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Category: General Interest
Many leisure activities, however enjoyable they may be, expose us to a growing list of pathogenic microbes, some new and many increasingly resistant to current therapies. In response, the fourth edition of Infections of Leisure has been thoroughly updated with the latest infectious threats, treatments, and preventive measures. In addition, three new chapters have been added to help manage the risk of infection associated with air travel, petting zoos, and cruise ships.
Designed for ease of use, each chapter focuses on the infection risks associated with a particular type of leisure activity. At the end of each chapter, Practical Tips, a new feature, underscores the most critical steps needed to prevent and manage the infections discussed in the chapter.
With the fourth edition’s extensive updating and new material, health care professionals and laypeople can confidently refer to it to assess the risk of leisure-associated infections, take measures to avoid them when possible, and make informed choices. Moreover, the book will help readers identify and treat those infections that do occur as quickly and effectively as possible.
Out of Print, paperback, 431 pages, illustrations, index.
Contaminated seafood was the leading cause of food-borne illness outbreaks, according to the Center for Science in the Public Interest, with seafood causing 340 outbreaks with 5,133 cases of food-borne illness in the United States between 1990 and 2001. Food-borne diseases associated with fish and shellfish can be categorized into allergic, infectious, and toxin-mediated etiologies. Ingestion of shellfish containing toxins produced by dinoflagellates may induce dramatic and sometimes fatal illness. Dinoflagellates, or plankton, are unicellular plant-like organisms with a worldwide distribution which serve as an important element of the food chain in marine animals. Mollusks become toxic when they ingest toxic dinoflagellates. Several species of toxic dinoflagellates have been implicated in outbreaks of paralytic shellfish poisoning (PSP). The neurotoxins produced by the dinoflagellate probably do not accumulate in fish but do concentrate in filter-feeding shellfish in the vicinity of a bloom. Ciguatera is a distinct clinical syndrome that may follow the ingestion of certain tropical reef fishes which have acquired toxicity through the food chain. Scombroid-fish poisoning is an acute clinical syndrome characterized by symptoms of histamine toxicity resulting from the ingestion of spoiled fish. The spectrum of human disease due to the pathogenic vibrios is dependent mainly on the causative species and ranges from mild self-limiting gastroenteritis and soft tissue infections to severe necrotizing wound infections and fulminant bacteremia, primarily in patients with underlying diseases. Rotavirus is a common viral pathogen responsible for a large percentage of childhood diarrheal illnesses.
This chapter focuses on human infections acquired in nonmarine environments, including natural freshwater environments (lakes, ponds, rivers, and streams) and man-made aquatic environments (swimming pools, hot tubs, whirlpools, and spas). The discussion is limited to infections associated with immersion or other exposure to aquatic macroor microenvironments. An appreciation of the wide variety of potential pathogens that occasionally cause problems for patients exposed to freshwater can be gained from the chapter. While Shigella, Naegleria, and Escherichia coli were more likely to cause outbreaks in freshwater, such as in lakes, ponds, and rivers, Cryptosporidium and Giardia were more likely to cause infections and outbreaks in treated waters, like in swimming pools. It is unusual to encounter community-acquired skin and soft tissue infections caused by mycobacteria other than Mycobacterium marinum and Mycobacterium ulcerans for which immersion in freshwater is an epidemiological factor. The antimicrobial susceptibility of Aeromonas species and the therapy of infections are discussed. Other free-living amoebae include Acanthamoeba and Balamuthia spp. These amphizoic amoebae may cause fulminant rapidly progressive central nervous system infection called primary amoebic meningoencephalitis (PAM) (due to Naegleria fowleri) or chronic slowly progressive disease called granulomatous amoebic encephalitis (GAE), primarily caused by several species of Acanthamoeba and by Balamuthia mandrillaris. Owners of swimming facilities need to pay more attention to maintenance, operation, disinfection, and filtration. While these issues are being resolved, some practical measures will come in handy to prevent further infections and associated outbreaks.
Venturing into wilderness environments can be exhilarating, and each year millions of people take time off to enjoy the pastime. During this relaxing endeavor, the majority of adventurers come into contact with different species of biting arthropods. Ticks, mosquitoes, lice, fleas, mites, bees, wasps, scorpions, and spiders can make time spent outdoors unpleasant, and they are potential carriers of disease. The major diseases in the United States which are transmitted to humans by ticks include Lyme disease, human monocytic ehrlichiosis (HME), human granulocytic anaplasmosis (HGA), Rocky Mountain spotted fever (RMSF), and tularemia. The major manifestation of the first stage of the disease (early, localized infection) is the localized skin rash termed erythema migrans, which is present in up to 80% of patients. The majority of reported cases, however, are from the southeastern part of the United States, with approximately 80% of reported cases occurring during the months of May and June. In the western United States, wood ticks (Dermacentor andersoni) are the primary carriers and vectors of infection, whereas the dog tick (Dermacentor variabilis) and the Lone Star tick (Amblyomma americanum) represent the most common arthropod hosts in the eastern United States and the south-central region, respectively. A proper wardrobe is essential in preventing tick-transmitted diseases. Permethrin can be sprayed on clothing to prevent tick attachment, and insect repellents that employ N,N-diethyl-3- methylbenzamide (DEET) can be applied to the skin for further protection.
Many infectious diseases acquired in the garden are age specific; e.g., small children are more likely than adults to get Strongyloides stercoralis or hookworm infections in the appropriate locale. The epidemiological associations with infectious diseases acquired from plants, soil, or animal vectors have been discussed in this chapter. With all of the diseases potentially acquired by working in the garden, the clinician needs to establish a working diagnosis and then arrive at a definitive diagnosis by ordering the appropriate specific tests. Specific infectious diseases including sporotrichosis, histoplasmosis and blastomycosis have also been discussed. The location of the garden and the characteristics of the soil play a part in determining its infectious potential. The most important factor making the garden an infectious and dangerous place is the number and interaction of animals, whether they are pets or in the wild, that temporarily use the garden for part of their daily activities. The diagnostic approach is to utilize epidemiological principles in concert with clinical clues, which together should suggest a reasonable list of diagnostic possibilities.
The relationship between humans and dogs is an ancient one. The dog has been our workmate, protector, guide, and companion. Occasionally, however, pathogens may be transmitted from dogs to human beings, resulting in problems ranging from a trivial rash to life threatening bacteremia. These infections are reviewed in this chapter. Bacterial zoonoses transmissible from dogs to human beings include campylobacteriosis, salmonellosis, leptospirosis, and brucellosis. Campylobacteriosis is found throughout the world and is an important cause of human bacterial diarrhea, being as common as or more common than salmonellosis and shigellosis. The common clinical presentation of canine salmonellosis consists of fever, vomiting, and diarrhea (varying from watery to mucoid to bloody). The most severe form of leptospirosis, known as Weil's disease, is characterized by hepatic and renal dysfunction, hemorrhage, and circulatory collapse. The clinical manifestations of human toxocariasis are classified as visceral larva migrans (VLM), ocular larva migrans, and neurological toxocariasis. Children exposed to dogs treated for roundworm infection are less likely to have positive serologic tests for Toxocara canis than children exposed to untreated dogs. Other preventive measures include removing children with pica from environments thought to be contaminated, prohibiting canine access to children's game areas, and frequently turning over sand in public parks. The majority of human infections with Echinococcus granulosus are asymptomatic. The disease is indolent, as cysts enlarge slowly over many years. The growing cysts may remain unilocular or become multilocular with the formation of daughter cysts.
There are numerous diseases that may be transmitted from cats to humans or that cats and people acquire from common sources, some of which are described in this chapter. The diseases discussed are arranged by the general method of transmission from cat to person, although more than one route is possible for certain infections. Recent data suggest that bacillary angiomatosis and hepatosplenic disease respond more favorably (rapidly and consistently) than typical cat scratch disease (CSD) to antimicrobial therapy for unclear reasons. Diagnosis is made by serologic studies or by isolation or cytologic demonstration of the organism from blood or body fluids or by histologic demonstration of the trophozoite. The prevalence of infection in cats being exclusively fed commercial rations is very low; however, up to 18% of healthy and healthy-appearing cats may be infected or carriers when foodstuffs are not restricted. Cats may be asymptomatic carriers but may also exhibit clinical infection, with anorexia, vomiting, and severe diarrhea, which are most likely to occur in the winter and spring. In cats, anthrax is manifested by inflammation, edema, and necrosis of the upper gastrointestinal tract. Infection with cowpox virus (an orthopoxvirus) is the most common poxvirus infection in cats. Older cats may develop draining abscesses as well as fever and adenopathy. As for cats, human therapy usually consists of topical antifungals such as clotrimazole, miconazole, etc., or in severe cases oral agents such as fluconazole or itraconazole.
Infectious diseases can be transmitted to humans from birds by one of several mechanisms. In group 1 infections, birds are the natural reservoirs for the infectious agent, which causes illness among them. Examples of such infections include psittacosis, Newcastle disease, avian influenza, and yersiniosis. In group 2 and 3 infections, birds are the natural reservoirs for the infectious agent but do not become ill themselves. The infectious agents of group 2 infections (for example, salmonellosis and mite infections) disseminate from the colonized birds into the environment directly, and the agents of group 3 infections (for example, eastern equine encephalitis [EEE], western equine encephalitis [WEE], St. Louis encephalitis [SLE], and Japanese B encephalitis [JE]) disseminate by means of arthropod vectors and involve humans as accidental hosts. Psittacosis is mainly an occupational disease among workers in turkey-processing plants, duck or goose pluckers, pigeon breeders, and pet store employees. Mites that infest wild and domestic birds have four stages (egg, larva, nymph, and adult) in their life cycles, which can be completed within 1 week under favorable circumstances. Gastrointestinal defenses may be compromised by antacids, gastrectomy, agents that slow intestinal motility, and antibiotics. Some diseases, such as cirrhosis, lymphoma, and human immunodeficiency virus (HIV) infection, which impair systemic host defenses, also increase susceptibility to salmonellosis. Acute pulmonary histoplasmosis resembles atypical pneumonia, the severity of which depends on the number of infectious particles inhaled.
This chapter focuses on the most common "house pets" (but not every species that can be kept as pets) and the major health threats that they can represent. Only a brief discussion at the end of the chapter is devoted to more uncommon pets, especially ferrets and primates. However, because of the outbreak of monkeypox in prairie dogs and humans which occurred in the spring of 2003 in the United States, a few words are devoted to the risk of ownership of exotic pets. Zoonoses potentially transmitted by pet rabbits and rodents have been discussed. The main pathogens acquired topically from fish (through spine puncture or open wounds) are Aeromonas hydrophila, Edwardsiella tarda, Erysipelothrix rhusiopathiae, Mycobacterium marinum, Streptococcus iniae, Vibrio vulnificus, and V. damsela. Despite the fact that ferrets are enjoyable pets, much concern has been raised following severe injuries to children by ferrets kept as house pets. In a recent study of non-occupational-exposure incidents involving macaques in the United States, children were more than three times as likely to be bitten as adults. Herpes B virus must be assumed to be a potential health hazard from macaque bite wounds; this risk makes macaques unsuitable as pets.
This chapter highlights the zoonotic diseases of rats, and in certain cases the same diseases in other rodents, which have clinical relevance in the United States and its territories. In an attempt to feed more often because of the blockage, the flea ingests the host's blood into its esophagus, where it mixes with yersiniae growing in this location and in the proventriculus. Aminoglycosides such as streptomycin and gentamicin are the most effective antibiotics in vivo against Yersinia pestis. Rarely, the patient presents with uveitis, myocarditis, cranial nerve palsy, or the Jarisch-Herxheimer reaction, which is attributed to decreasing bacterial numbers in the patient's blood and a massive cytokine release and occurs during initial treatment of the spirochetal infection with an effective antibiotic. As with other microbial infections, the disease's severity relates to the organism's serotype, the number of bacteria ingested, and the host's susceptibility. In a retrospective study of 23 patients with Helicobacter cinaedi-associated illness, 22 of the cases had the organism isolated from blood by an automated blood culture system, with which a slightly elevated growth index was noted. This study also described a new H. cinaedi-associated syndrome consisting of bacteremia and fever and accompanied by leukocytosis and thrombocytopenia. The major clinical difference between monkeypox and smallpox is the pronounced lymphadenopathy noted in the majority of patients infected with monkeypox virus.
In most areas of the world where the disease is endemic, dogs and other carnivores remain the common sources of human rabies virus infection, resulting in little change over time in the epidemiology of the disease. Routine public health activities consisting of animal rabies control, health communication and education, and preexposure prophylaxis and postexposure prophylaxis (PEP) will remain the most cost-effective methods for preventing human rabies. The most effective way to prevent exposure to rabies is to educate the public to avoid contact with all wild and unfamiliar domestic animals. Each year in the United States, as many as 40,000 persons receive rabies PEP and perhaps as many as 20,000 receive preexposure vaccination. The importance of immediate and thorough washing of all bite wounds and scratches with soap and water cannot be overemphasized, since it may, in itself, be one of the most effective measures for preventing rabies; tetanus prophylaxis and measures to control bacterial infection should be given as necessary. The regimen for preexposure vaccination consists of three 1.0-ml doses (0.5 ml for purified Vero cell rabies vaccine) given i.m. in the deltoid area on days 0, 7, and 21 or 28. Americans planning to travel to or reside in countries where canine rabies is enzootic should be informed about the risk of rabies and consider the possible benefits of rabies preexposure vaccination.
There are several mechanisms by which infectious agents may be spread during sports. The main routes of transmission include direct- and indirect-contact, droplet, common-source, and airborne transmission. Common etiologies of sports-related infections are discussed in this chapter. Transmission resulting from nonathletic bloody fistfights has been reported. Herpes simplex virus (HSV) is the cause of a contagious viral infection of the skin and mucous membranes. Upper respiratory tract infections (URI), which are caused by a number of viruses and bacteria, are some of the most common illnesses encountered in sports. Athletes participating in water sports may be at risk, depending on the type of activity and water quality. Leptospirosis and otitis externa, two of the prominent water-based diseases faced by athletes, are discussed. Acute otitis externa, also known as swimmer’s ear, is an inflammation of the external auditory canal. It is typically seen among athletes participating in water sports who commonly experience mechanical trauma to the external ear. Common-source exposure to infectious diseases in athletic settings normally occurs in cases where water or food containers are contaminated and shared. Vector-borne pathogens are spread by carriers such as ticks, insects, or animals. To avoid the spread of fungal infections of the feet, athletes should wear proper footwear, keep the feet and socks dry during sporting activities, and avoid going barefoot in shared areas, such as the locker room and shower.
In response to the hazards posed to travelers, the medical specialty of travel medicine has evolved, and numerous travel clinics are in operation. Travel medicine involves both the prevention of travel-related diseases and the diagnosis and treatment of exotic, primarily tropical, diseases upon the traveler’s return. The main areas involved in prevention include pretravel advice, preparation of an individualized medical kit, immunizations, malaria prophylactic measures, and prophylaxis and self-treatment of traveler's diarrhea. Vaccination is particularly indicated for field workers who could have direct contact with potentially plague-infected wild rodents in rural areas where plague is endemic. A case of plague imported into the United States by an American rodent collector infected in rural Bolivia emphasizes the importance of vaccination for such workers. The most common problems in returning travelers are diarrhea or other gastrointestinal difficulties, fever, unexplained eosinophilia, and skin rashes. Ciguatera poisoning from ingestion of large marine reef fish (including grouper, snapper, and barracuda) containing ciguatoxin is the most common form of fish poisoning. The major exotic tropical fevers occurring in travelers include malaria, enteric fever, hepatitis, bacterial dysentery, and rickettsial and arboviral infections. Intravenous artesunate is now available in the United States as an investigational new drug application and can be obtained for use in severe malaria infections. A number of filariae infect humans and can cause quite high eosinophilia.
This chapter reviews the clinical syndromes and epidemiology of the most commonly encountered sexually transmitted infections (STIs), as well as the clinical and behavioral aspects of travel and sexually transmitted disease (STD) epidemiology. Long-term travelers such as expatriates are at increased risk for human immunodeficiency virus (HIV) and STIs. Sexual intercourse with commercial sex workers (CSWs) is very common among travelers, expatriates, and military personnel and is one of the major risk factors for HIV and other STDs. A study of Hong Kong residents found that condom use was higher when they used CSWs in Hong Kong (91%) than when they used CSWs from mainland China (66%) and that self-reported STD rates were four times higher in those who had traveled to the mainland, 33% of travelers to the mainland had used services of CSWs, and 11% had used these services on the most recent trip. Several review papers have addressed special problems facing HIV-infected travelers. A major concern for all HIV-infected travelers is the risk for opportunistic infections. Persons who are sexually active with multiple partners should have periodic screening for STDs, especially gonorrhea, chlamydia, syphilis, and HIV, at least on an annual basis.
Tattoos and body piercing have received increased attention in recent years. Temporary tattoos and body jewelry (without actual piercing) are popular decorative items for children as well. These procedures include tattooing, body piercing, scarification, branding, and surgical modifications. Streptococci and staphylococci are the most common bacterial causes of local infection at the tattoo site and may cause cellulitis, impetigo, erysipelas, or furunculosis. Infections associated with endogenous microorganisms are not completely preventable, although the use of appropriate sterile techniques during tattoo application and proper aftercare of the new tattoo may serve to minimize the risk. Among the exogenously acquired diseases associated with tattoos, viral hepatitis has probably been reported most commonly. The earliest reported outbreaks of acute hepatitis following tattooing occurred in military personnel who had received their tattoos at the same parlor (in which hygienic techniques were not employed). All of the bacteria available for testing from patients were noted to be the USA300 genotype, the most common strain of CA-MRSA associated with skin infections. Genital piercings are predisposed to infections caused by aerobic gram-negative bacilli, especially the Enterobacteriaceae, as well as anaerobes, staphylococci, and streptococci. Medical practitioners and the general public should be aware of the potential risks of infection associated with tattooing and body piercing. Early recognition of infection following tattooing or body piercing is important to prevent potential complications, but such infections can be difficult to appreciate because most health care professionals are unfamiliar with the clinical characteristics of infections associated with these procedures.
Many host and environmental factors enhance susceptibility to infectious diseases, such as altered immune responses, hypoxia, physiological adaptation or lack of such adaptation, environmental stressors, increased UV radiation, cramped quarters, inability to maintain personal hygiene, and isolation from adequate medical care. The risk of contracting an infection varies depending on location, length of exposure, and nature of the high-altitude activity. There are few published data on this topic, and as a result, portions of this chapter are anecdotal and based on personal medical experience. Cysticercosis of the brain is one of the most common causes of epilepsy in Nepal. Respiratory problems are common at high altitudes. Arthropod-borne infections are extremely common in travel to developing countries, but arthropod vectors are less common at higher altitudes. Sexually transmitted diseases, fungal vaginitis, and urinary tract infections are usually present in typical fashion at high altitude. Physicians counseling patients who travel with cancer, human immunodeficiency virus, chronic steroid or other immunosuppressive medication use, functional or anatomic asplenia, and renal insufficiency should familiarize themselves and their patients with the travel risks associated with these conditions. The differential diagnosis of illness at high altitude includes other conditions that may be misdiagnosed as an infection. Physicians who may treat infectious diseases at high altitude should carry appropriate chemotherapy and supportive equipment. In essence, infections and infectious diseases at high altitude often parallel those in adjacent lowland environments.
This chapter focuses on the current knowledge about transmission of infectious diseases in the context of both transmissions within the aircraft passenger cabin and commercial aircraft serving as vehicles of worldwide infection spread. Ventilation of enclosed spaces is a key determinant of infection spread, and the chain of infection is influenced substantially by the ventilation conditions specific to the aircraft cabin. Although flight crews are legally obliged to report potentially infectious passengers, they receive no training on infectious disease control, and anecdotal evidence suggests that in many instances flight crews fail to recognize or report potentially infected passengers. Most pandemic preparedness plans do not address the issue of commercial air travel. The International Air Transport Association, in partnership with the WHO and other stakeholders, recently established guidelines for the aviation industry for operations during pandemic influenza outbreaks in order to minimize commercial air travel spread. Prevention is the most important means of control and requires a proactive approach. For individual air travelers, practicing hand hygiene remains the most effective means of minimizing risk of infection. Governmental, public health, aviation, and medical stakeholders should better educate the general public on health issues related to air travel and infection control.
There are many considerations in evaluating perils associated with the wide range of venues where animal contact can occur. First, many venues or events draw large numbers of people; some operate during a short time frame, while others, such as zoos and aquariums, operate year-round. Second, petting zoos and other animal contact venues are particularly popular with children, who are likely to have less stringent hygiene and are more susceptible to severe disease outcomes. Finally, there is remarkable variability in the physical layout of venues that permit animal contact and in the types of animals that may be contacted. Perils of animal contact include allergies, injury, and zoonotic disease transmission. Potential zoonotic pathogens in petting zoo venues are discussed in this chapter. The Centers for Disease Control and Prevention (CDC) first published recommendations to reduce perils associated with petting zoos following an outbreak of human Escherichia coli O157 infections associated with animal contact in 2000. The petting zoo associated with the outbreak was one of many exhibits where the public could contact animals. Hand washing is the single most important preventive measure to minimize infectious disease perils of the petting zoo. One practical tip is to educate the public to recognize zoonotic disease perils of the petting zoo.
The majority of the diarrheal outbreaks on cruise ships involve the introduction of the pathogen into the food and water supply, with the subsequent breakdown of the food and water sanitation chain. The prevention of gastrointestinal infections on cruise ships involves controlling potential deficiencies in food and water handling as well as in cooking and catering, preventing sewage contamination of the water supply, and isolating sick persons. In the absence of effective vaccines for the prevention of infections by the majority of the above organisms, with the exception of Salmonella serovar Typhi, these efforts are the primary preventive methods to decrease the burden of gastrointestinal illnesses on cruise ships. A study of the epidemiology of injuries and illnesses among passengers on cruise ships revealed that respiratory tract infections were the most common cause for seeking medical attention by passengers and crew members aboard the ship. Among the bacterial pathogens causing respiratory infections on cruise ships, the most common infections reported have been due to Legionella species. There have also been reported cases of vaccine-preventable infections, such as diphtheria and rubella, acquired on cruise ships. The presence of hot tubs and spas and the proximity of individuals on cruise ships can lead to the spread of skin infections among the passengers. The prevention of these infections involves meticulous care of the ship’s sanitary conditions, receiving appropriate vaccinations as necessary, and following basic infection control mechanisms, especially hand washing.
Many foods, such as seafood or dairy products, are preferentially eaten raw or unpasteurized in their most fresh and tasty form. This maximizes their potential to act as vectors for bacteria, viruses, and parasites. Some of these pathogens are well known to clinicians; others cause rare zoonoses that do not normally infect humans and may escape early recognition, and some may in fact cause newly emerging diseases. Alas, even cooked food can transmit prions, leading to diseases such as kuru, but since the ingestion of human brains is now rare, in this chapter the author focuses on more likely or exotic diseases. The capture or slaughter of some animals for food can also be risky. The recent pandemic of severe acute respiratory syndrome (SARS) caused by a coronavirus is illustrative. Wild game meat is now the most common source of infection, with transmission from bears, cougars, and boars being well documented. In individuals with AIDS, the most common manifestation of toxoplasmosis is recrudescent disease of the brain from old, formerly silent cysts. Central nervous system (CNS) toxoplasmosis is the most common CNS opportunistic infection in AIDS patients in the developed world. There is evidence that treatment of pregnant women with acute toxoplasmosis leads to reduced risk of disease in the fetus.
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At A Glance
This title provides a fascinating examination of the risks associated with an array of leisure activities. Whether camping, enjoying a day at the beach, or traveling to an exotic locale, humans continually expose themselves to a variety of infectious diseases. Widely readable, this new volume seeks to demystify infectious diseases that may be encountered and to alert physicians and the informed public to potential dangers and suggested treatment.
Description
This scholarly, multi-authored book describes infectious diseases that can be contracted while pursuing such activities as swimming at the beach, venturing into wilderness environments, pampering our (sometimes unusual) pets, toiling in the garden, or eating trendy cuisine. This is a thoroughly updated edition.
Purpose
The book identifies and organizes the infectious risks associated with our leisure time activities. Although these activities are enjoyable, they expose us to a growing list of pathogenic microbes, some new and many increasingly resistant to current therapies. These infectious risks are outlined and discussed in a convenient, user-friendly, and accessible format.
Audience
This is a useful book for general practitioners caring for patients who travel to adventuresome settings, keep exotic pets, pierce strange parts of their body ("body modification"), or eat trendy cuisine. It should also attract infectious diseases subspecialists who desire an organization of infectious diseases associated with specific recreational activities.
Features
Designed for ease of use, each chapter focuses on the infection risks associated with a particular type of recreational activity. Multiple zoonoses associated with common and less common pets (e.g. hedgehogs) are reviewed and practical guidelines provided. Three new chapters are designed to help manage the risk of infection associated with air travel, petting zoos, and cruise ships. New to this edition are the practical tips at the end of each chapter that underscore the most critical steps needed to prevent and manage the infectious diseases discussed in the chapter.
Assessment
This is a practical resource for a diverse group of infection risks associated with where and how our patients spend their leisure time. The book compiles information on leisure-associated infections into one, unique, user-friendly book. It is indexed to provide quick reference to material both by infectious agent and leisure activity. The new practical tips at the end of each chapter highlight salient points of prevention and management of infections of leisure.
Doody Enterprises
Reviewer: Robert Penn, MD (Nebraska Methodist Hospital)
Review Date: Unknown
©Doody’s Review Service