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Category: Clinical Microbiology
Infections of Leisure is now available on Wiley.comMembers, use the code ASM20 at check out to receive your 20% discount.
A day at the beach: delightful, restorative, and potentially dangerous.
Leisure activities, from the mundane to the exotic, expose us to a growing list of pathogenic microbes, some new and many increasingly resistant to current therapies. Common pets, livestock, traveling, and cuisine all have the potential to cause illnesses that may be difficult to diagnose and treat.
Engagingly written by a team of infectious disease specialists and edited by David Schlossberg, Infections of Leisure features 19 chapters focused on the infection risks associated with particular types of activities, including camping, playing sports, interacting with animals, receiving body modifications, and mountain climbing. This new edition includes vibrant, full-color images, recommended readings chosen by expert authors, and practical tips in each chapter.
Useful for health care professionals, microbial scientists, and infectious diseases specialists, the information in Infections of Leisure will support confident identification of leisure-associated infections and enable informed choices, as well as provide an understanding of the risks posed to human health.
David Schlossberg, MD, FACP, is Professor of Medicine at Temple University School of Medicine and Adjunct Professor of Medicine at the University of Pennsylvania School of Medicine. He is currently Medical Director of the Tuberculosis Control Program for the Philadelphia Department of Public Health. A graduate of Yale University and Tufts Medical School, Dr. Schlossberg completed his medical residency at Mount Sinai Hospital, and his infectious disease fellowship at Emory University. Dr. Schlossberg is editor of Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition (ASM Press, 2011). He has written hundreds of articles on internal medicine and infectious diseases.
Paperback, 411 pages EST., full-color illustrations, index.
In the United States, the consumption of seafood in 2012 alone totaled more than 4.7 billion pounds, or 14.4 pounds per person per year. An increase in the consumption of seafood is occurring with a resultant increase in the number of cases of fish- and shellfish-related food poisonings. Improved reporting of cases due to a greater awareness of the public and health care personnel of the association between seafood consumption and illness has also contributed to this observed increase. In the United States, food-borne illness due to contaminated fish and shellfish account for over 600,000 illnesses, including 3,000 hospitalizations and 94 deaths every year. Food-borne disease from fish and shellfish can be categorized into allergic, infectious, and toxin-mediated etiologies. The CDC and U.S. Department of Health and Human Services reported on all types of food-borne illness in the United States from 1998 to 2008. Bacterial causes were involved in more than 77% of confirmed outbreaks, whereas chemical poisonings from fish and shellfish toxins were responsible for 11.4% of outbreaks of confirmed etiology.
This chapter focuses on 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 macro- or microenvironments. Table 1 summarizes of the potential pathogens that occasionally cause problems after exposure to freshwater.
Arthropods are the invertebrate phylum that includes both the eight-legged arachnids (ticks, mites, and spiders) and the six-legged insects (mosquitoes, ants, bees, and wasps). Leisure-time activity frequently brings people in contact with these pests, so bites and stings are often part of the price paid for outdoor fun. Most bites and stings are simply painful nuisances that resolve without treatment. Unfortunately, some arthropods, most notably ticks, pose the risk of transmitting serious infectious diseases such as Lyme disease (Borrelia) and rickettsial infections. This article will focus primarily on North American tick-borne diseases and syndromes. In the tropics, mosquitoes and other arthropods are a major source of disease transmission, but a few mosquito and other arthropod-borne North American diseases (e.g., babesiosis and West Nile disease) also merit discussion. Climate change and global transportation have the potential to change disease patterns, and many so-called tropical diseases are moving north or appearing in new areas.
Although there are many infections that one may acquire in the garden, some people have gardened for years without becoming infected, yet others may become ill after a rather limited time in the garden. Being in the garden presents a series of complex possibilities from an infectious disease standpoint, and the likelihood of acquiring an infectious disease while gardening depends upon many factors. Gardens are usually near the home and may be the closest that many people get to being in the great outdoors, especially in urban or suburban environments. The time spent in the garden is not nearly as important as the age and nature of the gardener, his friends, or his family.
The relationship between humans and dogs is an ancient one. Dogs have been our workmates, protectors, guides, and companions. No one would question the merit of the long history of valuable service that dogs have provided to humans; it is the stuff of legend and literature. We even have evidence that a dog companion may be good for our physical health given that contact with dogs has been shown to lower blood pressure, ameliorate depression, and produce a survival benefit after myocardial infarction. 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 article.
The origins of the domestic cat are unknown. However, mummified cats have been found in the treasure rooms of the Egyptian pyramids, and their images are inscribed in the royal hieroglyphics. The genus Felis includes the modern domestic house cat as well as the puma (cougar), golden cats, jaguarundi, ocelot, serval, lynx, and bobcat. In the United States, it is estimated that 90 million cats are kept as household pets, and 34% of households have cats. There are numerous diseases that may be transmitted from cats to humans or that possibly cats and people acquire from common sources, some of which are described in this chapter. However, it is likely that the domestic cat can potentially act as a reservoir for many other zoonoses that are not yet recognized. The diseases discussed in this chapter are arranged by the general method of transmission from cat to person, although more than one route is possible for some of the infections.
Infectious diseases can be transmitted to humans from birds by one of several mechanisms ( Table 1 ). In group 1 infections, birds are the natural reservoirs for the infectious agent, which causes illness among them. The diseased birds then disseminate the infectious agent into the environment, and humans become infected as accidental hosts. 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. With group 4 infections, birds are not the natural reservoirs, but they facilitate growth of the organisms in the environment by means of their fecal matter. Examples of infections of the last category include the fungal diseases histoplasmosis and cryptococcosis.
Many infectious diseases in humans can be acquired through contact with pets. Dogs and cats may be the most common pets around the world, but there are also many other vertebrates that share our household environment.
Numerous methods have been used by countless countries attempting to eradicate the rat, but it continues to successfully colonize both urban and rural settings on a global level. One novel approach first introduced in Asia and Europe and then in the United States was the use of domestic ferrets for rodent control.
Contact with animals can be an enjoyable and beneficial activity. Health benefits have been attributed to animal contact. Reportedly, these benefits include reduced anxiety, lower blood pressure, and other physiologic effects (http://www.cdc.gov/healthypets/health-benefits/index.html). In addition to health benefits, petting zoos and animal contact settings provide educational opportunities. A growing segment of society in developed countries resides in urban or suburban settings with limited knowledge of agricultural practices or contact with farm animals. Petting zoos or agricultural exhibits provide education regarding food production, agricultural practices, and rural life. Similarly, zoological parks and aquariums are popular leisure attractions and provide opportunities for education about diverse and nonnative animal species and conservation of natural resources. Perils of animal contact can include allergies, injury, and zoonotic disease transmission.
Rabies is one of the oldest recognized zoonotic diseases. The first recorded description of canine rabies was apparently made by Democritus around 500 B.C.E. Aristotle, writing of rabies in his Natural History of Animals, described dogs suffering from a madness causing irritability and noted that other animals became diseased after being bitten by these sick dogs. Little has changed with this human-carnivore dynamic since the time of Aristotle’s observations. In most areas of the world where the disease is enzootic, dogs and other carnivores remain the predominant sources of human rabies virus infection. For the lucky few that live in countries where canine rabies has been eliminated, the epidemiology of human rabies continues to implicate bats as an important emerging rabies reservoir. Bats are also the focus of ongoing discovery of new lyssaviruses (15 total recognized or putative species), many of which are still poorly understood.
Sporting events have been a favorite pastime for countless generations. We participate in sports for recreation, competition, and good health ( Fig. 1 ). The hazards usually associated with sports are traumatic: strains, sprains, fractures, and concussion. People are generally unaware of infectious complications until they are highlighted by the media, such as when several players in the National Football League (NFL) developed skin infections involving antibiotic-resistant bacteria, when professional basketball star Magic Johnson was diagnosed with the human immunodeficiency virus (HIV), and the recent outbreak of mumps in the National Hockey League. Alas, recreational athletes and even spectators are not exempt from infectious hazards either. An outbreak of campylobacteriosis among participants of a long-distance obstacle adventure course has shown that even weekend warriors may be affected by sports-related infections. This chapter highlights the mechanisms by which infectious agents may be spread during sports, the treatment options available, and preventive strategies.
International tourist arrivals surpassed 1 billion by 2012 and continue to increase. In 2013, nearly 24 million U.S. residents traveled abroad for leisure or to visit friends and relatives (http://travel.trade.gov/outreachpages/outbound.general_information.outbound_overview.html). Of these travelers, 35% went to Europe, 27% to the Caribbean, 17% to Asia, 7% each to South America and Central America, 6% to the Middle East, and under 3% to Africa.
The types of diseases acquired during travel are dependent on the types of sexual activity, the types of sexual partners, and the reasons/type of travel that occurred. For example, the diseases and social situation of a military base are different from those of a refugee camp, which in turn are much different from the situations encountered by casual travelers. Travel is an important factor in the spread of new types of infections, such as antimicrobial-resistant Neisseria gonorrhoeae and human immunodeficiency virus (HIV) infection. In areas where STI incidence is low, travelers are often implicated in the reestablishment of new epidemic foci (reintroductions), as occurred in the reintroduction of syphilis and lymphogranuloma venereum (LGV) to disease-free areas in Europe and North America. In this chapter, we review the clinical syndromes and epidemiology of the most commonly encountered STIs, as well as the clinical and behavioral aspects of travel and STI epidemiology.
Tattoos and body piercing have received more attention from the medical community in recent years. The increasing acceptance of tattoo and body piercing culture by mainstream society is evidenced by the popularity of numerous reality television shows, particularly those focused on tattooing. Temporary tattoos and body jewelry (without actual piercing) are popular decorative items for children as well. The term “body modification” or “body art” has been used to describe procedures that “enhance” a person’s appearance, whether permanent or temporary. These procedures include tattooing, body piercing, scarification, branding, and surgical modifications. For many people, body modification represents a form of artistic or creative expression that provides long-term enjoyment and thus can be considered a recreational pursuit. A positive effect of the increased interest in tattoos and body piercing has been the development of standardized protocols of infection control to protect the health and safety of both the client and the tattooist or piercer. Though the incidence of serious postprocedure complications appears to be low, a significant number of tattoos and body piercings are still performed by personnel who often do not follow appropriate precautions, thus increasing the possibility of both infectious and noninfectious complications.
High mountain ranges cover approximately one-fifth of the earth’s surface, and approximately 400 million people permanently reside in these locations. Travel to elevations above 2,500 m is an increasingly common activity undertaken by a diverse population of individuals. These may be trekkers, climbers, miners in high-altitude sites in South America, and more recently, soldiers deployed for high-altitude duty in remote areas of the world. What is also being increasingly recognized is the plight of the millions of pilgrims, many with comorbidities, who annually ascend to high-altitude sacred areas.
The air provided to passengers and crew on commercial jet aircraft is typically a combination of conditioned external (ambient) air that has been diverted to the cabin from the engine compressor stages, and air that is taken from the cabin, filtered, and recirculated. The first filter of recirculated air traps the largest particles. Then, on most modern aircrafts, the air passes through high-efficiency particular air (HEPA) filters before reentering the passenger cabin. The most efficient HEPA filters capture 99.97% of particles between 0.1 and 0.3 micrometer and 100% of the larger particles. In addition, the ultra-small contagion also gets captured by Brownian and electrostatic forces. The environmental control system is designed to minimize the introduction of harmful contaminants into the cabin and to control cabin pressure, ventilation, and temperature. Most commercial aircraft provide 10 to 15 air changes per hour of the passenger cabin depending upon the aircraft type, as the original cabin air is progressively diluted with incoming ambient air. Cabin airflow is principally side to side and compartmentalized into four- to seven-seat rows within the passenger cabin, thereby limiting longitudinal (front to back and vice versa) cabin contamination. However, although the principle is side-to-side airflow, evidence employing computational fluid dynamic modeling in a mockup full-sized aircraft cabin section suggests that airflow patterns can be influenced by many factors including seat and cabin geometry, occupancy density, and thermal loads of passengers and equipment.
The spread of humanity across the Earth involved travel across the high seas, and until the advent of air travel, ships were the only way to cross the seas. The migration of humans also led to the spread of new diseases into nonimmune populations, with the introduction of pathogenic organisms or their vectors into these populations from ships and their crew. At the same time the presence of large groups of people on ships with limited sanitation, as well as poor food supplies, led to an increased risk of infectious diseases such as typhus and diseases of deficiency such as scurvy. With the advent of air travel, the number of people traveling by sea decreased until the recent resurgence of the cruise ship industry. The popularity of cruise ships for vacation travel has grown rapidly in recent years, and the Cruise Line International Association estimated that 21.3 million passengers traveled on cruise ships in 2103, and this number was forecast to be 21.7 million in 2014. The cruise industry has responded to these increasing passenger loads by increasing the size and capacity of cruise ships, with large “mega ships” that often carry over 5,000 passengers. While the most common cruise destination is the Caribbean, cruise ships are expanding their areas of operation and include river cruises and other destinations such as Antarctica, which are often inaccessible by other means of travel.
“Exotic” food dishes reflect the diversity of human culture. From raw turtle eggs and raw snake meat in Asia, crocodile meat in Australia, and raw duck blood soup in Vietnam, examples abound of food considered exotic to those from other areas of the world. With the increase in international travel to remote areas of the world, globalization of the food supply, and changes in food habits, more people are consuming dishes once considered exotic. Many such individuals are immunosuppressed or susceptible to infection based on underlying medical conditions (e.g., HIV) or age and expose themselves to potentially risky food for the purposes of cultural exploration and adventure. Despite improvements in hygiene, water purification, and food sanitation in some locales, many parts of the world continue to be plagued by deficiencies in these areas.
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Choice Connect
In Infections of Leisure, infectious disease specialists discuss the risks of infection associated with various activities—traveling, high-altitude trekking and mountaineering, camping (arthropod-borne diseases/arboviruses), gardening,
swimming/hot tub use, body piercing and tattooing, consumption of exotic foods, sports participation, interaction with animals (zoonoses), and sexual activity. Select envenomations/poisonings, primarily those associated with dangerous marine life, are also included. Considerations are global in scope, highlighting information on pathogenic organisms, clinical disease, epidemiology, and treatment. While interesting and informative, the depth of discussion varies significantly within the chapters. The categorization of some infectious disease agents seems forced and artificial. In some of the considered circumstances, infections discussed are rarely (if ever) reported. In other cases, important considerations may be relegated to a brief entry in a table. As expected, considering the ubiquity of environmental pathogens, there is
extensive repetition from chapter to chapter. However, each chapter contains a section on practical tips. In some instances, these tips are meant as differential diagnostic aids for healthcare workers; in other instances, these serve as
advice for ways to avoid infections. This book will primarily interest healthcare workers, especially those working in the field of infectious disease.
Summing Up: Recommended. Upper-division undergraduates through professionals and practitioners.
Reviewer: D. A. Brass, independent scholar
Review Date: October 2016