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Textbook of Diagnostic Microbiology - E-Book

Textbook of Diagnostic Microbiology - E-Book

Connie R. Mahon | Donald C. Lehman | George Manuselis

(2014)

Additional Information

Book Details

Abstract

Providing a reader-friendly "building-block" approach to the essentials of diagnostic microbiology, this accessible, full-color text helps you develop the problem-solving skills necessary for success in the clinical setting. This updated edition has new content on nanomedicine and HIV/AIDS and the immunocompromised patient, including the latest information on prevention, treatment modalities, and CDC guidelines. Updated photos offer new examples of automated lab instruments, while case studies, review questions, and learning objectives present information in an easy-to-learn way.

  • A building-block approach encourages you to use previously learned information to sharpen your critical-thinking and problem-solving skills.
  • Full-color design, with many full-color photomicrographs, prepares you for the reality of diagnostic microbiology.
  • Learning objectives at the beginning of each chapter supply you with a measurable outcome to achieve by completing the material.
  • A case study at the beginning of each chapter provides you with the opportunity to form your own questions and answers through discussion points.
  • Issues to Consider boxes encourage you to analyze important points.
  • Bolded key terms at the beginning of each chapter equip you with a list of the most important and relevant terms in each chapter.
  •  Points to Remember sections at the end of each chapter identify key concepts in a quick-reference, bulleted format.
  • Hands-on procedures describe exactly what takes place in the micro lab, making content more interesting and relevant.
  • Learning assessment questions at the conclusion of each chapter allow you to evaluate how well you have mastered material.
  • Agents of bioterrorism chapter furnishes you with the most current information about this hot topic.
  • Glossary of key terms at the end of the book supplies you with a quick reference for looking up definitions.
  • NEW! Nanomedicine and HIV/AIDS and the immunocompromised patient content supplies you with the latest information on prevention, treatment modalities, and CDC guidelines.
  • NEW! Updated photos familiarize you with the equipment you’ll use in the lab.
  • NEW! Case Checks throughout each chapter tie content to case studies for improved understanding.
  • NEW! An editable and printable lab manual provides additional opportunities to learn course content using real-life scenarios with questions to reinforce concepts.
  • Review questions for each learning objective help you learn to think critically about the information in each chapter, enhancing your comprehension and retention of material.

Table of Contents

Section Title Page Action Price
Front Cover cover
Evolve page IFC2
Textbook of Diagnostic Microbiology, 5/e i
Copyright Page iv
Dedication v
Reviewers vii
Contributors ix
Preface xiii
Organization xiii
Pedagogic Features xiv
Ancillaries for Instructors and Students xiv
Acknowledgments xv
Table Of Contents xvii
I Introduction to Clinical Microbiology 1
1 Bacterial Cell Structure, Physiology, Metabolism, and Genetics 2
Chapter Outline 2
Objectives 2
Key Terms 3
Significance 3
Overview of the Microbial World 3
Bacteria 4
Parasites 4
Fungi 4
Viruses 5
Classification/Taxonomy 6
Nomenclature 6
Classification by Phenotypic and Genotypic Characteristics 6
Classification by Cellular Type: Prokaryotes, Eukaryotes, and Archaeobacteria 6
Comparison of Prokaryotic and Eukaryotic Cell Structure 7
Prokaryotic Cell Structure 7
Cytoplasmic Structures 7
Cell Envelope Structures 7
Plasma Membrane (Cell Membrane). 7
Cell Wall. 7
Gram-Positive Cell Wall. 8
Gram-Negative Cell Wall. 8
Acid-Fast Cell Wall. 8
Absence of Cell Wall. 9
Surface Polymers 9
Cell Appendages. 9
Eukaryotic Cell Structure 10
Cytoplasmic Structures 10
Cell Envelope Structures 10
Plasma Membrane. 10
Cell Wall. 10
Motility Organelles. 10
Bacterial Morphology 10
Microscopic Shapes 10
Common Stains Used for Microscopic Visualization 10
Gram Stain 10
Acid-Fast Stains 11
Acridine Orange 11
Calcofluor White 11
Methylene Blue 11
Lactophenol Cotton Blue 11
India Ink 11
Endospore Stain 12
Microbial Growth and Nutrition 12
Nutritional Requirements for Growth 12
Types of Growth Media 13
Environmental Factors Influencing Growth 13
Bacterial Growth 14
Generation Time 14
Growth Curve 14
Determination of Cell Numbers 14
Bacterial Biochemistry and Metabolism 14
Metabolism 14
Fermentation and Respiration 15
Biochemical Pathways from Glucose to Pyruvic Acid 15
Anaerobic Utilization of Pyruvic Acid (Fermentation) 15
Aerobic Utilization of Pyruvate (Oxidation) 17
Carbohydrate Utilization and Lactose Fermentation 17
Bacterial Genetics 17
Anatomy of a DNA and RNA Molecule 18
Terminology 18
Genetic Elements and Alterations 19
Bacterial Genome 19
Extrachromosomal Elements 20
Mobile Genetic Elements 20
Mutations 20
Genetic Recombination 20
Mechanisms of Gene Transfer 20
Transformation 20
Transduction 20
Conjugation 20
Restriction Enzymes 21
Bibliography 22
2 Host-Parasite Interaction 23
A. Role of the Usual Microbial Flora 23
Chapter Outline 23
Objectives 23
Key Terms 23
Origin of Microbial Flora 24
Characteristics of Indigenous Microbial Flora 24
Factors That Determine the Composition of the Usual Microbial Flora 24
Composition of Microbial Flora at Different Body Sites 25
Usual Flora of the Skin 25
Usual Flora of the Mouth 25
Usual Flora of the Respiratory Tract 26
Usual Flora of the Gastrointestinal Tract 26
Usual Flora of the Genitourinary Tract 27
Role of the Microbial Flora in the Pathogenesis of Infectious Disease 27
Role of the Microbial Flora in the Host Defense Against Infectious Disease 27
Bibliography 28
B. Pathogenesis of Infection 28
Objectives 29
Key Terms 29
Microbial Factors Contributing to Pathogenesis and Virulence 29
Pathogenesis 29
Virulence 30
Microbial Virulence Factors 30
Ability to Resist Phagocytosis 30
Surface Structures That Promote Adhesion to Host Cells and Tissues 31
Ability to Survive Intracellularly and Proliferate 32
Ability to Produce Extracellular Toxins and Enzymes 32
Exotoxins 33
Endotoxins 34
Host Resistance Factors 34
Physical Barriers 34
Cleansing Mechanisms 35
Antimicrobial Substances 35
Indigenous Microbial Flora 35
Phagocytosis 36
Chemotaxis 36
Attachment 36
Ingestion 36
Killing 37
Inflammation 37
Immune Responses 37
Innate, or Natural, Immunity 37
Adaptive, or Specific, Immunity 39
Nature of the Immune Response to Infectious Agents 40
Classification and Characteristics of Antibodies 40
Primary and Secondary Antibody Responses 41
Cell-Mediated Immune Response 41
Mechanisms by Which Microbes May Overcome Host Defenses 42
Routes of Transmission 43
Airborne Transmission 43
Transmission by Food and Water 44
Close Contact 45
Cuts and Bites 45
Arthropods 45
Zoonoses 45
Bibliography 46
3 The Laboratory Role in Infection Control 47
Chapter Outline 47
Objectives 47
Key Terms 48
General Concepts in Infection Prevention and Control Practice 48
Infection Prevention and Control in Health Care Settings 48
Infection Control Surveillance 49
Surveillance Definitions 49
General or Targeted Surveillance. 49
Baseline Data. 50
Data Gathering 50
Culture Review. 50
Cases. 50
Laboratory Support and Data Gathering. 51
Frequently Identified Microbes 51
Public Health and Community Setting 51
Acute Care Setting 52
Ambulatory Care Setting 52
Extended Care Facility and Home Care Settings 52
Communal Living 52
Outbreak Investigation 52
Local Outbreaks 52
Widespread Outbreaks 52
Steps of an Outbreak Investigation 53
Investigation Support from the Laboratory 54
Cultures and Serology 54
Antibiograms 54
Pulsed-Field Gel Electrophoresis 54
Environmental Culturing 55
Air 55
Water 55
Surfaces 55
Reporting 56
Reporting to Public Health 56
Reporting to Committees and Programs 56
Reporting to the Media 56
Education 56
Technologists and Infection Prevention and Control Practitioners 56
Safety 57
Emerging and Reemerging Pathogens 57
Emerging Pathogens 57
Reemerging Pathogens 57
Response Plans 57
Bibliography 58
4 Control of Microorganisms 59
A. Disinfection and Sterilization 59
Chapter Outline 59
Objectives 59
Key Terms 60
Sterilization versus Disinfection 60
Factors That Influence the Degree of Killing 60
Types of Organisms 61
Number of Organisms 61
Concentration of Disinfecting Agent 61
Presence of Organic Material 61
Nature of Surface to Be Disinfected 62
Contact Time 62
Temperature 62
pH 62
Biofilms 62
Compatibility of Disinfectants 62
Methods of Disinfection and Sterilization 62
Physical Methods 62
Heat 62
Filtration 63
Radiation 63
Chemical Methods 64
Disinfectants versus Antiseptics 64
Alcohols 65
Aldehydes 65
Formaldehyde 65
Glutaraldehyde 65
Halogens 65
Iodophors 65
Chlorine and Chlorine Compounds 66
Detergents: Quaternary Ammonium Compounds 66
Phenolics 66
Chlorhexidine Gluconate 66
Hexachlorophene 67
Chloroxylenol 67
Triclosan 67
Heavy Metals 67
Gases 67
Ethylene Oxide 67
Hydrogen Peroxide 67
Periacetic Acid 67
Hydrogen Peroxide and Periacetic Acid 67
Environmental Protection Agency Regulations on Chemical Surface Disinfectants 68
Food and Drug Administration Regulations on Chemical Skin Antiseptics 68
Hygienic Handwashing and Waterless Handrubs 68
Surgical Hand Scrub and Waterless Surgical Handrubs 69
Presurgical Skin Disinfection 70
Bibliography 71
B. Microbiology Safety 71
Chapter Outline 71
Objectives 72
Key Terms 72
General Laboratory Safety 72
Safety Program for the Clinical Laboratory 72
Occupational Safety and Health Administration 73
Exposure Control Plan 73
Universal/Standard Precautions 73
Transmission-Based Precautions 73
Engineering Controls 74
Work Practice Controls 74
Personal Protective Equipment 74
Biological Risk Assessment 74
Processing of Patient Specimens 76
Working with Actively Growing Cultures 76
Biological Safety Cabinets 77
Biosafety Levels 78
Biosafety Level 1. 78
Biosafety Level 2. 78
Biosafety Level 3. 79
Biosafety Level 4. 79
Hazardous Waste 79
Disposal of Infectious Waste 79
Hazardous Waste Reduction 79
Chemical Safety 80
Safety Data Sheets 81
Chemicals Inventory 81
Chemical Storage 81
Hazardous Chemical Classification 81
Laboratory Safety for Hazardous Chemicals 81
Chemical Spills 81
Signage 81
Fire Safety 88
Thermal Injuries 89
Storage of Compressed Gases 89
Electrical Safety 89
Miscellaneous Safety Considerations 89
Back Safety 89
First Aid Training 89
Immunizations 89
Safety Training 89
Bioterrorism and the Clinical Microbiology Laboratory 90
Laboratory Response Network 90
Sentinel Laboratories 90
Reference Laboratories and National Laboratories 90
Safety During a Possible Bioterrorism Event 90
Packaging and Shipping of Infectious Substances 90
Bibliography 91
5 Performance Improvement in the Microbiology Laboratory 93
A. Quality Issues in Clinical Microbiology 93
Chapter Outline 93
Objectives 93
Key Terms 94
General Guidelines for Establishing Quality Control 94
Temperature 94
Thermometer Calibration 95
Equipment Quality Control 95
Media Quality Control 95
Reagent Quality Control 98
Antimicrobial Susceptibility Quality Control 99
Personnel Competency 100
Use of Stock Cultures 100
Quality Control Manual 100
Performance Improvement 100
Vision and Mission Statements 100
Indicators of Performance Improvement: Process versus Outcome 102
Establishing Performance Monitors 102
Problem-Action Form 102
The Customer Concept 102
Fixing the Process 103
Benchmarking 103
Commercially Purchased Monitors 103
Bibliography 104
B. Putting the Laboratory Test to the Test 104
Chapter Outline 104
Objectives 104
Key Terms 105
Analytic Analysis of Tests 105
Analytic (Technical) Sensitivity and Specificity 105
Sensitivity 105
Specificity 105
Accuracy 105
Clinical Analysis of Tests 105
Clinical (Diagnostic) Sensitivity 105
Clinical (Diagnostic) Specificity 106
Operational Analysis of Tests 106
Incidence of Disease 106
Prevalence of Disease 106
Predictive Values of Tests 106
Positive Predictive Value 106
Negative Predictive Value 106
Example 106
Clinical Applications of Positive and Negative Predictive Values 107
Group A Streptococcus Testing of Throat Samples. 107
Direct Detection of Chlamydia trachomatis in Urethral and Cervical Specimens. 107
Efficiency of Tests 107
Other Concepts 108
Choosing a Laboratory Method 108
Test Validation 109
Bibliography 109
6 Specimen Collection and Processing 111
Chapter Outline 111
Objectives 111
Key Terms 112
Basic Principles of Specimen Collection 112
Fundamentals 112
Collection Procedures 112
Patient-Collected Specimens 112
Urine 114
Sputum 114
Stool 114
Labeling and Requisitions 114
Safety 115
Preservation, Storage, and Transport of Specimens 115
Specimen Storage 115
Preservatives 115
Anticoagulants 116
Holding or Transport Media 116
Shipping Infectious Substances 116
Specimen Receipt and Processing 117
Specimen Priority 117
Unacceptable Specimens and Specimen Rejection 118
Macroscopic Observation 118
Microscopic Observation 118
Primary Inoculation 119
Types of Culture Media 119
Culture Media Selection 119
Specimen Preparation 119
Isolation Techniques 119
Incubation 121
Culture Workup 121
Nonroutine Specimens 123
Communication of Laboratory Findings 123
Bibliography 125
7 Microscopic Examination of Materials from Infected Sites 126
Chapter Outline 126
Objectives 126
Key Terms 127
Preparation of Samples 127
Smears from Swabs 127
Smears from Thick Liquids or Semisolids 127
Smears from Thick, Granular, or Mucoid Materials 127
Smears from Thin Fluids 128
Cytocentrifuge Preparations 129
Cytocentrifuge Technique 129
Stains 129
Microscopes 129
Terminology for Direct Examinations 129
Examination of Prepared Material 133
Characterization of Background Materials 133
Search for Microorganisms 135
Evaluation of Choice of Antibiotic 135
Direct Examination Summary 136
Initiation of Special Handling for Unsuspected or Special Pathogens 136
Grading or Classifying Materials 136
Contaminating Materials 136
Criteria 136
Gram Smear Report 136
Culture Identification Guidelines 136
II Laboratory Identification of Significant Isolates 313
14 Staphylococci 314
Chapter Outline 314
Objectives 314
Key Terms 315
General Characteristics 315
Clinically Significant Species 316
Staphylococcus aureus 316
Virulence Factors 316
Enterotoxins. 317
Toxic Shock Syndrome Toxin-1. 317
Exfoliative Toxin. 317
Cytolytic Toxins. 317
Enzymes. 317
Protein A. 317
Epidemiology 317
Infections Caused by Staphylococcus aureus 317
Skin and Wound Infections. 317
Scalded Skin Syndrome. 318
Toxic Shock Syndrome. 318
Toxic Epidermal Necrolysis. 318
Food Poisoning. 318
Other Infections. 319
Staphylococcus epidermidis 319
Staphylococcus saprophyticus 319
Staphylococcus lugdunensis 319
Other Coagulase-Negative Staphylococci 319
Laboratory Diagnosis 319
Specimen Collection and Handling 319
Microscopic Examination 319
Isolation and Identification 320
Cultural Characteristics 320
Identification Methods 320
Rapid Methods of Identification 323
Antimicrobial Susceptibility 324
Methicillin-Resistant Staphylococci 324
Vancomycin-Resistant Staphylococci 325
Macrolide Resistance 325
Bibliography 326
15 Streptococcus, Enterococcus, and Other Catalase-Negative, Gram-Positive Cocci 328
Chapter Outline 328
Objectives 328
Key Terms 329
General Characteristics 329
Cell Wall Structure 329
Hemolysis 330
Clinically Significant Streptococci and Streptococcus-like Organisms 330
Streptococcus pyogenes 331
Antigenic Structure 331
Virulence Factors 331
Clinical Infections 332
Bacterial Pharyngitis. 332
Pyodermal Infections. 332
Necrotizing Fasciitis. 332
Streptococcal Toxic Shock Syndrome. 332
Poststreptococcal Sequelae. 333
Laboratory Diagnosis 333
Streptococcus agalactiae 333
Antigenic Structure 333
Virulence Factors 333
Clinical Infections 335
Laboratory Diagnosis 335
Groups C and G Streptococci 336
Streptococcus pneumoniae 336
Antigenic Structure 336
Virulence Factors 336
Clinical Infections 336
Laboratory Diagnosis 337
Antimicrobial Resistance 338
Viridans Streptococci 338
Clinical Infections 338
Virulence Factors 338
Laboratory Diagnosis 339
Enterococcus 340
Virulence Factors 340
Clinical Infections 340
Laboratory Diagnosis 340
Antimicrobial Resistance 340
Streptococcus-like Organisms 341
Abiotrophia and Granulicatella 341
Aerococcus 341
Gemella 341
Lactococcus 341
Leuconostoc 342
Pediococcus 342
Laboratory Diagnosis 342
Classification Schemes 342
Hemolytic Patterns 342
Physiologic Characteristics 342
Lancefield Classification Scheme 343
Biochemical Identification 343
Bacitracin Susceptibility. 344
CAMP Test. 345
Hippurate Hydrolysis. 345
Pyrrolidonyl-α-Naphthylamide Hydrolysis. 345
Leucine Aminopeptidase. 346
Voges-Proskauer Test. 346
β-d-Glucuronidase. 346
Bile Esculin and Salt Tolerance. 346
Optochin Susceptibility. 346
Bile Solubility. 346
Noncultural Identification 346
Immunoassays 346
Nucleic Acid Probes 347
Susceptibility Testing 347
Bibliography 348
16 Aerobic Gram-Positive Bacilli 349
Chapter Outline 349
Objectives 349
Key Terms 350
Non–Spore-Forming, Nonbranching Catalase-Positive Bacilli 350
Corynebacterium 350
General Characteristics 350
Corynebacterium diphtheriae 350
Virulence Factors. 350
Clinical Infections. 351
Laboratory Diagnosis 352
Microscopy. 352
Culture Characteristics. 352
Identification. 353
Test for Toxigenicity. 353
Other Corynebacteria 353
Corynebacterium amycolatum. 353
Corynebacterium jeikeium. 355
Corynebacterium pseudodiphtheriticum. 355
Corynebacterium pseudotuberculosis. 355
Corynebacterium striatum. 355
Corynebacterium ulcerans. 355
Corynebacterium urealyticum. 355
Identification of Coryneform Bacteria 356
Rothia 356
Related Genera and Undesignated CDC Coryneform Groups 356
Listeria monocytogenes 356
General Characteristics. 356
Virulence Factors. 356
Clinical Infections. 356
Disease in Pregnant Women. 356
Disease in the Newborn. 356
Disease in the Immunosuppressed Host. 357
Laboratory Diagnosis 357
Microscopy. 357
Cultural Characteristics. 357
Identification. 357
Non–Spore-Forming, Nonbranching Catalase-Negative Bacilli 358
Erysipelothrix rhusiopathiae 358
General Characteristics 358
Clinical Infections 358
Laboratory Diagnosis 359
Microscopy. 359
Culture Characteristics. 359
Identification. 360
Arcanobacterium 360
Gardnerella vaginalis 361
III Laboratory Diagnosis of Infectious Diseases: an Organ System Approach to Diagnostic Microbiology 764
32 Upper and Lower Respiratory Tract Infections 765
Chapter Outline 765
Objectives 765
Key Terms 766
General Concepts of Infectious Diseases of the Respiratory Tract 766
Anatomy of the Respiratory Tract 766
Barriers to Infection 766
The Role of Normal Biota 766
Distinguishing Among Normal Biota, Colonizing, and Pathogenic Microorganisms 767
Host Risk Factors 768
Immune Status of the Host 768
Age as a Risk Factor 768
Reduced Clearance of Secretions 769
Infection-Induced Airway Obstruction 769
Seasonal and Community Trends in Infections 769
Empiric Antimicrobial Therapy 769
Virulence Factors of Pathogenic Organisms 769
Adherence 770
Toxin Elaboration 770
Evasion of Host Defenses 770
Upper Respiratory Tract Infections 770
Pharyngitis 770
Epidemiology 770
Causes 770
Pathogenesis 771
Clinical Manifestations 771
Complications 772
Laboratory Diagnosis 772
Treatment 773
Sinusitis 773
Epidemiology 773
Causes 773
Pathogenesis 773
Clinical Manifestations 773
Complications 774
Laboratory Diagnosis 774
Treatment 775
Otitis Media 775
Epidemiology 775
Causes 775
Pathogenesis 775
Clinical Manifestations 776
Complications 776
Laboratory Diagnosis 776
Treatment 776
Epiglottitis 776
Epidemiology 776
Causes 777
Pathogenesis 777
Clinical Manifestations 777
Complications 777
Laboratory Diagnosis 777
Treatment 777
Pertussis 778
Epidemiology 778
Causes 778
Pathogenesis 778
Clinical Manifestations 778
Complications 778
Laboratory Diagnosis 778
Treatment 779
Lower Respiratory Tract Infections 779
Bronchitis and Bronchiolitis 779
Epidemiology 779
Causes 779
Pathogenesis 779
Clinical Manifestations 781
Acute Versus Chronic Bronchitis. 781
Complications 781
Laboratory Diagnosis 782
Treatment 782
Influenza 782
Epidemiology 782
Causes 782
Pathogenesis 782
Clinical Manifestations 782
Complications 782
Diagnosis 783
Treatment and Prevention 783
Emerging Viral Respiratory Tract Infections 783
Avian Influenza: H5N1 783
Pandemic H1N1 Influenza A and Other Swine Influenza Variants 783
Severe Acute Respiratory Syndrome 784
Adenovirus Infections: Reemergence in Military and Civilian Populations 784
Metapneumovirus 784
Human Bocavirus 784
Acute Pneumonia 785
Community-Acquired Pneumonia 785
Epidemiology. 785
Causes. 785
Pathogenesis. 786
Clinical Manifestations. 786
Complications. 787
Laboratory Diagnosis. 787
Treatment. 788
Health Care–Associated Pneumonia 789
Epidemiology. 789
Causes. 789
Pathogenesis. 789
Clinical Manifestations. 790
Complications. 790
Laboratory Diagnosis. 790
Treatment. 790
Empyema 791
Epidemiology 791
Causes 791
Pathogenesis 791
Clinical Manifestations 791
Complications 791
Laboratory Diagnosis 792
Treatment 792
Tuberculosis and Other Chronic Pneumonias 792
Causes 792
Pathogenesis 793
Clinical Manifestations 793
Complications 793
Laboratory Diagnosis 793
Treatment 794
Aspiration Pneumonia 795
Epidemiology. 795
Causes. 795
Pathogenesis. 795
Clinical Manifestations. 795
Complications. 795
Diagnosis. 795
Treatment. 796
Respiratory Tract Infections in the Immunocompromised Host 796
Patients with HIV 796
Epidemiology 796
Clinical Manifestations 797
Laboratory Diagnosis 797
Treatment 798
Patients with Other Immunocompromised States 798
Epidemiology 799
Clinical Manifestations 799
Laboratory Diagnosis 799
Treatment 799
Bioterrorism and Respiratory Infections 800
Bibliography 801
33 Skin and Soft Tissue Infections 804
Chapter Outline 804
Objectives 804
Key Terms 805
Anatomy of the Skin 805
Skin Biota 805
Localized Bacterial and Fungal Skin Infections 805
Dermatitis 807
Intertrigo and Superficial Candidiasis 807
Erythrasma 808
Dermatophytes 808
Pyoderma 809
Impetigo 809
Erysipelas 810
Erysipeloid 810
Anthrax 810
Cellulitis 810
Recurrent Cellulitis. 811
MRSA Infections 811
Paronychia. 811
Folliculitis. 811
Furuncles and Carbuncles. 811
Hidradenitis Suppurativa. 812
Other Soft Tissue Infections 812
Bite Infections 812
Diabetic Foot Infections 812
Necrotizing Soft Tissue Infection 813
Mycetoma 813
Chromoblastomycosis 814
Other Uncommon Fungi 814
Nodular Lymphangitis 815
Sporotrichosis 815
Nocardiosis 816
Mycobacterial Infection 816
Nontuberculous Mycobacteria. 816
Mycobacterium tuberculosis. 817
Actinomycosis 817
Dermatologic Manifestations of Systemic Bacterial and Fungal Infections 817
Bacteria 817
Pseudomonas Infection 817
Vibrio and Aeromonas Infections 817
Borreliosis 818
Treponema Infection 818
Zoonoses 819
Rickettsiosis. 819
Leptospirosis. 819
Bartonellosis. 819
Rat Bite Fever. 819
Tularemia. 820
Mycobacteria 820
Nontuberculous Mycobacteria and Tuberculosis. 820
Leprosy. 820
Fungi 821
Candidiasis 821
Systemic Dimorphic Fungi and Molds 821
Viral Infections 822
Rubeola 822
Rubella 822
Parvovirus B19 Infection 822
Enteroviruses 822
Herpesviridae 823
Varicella-Zoster Virus 823
Herpes Simplex Virus 823
Other Herpesviruses 824
Molluscum Contagiosum 825
Orf and Milker’s Nodule 825
Human Papillomavirus 825
Hemorrhagic Fever Viruses 826
Parasitic Infections 826
Helminths 826
Schistosomiasis 826
Strongyloides Infection 826
Filariasis 827
Hookworm Infection 828
Leishmaniasis 828
Ectoparasites 828
Immune- or Toxin-Mediated Dermatologic Manifestations of Infectious Agents 829
Immune-Mediated Cutaneous Disease 829
Disseminated Intravascular Coagulation 829
Vasculitis 829
Immune Complex Disease 830
Toxin-Mediated Cutaneous Disease 830
Staphylococcal Scalded-Skin Syndrome 830
Toxic Shock Syndrome 830
Scarlet Fever 830
Laboratory Diagnosis 831
Bibliography 832
34 Gastrointestinal Infections and Food Poisoning 835
Chapter Outline 835
Objectives 835
Key Terms 835
Evaluating Gastrointestinal Infections and Food Poisoning 836
Anatomic Considerations 836
Approach to Diagnosis of the Patient with Diarrhea 837
History 837
Physical Examination 838
Laboratory Studies 839
Clinical Presentation and Pathogenic Mechanisms of Acute Diarrhea 839
Enterotoxin-Mediated Diarrhea 839
Diarrhea Mediated by Invasion of the Bowel Mucosal Surface 840
Diarrhea Mediated by Invasion of Full-Bowel Thickness with Lymphatic Spread 840
Common Viral, Bacterial, and Parasitic Pathogens 841
Viral Pathogens 841
Rotaviruses 841
Enteric Adenoviruses 841
Caliciviruses 841
Astroviruses 841
Bacterial Pathogens 841
Campylobacter jejuni 841
Salmonella Species 842
Gastroenteritis and Food Poisoning. 842
Enteric Fever. 842
Shigella Species 842
Escherichia coli 842
Enterotoxigenic Escherichia coli. 842
Enteroinvasive Escherichia coli. 842
Enterohemorrhagic Escherichia coli. 842
Enteropathogenic Escherichia coli. 843
Enteroaggregative Escherichia coli. 843
Vibrio Species 843
Yersinia enterocolitica 843
Clostridium difficile. 844
Listeria monocytogenes 844
Helicobacter Species 844
Other Bacterial Pathogens 845
Parasitic Pathogens 845
Giardia lamblia 845
Entamoeba histolytica 845
Cryptosporidium parvum and Cryptosporidium hominis 845
Cyclospora cayetanensis and Cystoisospora belli 846
Microsporidia 846
Other Parasitic Infections 846
Diarrhea in Special Circumstances 846
Toxic Agents of Food Poisoning 846
Returning Travelers 846
Immunocompromised Hosts 848
Laboratory Diagnosis of Gastrointestinal Pathogens 849
Specimen Collection and Handling 849
Direct Microscopic Examination 849
Culture 849
Campylobacter jejuni 849
Salmonella Species 849
Shigella Species 851
Escherichia coli 851
Yersinia Species 851
Vibrio Species 851
Clostridium difficile 852
Treatment and Prevention of Diarrhea 852
Bibliography 853
35 Infections of the Central Nervous System 854
Chapter Outline 854
Objectives 854
Key Terms 854
General Concepts Related to Infections of the Central Nervous System 855
Anatomic Organization 855
Cerebrospinal Fluid Characteristics 856
Host-Pathogen Relationships 856
Central Nervous System Infections 856
Meningitis 856
Bacterial Meningitis 856
Pathogenesis. 856
Other Bacteria. 857
Shunt Infections. 858
Viral Infections 858
Enteroviruses. 858
Arboviruses. 859
Mumps Virus. 859
Lymphocytic Choriomeningitis Virus. 859
Herpesvirus. 859
Human Immunodeficiency Virus. 859
Mycobacterial Infections 860
Spirochetal Infections 860
Fungal Infections 860
Parasitic Infections 861
Protozoa. 861
Helminths. 861
Meningoencephalitis and Encephalitis 862
Brain Abscesses 863
Bacterial Pathogens 863
Fungal Pathogens 863
Laboratory Diagnosis 864
Cerebrospinal Fluid Transport and Analysis 864
Culture 864
Bacterial Infections 864
Viral Infections 865
Mycobacterial Infections 866
Fungal Infections 866
Parasitic Infections 866
Bibliography 867
36 Bacteremia and Sepsis 868
Chapter Outline 868
Objectives 868
Key Terms 869
General Concepts Related to Bacteremic Infections 869
Definitions 869
Classification of Bacteremia 869
Site of Origin 869
Causative Agent 870
Place of Acquisition 870
By Duration 870
Epidemiology 870
Incidence and Mortality 870
Risk Factors 870
Decreased Immune Competency of Selected Patient Populations 871
Increased Use of Invasive Procedures 871
Age of the Patient 871
Antimicrobial Resistance 871
Diagnostic Criteria and Coding Practices 871
Causes 871
Pathogenesis 872
Clinical Aspects of Bacteremia 873
Syndromes Associated with Bacteremia 873
Catheter-Related Bloodstream Infections 873
Urinary Tract Infections 873
Pneumonias 873
Intraabdominal Infections 873
Skin Infections 873
Infective Endocarditis 874
Musculoskeletal Infections 874
Central Nervous System Infections 874
Signs and Symptoms 874
Laboratory Diagnosis 874
Specimen Collection 874
Determining the Volume, Frequency, and Number of Blood Cultures 875
Density of Bacteremia in Adults Versus Neonates. 875
Frequency of Bacteremic Episodes Versus Time and Frequency of Collection. 875
Rationale for Multiple Blood Collections. 876
Blood Culture Methods 876
Culture Media Used in Conventional Broth Systems 876
Neutralization of Inhibitors. 877
Anticoagulants and Other Additives. 877
Incubation Conditions. 877
Blood Culture Systems 877
Manual Systems 877
Examination of Blood Culture Bottles in a Manual System 878
Continuous-Monitoring Blood Culture Systems 878
BACTEC 9000 Series and BD FX. 878
VersaTREK. 878
BacT/ALERT 3D System. 878
Recovery of Other Types of Organisms from Blood 878
Francisella tularensis. 878
Leptospira spp. 878
Brucella spp. 879
Nutritionally Deficient Streptococci. 879
Campylobacter spp. 879
Coxiella burnetii. 879
Bartonella spp. 879
HACEK Group of Gram-Negative Bacilli. 879
Mycobacteria from the Blood. 880
Fungemia. 880
Viremia. 880
Contamination in Blood Cultures 880
Rapid Identification of Microorganisms Growing in Blood Cultures 880
Direct Tube Coagulase. 880
Fluorescence in situ Hybridization. 880
Nucleic Acid Amplification Methods. 880
Other Rapid Diagnostic Tests. 881
Biomarkers 881
Treatment 881
Antimicrobial Therapy 881
Antisepsis Therapy 882
Physiologic Support 882
Anticoagulation Agents 882
Glucocorticoids 882
Anticytokine Therapies 882
Prevention 882
Bibliography 883
37 Urinary Tract Infections 884
Chapter Outline 884
Objectives 884
Key Terms 884
The Urinary System 886
Epidemiology and Risk Factors 886
Age 886
Children 886
Adults to Age 65 887
Geriatric Population 887
Institutionalized Care 888
Pregnancy 888
Renal Transplantation 888
Bladder Catheterization 888
Clinical Signs and Symptoms 888
Causes of Urinary Tract Infections 889
Pathogenesis 889
Causative Agents 890
Gram-Negative Bacilli 890
Gram-Positive Cocci 890
Gram-Positive Bacilli 891
Fungi 891
Other Agents of Urinary Tract Infections 891
Laboratory Diagnosis 892
Significance of Colony Counts: Historical Background 892
Specimen Collection 893
Voided Midstream Specimen Collection 893
Catheterized Specimen Collection 893
Suprapubic Aspiration 893
Other Considerations 894
Urine Volume. 894
Number of Specimens and Timing of Collection. 894
Additives 894
Specimen Transport 894
Microbial Detection 894
Specimen Screening: Rapid Nonculture Methodologies 894
Manual Urine Screening Methods 895
Microscopy 895
Detection of Bacteria when Pyelonephritis is Suspected. 895
Detection of Pyuria. 895
Detection of Fungi and Mycobacteria. 895
Chemical Methods. 896
Automated Urine Screening Methods 896
Rejection Criteria 896
Culture for Causative Agents of Urinary Tract Infections 896
Asymptomatic Bacteriuria 897
Pyelonephritis 897
Lower Urinary Tract Infections 897
Suprapubic Aspirates 897
Catheterized Specimens 897
Prostatic Secretions 897
Interpretation of Results 897
Susceptibility Reporting 899
Urinary Tract Infection Antibiograms 899
Bibliography 900
38 Genital Infections and Sexually Transmitted Infections 901
Chapter Outline 901
Objectives 901
Key Terms 902
Urethritis 903
Causes 903
Epidemiology 903
Clinical Manifestations 904
Laboratory Diagnosis 905
Treatment 906
Cervicitis 907
Causes 907
Epidemiology 907
Clinical Manifestations 907
Laboratory Diagnosis 907
Treatment 907
Vulvovaginitis 908
Causes 908
Bacterial Vaginosis 908
Epidemiology 908
Clinical Manifestations 908
Laboratory Diagnosis 908
Treatment 909
Trichomoniasis 909
Epidemiology 909
Clinical Manifestations 909
Laboratory Diagnosis 910
Treatment 910
Candidiasis 910
Epidemiology 910
Clinical Manifestations 911
Laboratory Diagnosis 911
Treatment 911
Genital Ulcer Disease 912
Causes 912
Genital Herpes 912
Epidemiology 912
Clinical Manifestations 912
Laboratory Diagnosis 913
Treatment 914
Syphilis 914
Epidemiology 914
Clinical Manifestations 915
Laboratory Diagnosis 916
Treatment 917
Chancroid 917
Epidemiology 917
Clinical Manifestations 918
Laboratory Diagnosis 918
Treatment 919
Lymphogranuloma Venereum 919
Epidemiology 919
Clinical Manifestations 919
Laboratory Diagnosis 920
Treatment 920
Donovanosis 920
Epidemiology 920
Clinical Manifestations 920
Laboratory Diagnosis 921
Treatment 921
Acquired Immunodeficiency Syndrome 922
Causes 922
Epidemiology 922
Clinical Manifestations 923
Acute Infection 923
Clinically Latent Infection 923
Progression to AIDS 924
Laboratory Diagnosis 924
Treatment 925
Other Sexually Transmitted Diseases 926
Genital Warts 926
Epidemiology 926
Clinical Manifestations 926
Diagnosis 926
Treatment 926
Viral Hepatitis 927
Epidemiology 927
Appendices 977
Appendix A Selected Bacteriologic Culture Media 977
Acetate Agar 977
Alkaline Peptone Water 977
American Trudeau Society Medium 977
Bacteroides Bile Esculin Agar 977
Bile Esculin Agar 977
Bismuth Sulfite Agar 978
Blood Agar, Anaerobic, CDC 978
Blood Agar, Anaerobic, Brucella Base, Wadsworth 978
Blood Agar, Anaerobic, with Kanamycin and Vancomycin 978
Blood Agar, Anaerobic, Laked, with Kanamycin, Vancomycin, and Vitamin K 978
Blood Agar, Rabbit 978
Blood Agar, Sheep 978
Blood Phenylethyl Alcohol Agar, Anaerobic, CDC 978
Bordet-Gengou Blood Agar 979
Brain-Heart Infusion Broth 979
Buffered Charcoal Yeast Extract Agar 979
Burkholderia cepacia Agar 979
Burkholderia cepacia Selective Agar 979
Campylobacter Blood Agar (Campy-BA) 980
Campylobacter Charcoal Differential Agar 980
Campylobacter Thioglycolate Broth 980
Cefsulodin-Irgasan-Novobiocin 980
Cetrimide Agar 980
Chocolate Agar 980
Chromagars 980
Citrate Agar, Simmons 980
Columbia Agar with and without 5% Sheep Blood 981
Cooked Meat (Chopped Meat Glucose) Medium 981
Cystine Tryptic Agar with Sugar 981
Cycloserine Cefoxitin Fructose Agar 981
Decarboxylase Test Medium (Moeller) 981
Deoxyribonuclease (DNAse) Test Agar 982
Dilute Gelatin Medium (0.4%) 982
Egg Yolk Agar, CDC Formulation 982
Eosin–Methylene Blue Agar 982
Esculin Agar 982
Fletcher Semisolid Medium for Leptospira 982
Gelatin Medium (Nutrient) 983
Gram-Negative Broth 983
Haemophilus Test Medium 983
Hektoen Enteric Agar 983
Hippurate Broth 983
Hydrogen Sulfide, Lead Acetate 983
Kligler’s Iron Agar 983
Lim Broth 984
Loeffler Coagulated Serum Slant 984
Löwenstein-Jensen Medium 985
Lysine Iron Agar 985
MacConkey Agar 985
Macconkey Sorbitol Agar 985
Malonate Broth 986
Mannitol Salt Agar 986
Methyl Red Voges-Proskauer Medium 986
Middlebrook 7H10 and 7H11 Agars 986
Mitchison 7H11 Selective Agar 987
Modified Thayer-Martin Agar 987
Motility Test Medium 987
Mueller-Hinton Agar 987
Mueller-Hinton Agar with 2% NaCl 987
Mueller-Hinton Agar with 4% NaCl and 6 µg Oxacillin 987
New York City Medium 988
Nitrate Reduction Broth 988
Nutrient Agar 988
Oxidative-Fermentative Medium (Hugh and Leifson Formulation) 988
Oxidative-Fermentative Polymyxin B–Bacitracin-Lactose Agar 988
Peptone–Yeast Extract–Glucose Broth 989
Phenylalanine Deaminase Agar 989
Phenylethyl Alcohol Agar 989
Potassium Tellurite Blood Agar 989
PPLO Agar 989
Regan-Lowe Medium 989
Salmonella-Shigella Agar 990
Schaedler Agar 990
Selenite Broth 990
Sodium Chloride Broth, 6.5% 990
SP-4 Broth and SP-4 Agar 990
Streptococcus-Selective Agar 991
Tetrathionate Broth 991
Thioglycolate Broth, Basal and Enriched 991
Thiosulfate Citrate Bile Salts Sucrose Agar 991
Tinsdale Agar 991
Todd-Hewitt Broth with Gentamicin and Nalidixic Acid 992
Triple Sugar Iron Agar 992
Trypticase Soy Agar 992
Trypticase Soy Broth 992
Tryptophan Broth, 1% 992
Urea Agar and Broth 993
Vaginalis Agar 993
Xylose-Lysine-Desoxycholate Agar 993
Bibliography 993
Appendix B Selected Mycology Media, Fluids, and Stains 994
Fungal Media 994
Antifungal Susceptibility Testing Media 994
Assimilation Base for Carbohydrates 994
Birdseed Agar 994
Brain-Heart Infusion Agar 994
Canavanine–Glycine–Bromthymol Blue Agar 994
Chromogenic Agar for Candida 994
Cornmeal Agar 995
Dermatophyte Test Medium 995
Inhibitory Mold Agar 995
Littman Oxgall Agar 995
Modified Potassium Nitrate Assimilation Medium 995
Mycosel/Mycobiotic Agar 995
Potato Dextrose Agar 995
Potato Flake Agar 995
Rice Extract Agar 995
Rice Grains Medium 995
Sabouraud-Brain-Heart Infusion Agar 995
Sabouraud Dextrose Agar or Broth (Emmons Modification) 996
Trichophyton Agars 1-7 996
Fungal Mounting Fluid 996
KOH-Glycerin 996
Fungal Stains 996
Calcofluor White Stain 996
India Ink 996
Lactophenol Cotton Blue 996
Bibliography 996
Appendix C Answers to Learning Assessment Questions 997
Chapter 1 997
Chapter 2 997
Section A 997
Section B 997
Chapter 3 998
Chapter 4 998
Section A 998
Glossary 1026
A 1026
B 1027
C 1029
D 1031
E 1032
F 1033
G 1034
H 1034
I 1035
J 1036
K 1036
L 1036
M 1037
N 1038
O 1039
P 1040
Q 1042
R 1042
S 1043
T 1045
U 1046
V 1046
W 1047
X 1047
Y 1047
Z 1047
Index 1048
A 1048
B 1050
C 1052
D 1054
E 1055
F 1057
G 1058
H 1059
I 1060
J 1061
K 1061
L 1061
M 1062
N 1065
O 1066
P 1066
Q 1069
R 1069
S 1070
T 1073
U 1074
V 1075
W 1076
X 1076
Y 1076
Z 1076