporidiosis in AIDS patients is the use of highly active antiretroviral therapy (HAART). Reports of food-related infections by Cryptosporidium are few, difficult to document, and probably greatly underreported, with individual cases and small-group outbreaks unlikely to be recognized. A small number of food-borne outbreaks of cryptosporidiosis have been reported. Genetic characterization of 25 T. gondii isolates from market pigs identified three distinct strains based on RFLP assays at the SAG2 locus with no evidence of recombinants, implying that three distinct exposure events occurred during the lifespans of the pigs. Whether the risks are associated with improper water or sewage treatment, improper or inadequate food preparation or agricultural practices, or simply hygiene failures leading to person-to-person transmission, the efforts to control these opportunistic parasites will continue to be a challenge.
This chapter discusses the military's clinical experience with severe infection caused by multidrug-resistant (MDR) Acinetobacter spp. in wounded personnel. Acinetobacter is primarily associated with nosocomial infections, accounting for 1% of nosocomial bloodstream infections (BSIs) and 3% of nosocomial pneumonias in U.S. hospitals, according to the Centers for Disease Control and Prevention National Nosocomial Infection Surveillance report. The majority of infections have involved wounds and osteomyelitis. There have also been a number of cases of bacteremia and a few isolated cases of pneumonia, empyema, peritonitis, urinary tract infections, sinusitis, and meningitis. Treatment of Acinetobacter infections in personnel stationed in or returning from Southwest Asia has become a major challenge. The majority of isolates were resistant to ampicillin, cefepime, ceftazidime, cefotaxime, ciprofloxacin, levofloxacin, gentamicin, tobramycin, piperacillin, and trimethoprim-sulfamethoxazole. Our current recommendation for treatment of active-duty personnel with Acinetobacter infections is directed based on susceptibility testing. The outbreak of infections with MDR Acinetobacter in military personnel has resulted in the institution of new infection control standards in military medical centers caring for these casualties. Osteomyelitis caused by MDR Acinetobacter seems to initially respond to a multifaceted approach, including appropriate surgical debridement, carefully selected antimicrobial therapy based on susceptibility patterns, and careful follow-up.
Leishmaniasis is caused by a protozoan parasite of the genus Leishmania and is associated with several clinical syndromes: visceral (the most serious), mucosal (the most disfiguring), and cutaneous (the most common). To date, only five cases of visceral leishmaniasis have been reported, with three cases from Operation Enduring Freedom and two acquired during Operation Iraqi Freedom. Using the Defense Medical Surveillance System, all reportable medical events, hospitalizations, and ambulatory visits to military treatment facilities coded with the diagnosis of leishmaniasis (ICD-9, 085.0 to 085.9) were searched. The leishmaniasis attack rate in one squadron was 211/1,000, with the associated division having an attack rate of 12/1,000. The major clinical syndromes of leishmaniasis are cutaneous, mucosal, and visceral leishmaniasis. There have been instances of significant enlargement of leishmaniasis lesions along broken-down suture lines and discourage excision as a treatment modality. The symptomatic expression of visceral leishmaniasis (VL) (known as kala-azar) includes fever, cachexia, pancytopenia, hepatosplenomegaly, and hypergammaglobulinemia with hypoalbuminemia. Visceral leishmaniasis can be asymptomatic, subclinical, symptomatic, or very severe. While the old world cutaneous leishmaniasis (OWCL) described in U.S. military personnel is generally benign, the impact of VL on the global poorest of the poor can be associated with high mortality and is estimated by the World Health Organization (WHO) to be in excess of 500,000 cases per year. Much remains to be done; the most effective treatments are expensive and generally challenging to administer, drug resistance is developing, and the prevalence of concomitant immunocompromising conditions is increasing.
This chapter deals with the smallpox vaccine, its benefits, its risks, and the current state of its use. To ensure the future availability of appropriate amounts of smallpox vaccine, the U.S. government has funded the manufacture of tissue culture vaccine; the most likely candidate is an Acambis/Baxter Laboratories’ product, grown in Vero monkey kidney cell culture. It is critical to emphasize that the vast majority of vaccinees (nearly all) undergo vaccination without serious complications. The potential vulnerabilities to adverse events after smallpox vaccination are described. It is known that in the era when smallpox vaccination was routine, many patients with hypogammaglobulinemia but with intact T-cell function underwent smallpox vaccination without incidents, presumably because their T-cell immunity was sufficient to contain the virus and to rid the body of infected skin cells, preventing further spread to other areas of the body. It also known that a few individuals with progressive vaccinia virus infection had a lack of T-cell function but intact antibody capacity to various degrees. These individuals had lesser degrees of progression, often without viremic spread. Due to our lack of knowledge of the degree of susceptibility, if any, of individuals with non-T-cell immunodeficiencies, the recommendation has evolved to exclude such individuals from elective smallpox vaccination. The minimal reactions are split into noninfectious consequences of smallpox vaccination and infectious complications.
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At A Glance
Emerging Infections 7 is the seventh of an annual series of books based on ICAAC Symposia on Emerging Infections. It provides a complete and updated discussion of new and emerging infectious diseases, covering both basic science and clinical topics. The editors are in the forefront of the scientific and clinical communities dealing with emerging pathogens. This book and the series will be valuable to a wide range of people working in microbiology, infectious diseases, epidemiology, public health, and clinical medicine.
Description
This is the seventh in a series of books on emerging infections taken from symposia. The 18 chapters cover topics that range from the commonly discussed avian flu to the less discussed Chandipura encephalitis.
Purpose
This book is intended to provide information to help practitioners learn from past experience to guide decisions in the future. In the author's words, it "should serve as a valuable source of information for those responsible for these and other microbial threats to global health, economies and security." The book meets these very worthy objectives.
Audience
The intended audience includes healthcare practitioners who deal with these agents, such as infectious disease physicians, infection control practitioners, and public health epidemiologists.
Features
The book covers the topics in a very thorough manner, although there is no cohesive overall pattern of how a topic is approached. A wide range of topics are covered and each chapter includes information ranging form the pathophysiologic to the clinical to the epidemiologic; local to global; civilian to military. The detailed figures are mostly black and white and the footnotes can be excessive (435 in one chapter alone).
Assessment
A very comprehensive and well thought out approach to 18 different emerging infection topic areas is provided. Since these topic areas were drawn from specific symposia at the annual Infectious Diseases Society of America meeting, it is difficult to get a cohesive message. Nonetheless, the information is complementary to the current literature on each of the topics, and is a worthy contribution to the literature.
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Reviewer: Peter Katona, MD (UCLA School of Medicine)
Review Date: Unknown
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