BOOK
Textbook of Diagnostic Microbiology - E-Book
Connie R. Mahon | Donald C. Lehman | George Manuselis
(2018)
Additional Information
Book Details
Abstract
Learn to develop the problem-solving skills necessary for success in the clinical setting! The Textbook of Diagnostic Microbiology, 6th Edition uses a reader-friendly "building-block" approach to the essentials of diagnostic microbiology. This updated edition has new content on viruses like Zika, an expanded molecular chapter, and the latest information on prevention, treatment modalities, and CDC guidelines. Updated photos offer clear examples of automated lab instruments, while case studies, review questions, and learning objectives present information in an easy-to-understand, accessible manner for students at every level.
- A building-block approach encourages you to use previously learned information to sharpen critical-thinking and problem-solving skills.
- Full-color design, with many full-color photomicrographs, prepares you for the reality of diagnostic microbiology.
- A case study at the beginning of each chapter provides you with the opportunity to form your own questions and answers through discussion points.
- Hands-on procedures describe exactly what takes place in the micro lab, making content more practical and relevant.
- Agents of bioterrorism chapter furnishes you with the most current information about this hot topic.
- Issues to Consider boxes encourages you to analyze important points.
- Case Checks throughout each chapter tie content to case studies for improved understanding.
- Bolded key terms at the beginning of each chapter equip you with a list of the most important and relevant terms in each chapter.
- Learning objectives at the beginning of each chapter supply you with a measurable outcome to achieve by completing the material.
- Review questions for each learning objective help you think critically about the information in each chapter, enhancing your comprehension and retention of material.
- Learning assessment questions at the conclusion of each chapter allow you to evaluate how well you have mastered the material.
- Points to Remember sections at the end of each chapter identify key concepts in a quick-reference, bulleted format.
- An editable and printable lab manual provides you with additional opportunities to learn course content using real-life scenarios with questions to reinforce concepts.
- Glossary of key terms at the end of the book supplies you with a quick reference for looking up definitions.
- NEW! Content about Zika and other viruses supplies students with the latest information on prevention, treatment modalities, and CDC guidelines.
- NEW! Expanded Molecular Diagnostics chapter analyzes and explains new and evolving techniques.
- NEW! Updated photos helps familiarize you with the equipment you’ll use in the lab.
- NEW! Reorganized and refocused Mycology chapter helps you better understand the toxicity of fungi.
- NEW! Updated content throughout addresses the latest information in diagnostic microbiology.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Inside Front Cover | ifc1 | ||
| Textbook of Diagnostic Microbiology | i | ||
| Copyright | ii | ||
| Dedication | iii | ||
| Reviewers | v | ||
| Contributors | vii | ||
| Preface | xi | ||
| Organization | xi | ||
| Pedagogic Features | xii | ||
| Ancillaries for Instructors and Students | xii | ||
| Acknowledgments | xiii | ||
| Table Of Contents | xv | ||
| 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 | 5 | ||
| Nomenclature | 6 | ||
| Classification by Phenotypic and Genotypic Characteristics | 6 | ||
| Classification by Cellular Type: Prokaryotes, Eukaryotes, and Archaea | 6 | ||
| Comparison of Prokaryotic and Eukaryotic Cell Structure | 7 | ||
| Prokaryotic Cell Structure | 7 | ||
| Cytoplasmic Structures | 7 | ||
| Cell Envelope Structures | 7 | ||
| Plasma (Cell) Membrane. | 7 | ||
| Cell Wall. | 7 | ||
| Gram-Positive Cell Wall. | 7 | ||
| Gram-Negative Cell Wall. | 8 | ||
| Acid-Fast Cell Wall. | 9 | ||
| Absence of Cell Wall. | 9 | ||
| Surface Polymers | 9 | ||
| Cell Appendages. | 9 | ||
| Eukaryotic Cell Structure | 9 | ||
| 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 | 11 | ||
| Gram Stain | 11 | ||
| Acid-Fast Stains | 12 | ||
| Acridine Orange | 12 | ||
| Calcofluor White | 12 | ||
| Methylene Blue | 12 | ||
| Lactophenol Cotton Blue | 13 | ||
| India Ink | 13 | ||
| Endospore Stain | 13 | ||
| Microbial Growth and Nutrition | 13 | ||
| Nutritional Requirements for Growth | 13 | ||
| 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) | 16 | ||
| Aerobic Utilization of Pyruvate (Oxidation) | 16 | ||
| Carbohydrate Utilization and Lactose Fermentation | 17 | ||
| Bacterial Genetics | 17 | ||
| Anatomy of a DNA and RNA Molecule | 17 | ||
| Terminology | 18 | ||
| Genetic Elements and Alterations | 18 | ||
| Bacterial Genome | 18 | ||
| Extrachromosomal DNA Elements | 19 | ||
| Mobile Genetic Elements | 20 | ||
| Mutations | 20 | ||
| Genetic Recombination | 20 | ||
| Mechanisms of Gene Transfer | 20 | ||
| Transformation | 20 | ||
| Transduction | 20 | ||
| Conjugation | 21 | ||
| Restriction Enzymes | 21 | ||
| Bibliography | 21 | ||
| 2 Host-Parasite Interaction | 22 | ||
| Chapter Outline | 22 | ||
| Objectives | 22 | ||
| Key Terms | 23 | ||
| Origin of Microbial Biota | 23 | ||
| Characteristics of Indigenous Microbial Biota | 23 | ||
| Factors That Determine the Composition of the Usual Microbial Biota | 24 | ||
| Composition of Microbial Biota at Different Body Sites | 24 | ||
| Normal Microbiota of the Skin | 24 | ||
| Normal Microbiota of the Oral Cavity | 25 | ||
| Normal Microbiota of the Respiratory Tract | 25 | ||
| Normal Microbiota of the Gastrointestinal Tract | 26 | ||
| Normal Microbiota of the Genitourinary Tract | 26 | ||
| Role of the Microbial Biota in the Pathogenesis of Infectious Disease | 27 | ||
| Role of the Microbial Biota in the Host Defense Against Infectious Disease | 27 | ||
| Microbial Factors Contributing to Pathogenesis and Virulence | 27 | ||
| Pathogenesis | 27 | ||
| Routes of Transmission | 28 | ||
| Airborne Transmission | 28 | ||
| Transmission by Food and Water | 30 | ||
| Close Contact | 30 | ||
| Cuts and Bites | 30 | ||
| Arthropods | 30 | ||
| Zoonoses | 30 | ||
| Virulence | 30 | ||
| Microbial Virulence Factors | 31 | ||
| Ability to Resist Phagocytosis | 31 | ||
| 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 | 33 | ||
| Exotoxins | 33 | ||
| Endotoxins | 33 | ||
| Host Resistance Factors | 34 | ||
| Physical Barriers | 34 | ||
| Cleansing Mechanisms | 35 | ||
| Antimicrobial Substances | 35 | ||
| Indigenous Microbial Biota | 36 | ||
| Phagocytosis | 36 | ||
| Chemotaxis | 36 | ||
| Attachment | 36 | ||
| Ingestion | 37 | ||
| Killing | 37 | ||
| Inflammation | 37 | ||
| Immune Responses | 37 | ||
| Innate, or Natural, Immunity | 38 | ||
| 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 | ||
| Bibliography | 43 | ||
| 3 The Laboratory Role in Infection Control | 44 | ||
| Chapter Outline | 44 | ||
| Objectives | 44 | ||
| Key Terms | 45 | ||
| General Concepts in Infection Prevention and Control Practice | 45 | ||
| Infection Prevention and Control in Health Care Settings | 45 | ||
| Infection Control Surveillance | 46 | ||
| Surveillance Definitions | 46 | ||
| General or Targeted Surveillance. | 46 | ||
| Baseline Data. | 47 | ||
| Data Gathering | 47 | ||
| Culture Review. | 47 | ||
| Cases. | 47 | ||
| Laboratory Support and Data Gathering. | 48 | ||
| Frequently Identified Microbes | 48 | ||
| Public Health and Community Setting | 48 | ||
| Acute Care Setting | 48 | ||
| Ambulatory Care Setting | 49 | ||
| Extended Care Facility and Home Care Settings | 49 | ||
| Communal Living | 49 | ||
| Outbreak Investigation | 49 | ||
| Local Outbreaks | 49 | ||
| Widespread Outbreaks | 49 | ||
| Steps of an Outbreak Investigation | 50 | ||
| Investigation Support from the Laboratory | 51 | ||
| Cultures and Serology | 51 | ||
| Antibiograms | 51 | ||
| Molecular Epidemiology | 51 | ||
| Environmental Culturing | 52 | ||
| Air | 52 | ||
| Water | 52 | ||
| Surfaces | 53 | ||
| Reporting | 53 | ||
| Reporting to Public Health | 53 | ||
| Reporting to Committees and Programs | 53 | ||
| Reporting to the Media | 53 | ||
| Education | 53 | ||
| Laboratory Scientists and Infection Prevention and Control Practitioners | 53 | ||
| Safety | 54 | ||
| Emerging and Reemerging Pathogens | 54 | ||
| Emerging Pathogens | 54 | ||
| Reemerging Pathogens | 54 | ||
| Response Plans | 54 | ||
| Bibliography | 55 | ||
| 4 Control of Microorganisms | 57 | ||
| Chapter Outline | 57 | ||
| Objectives | 57 | ||
| Key Terms | 58 | ||
| Disinfection and Sterilization | 58 | ||
| Sterilization Versus Disinfection | 58 | ||
| Factors That Influence the Degree of Killing | 59 | ||
| Types of Organisms | 59 | ||
| Number of Organisms | 59 | ||
| Concentration of Disinfecting Agent | 59 | ||
| Presence of Organic Material | 60 | ||
| Nature of Surface to Be Disinfected | 60 | ||
| Contact Time | 60 | ||
| Temperature | 60 | ||
| pH | 60 | ||
| Biofilms | 60 | ||
| Compatibility of Disinfectants | 60 | ||
| Methods of Disinfection and Sterilization | 60 | ||
| Physical Methods | 61 | ||
| Heat | 61 | ||
| Filtration | 61 | ||
| Radiation | 61 | ||
| Chemical Methods | 62 | ||
| Disinfectants Versus Antiseptics | 62 | ||
| Alcohols | 63 | ||
| Aldehydes | 63 | ||
| Formaldehyde | 63 | ||
| Glutaraldehyde | 63 | ||
| Halogens | 64 | ||
| Iodophors | 64 | ||
| Chlorine and Chlorine Compounds | 64 | ||
| Detergents: Quaternary Ammonium Compounds | 64 | ||
| Phenolics | 64 | ||
| Chlorhexidine Gluconate | 65 | ||
| Hexachlorophene | 65 | ||
| Chloroxylenol | 65 | ||
| Triclosan | 65 | ||
| Heavy Metals | 65 | ||
| Gases | 66 | ||
| Ethylene Oxide | 66 | ||
| Hydrogen Peroxide | 66 | ||
| Peracetic Acid | 66 | ||
| Hydrogen Peroxide and Peracetic Acid | 66 | ||
| Environmental Protection Agency Regulations on Chemical Surface Disinfectants | 66 | ||
| Food and Drug Administration Regulations on Chemical Skin Antiseptics | 66 | ||
| Hygienic Handwashing and Waterless Handrubs | 67 | ||
| Surgical Hand Scrub and Waterless Surgical Handrubs | 68 | ||
| Presurgical Skin Disinfection | 68 | ||
| Microbiology Safety | 68 | ||
| General Laboratory Safety | 69 | ||
| Safety Program for the Clinical Laboratory | 69 | ||
| Occupational Safety and Health Administration | 69 | ||
| Exposure Control Plan | 69 | ||
| Standard Precautions | 69 | ||
| Transmission-Based Precautions | 70 | ||
| Engineering Controls | 70 | ||
| Work Practice Controls | 70 | ||
| Personal Protective Equipment | 70 | ||
| Biological Risk Assessment | 70 | ||
| Processing of Patient Specimens | 72 | ||
| Working with Actively Growing Cultures | 73 | ||
| Biological Safety Cabinets | 73 | ||
| Biosafety Levels | 73 | ||
| Biosafety Level 1. | 73 | ||
| Biosafety Level 2. | 74 | ||
| Biosafety Level 3. | 75 | ||
| Biosafety Level 4. | 75 | ||
| Hazardous Waste | 76 | ||
| Disposal of Infectious Waste | 76 | ||
| Hazardous Waste Reduction | 76 | ||
| Chemical Safety | 76 | ||
| Safety Data Sheets | 76 | ||
| Chemicals Inventory | 77 | ||
| Chemical Storage | 84 | ||
| Hazardous Chemical Classification | 84 | ||
| Laboratory Safety for Hazardous Chemicals | 84 | ||
| Chemical Spills | 84 | ||
| Signage | 84 | ||
| Fire Safety | 84 | ||
| Thermal Injuries | 85 | ||
| Storage of Compressed Gases | 85 | ||
| Electrical Safety | 85 | ||
| Miscellaneous Safety Considerations | 86 | ||
| Back Safety | 86 | ||
| First Aid Training | 86 | ||
| Immunizations | 86 | ||
| Safety Training | 86 | ||
| Bioterrorism and the Clinical Microbiology Laboratory | 86 | ||
| Laboratory Response Network | 86 | ||
| Sentinel Laboratories | 86 | ||
| Reference Laboratories and National Laboratories | 86 | ||
| Safety During a Possible Bioterrorism Event | 86 | ||
| Packaging and Shipping of Infectious Substances | 87 | ||
| Bibliography | 88 | ||
| 5 Performance Improvement in the Microbiology Laboratory | 90 | ||
| Chapter Outline | 90 | ||
| Objectives | 90 | ||
| Key Terms | 91 | ||
| General Guidelines for Establishing Quality Control | 91 | ||
| Temperature | 92 | ||
| Thermometer Calibration | 92 | ||
| Equipment Quality Control | 92 | ||
| Media Quality Control | 92 | ||
| Reagent Quality Control | 93 | ||
| Antimicrobial Susceptibility Quality Control | 95 | ||
| Personnel Competency | 96 | ||
| Use of Stock Cultures | 97 | ||
| Quality Control Manual | 97 | ||
| Performance Improvement | 97 | ||
| Vision and Mission Statements | 97 | ||
| Individualized Quality Control Plan | 97 | ||
| Proficiency Testing | 99 | ||
| Indicators of Performance Improvement: Process Versus Outcome | 99 | ||
| Establishing Performance Monitors | 99 | ||
| Problem-Action Form | 99 | ||
| The Customer Concept | 99 | ||
| Fixing the Process | 100 | ||
| Benchmarking | 100 | ||
| Commercially Purchased Monitors | 100 | ||
| Evaluating and Interpreting Diagnostic Laboratory Tests | 100 | ||
| Analytic Analysis of Tests | 100 | ||
| Analytic (Technical) Sensitivity and Specificity | 100 | ||
| Sensitivity | 100 | ||
| Specificity | 101 | ||
| Accuracy | 101 | ||
| Clinical Analysis of Tests | 101 | ||
| Clinical (Diagnostic) Sensitivity | 101 | ||
| Clinical (Diagnostic) Specificity | 101 | ||
| Operational Analysis of Tests | 101 | ||
| Incidence of Disease | 101 | ||
| Prevalence of Disease | 101 | ||
| Predictive Values of Tests | 102 | ||
| Positive Predictive Value | 102 | ||
| Negative Predictive Value | 102 | ||
| Example | 102 | ||
| Clinical Applications of Positive and Negative Predictive Values | 102 | ||
| Group A Streptococcus Testing of Throat Samples | 102 | ||
| Direct Detection of Chlamydia trachomatis in Urethral and Cervical Specimens | 102 | ||
| Efficiency of Tests | 103 | ||
| Choosing a Laboratory Method | 103 | ||
| Test Validation | 103 | ||
| Bibliography | 105 | ||
| 6 Specimen Collection and Processing | 106 | ||
| Chapter Outline | 106 | ||
| Objectives | 106 | ||
| Key Terms | 107 | ||
| Basic Principles of Specimen Collection | 107 | ||
| Fundamentals | 107 | ||
| Collection Procedures | 107 | ||
| Patient-Collected Specimens | 107 | ||
| Urine | 109 | ||
| Sputum | 109 | ||
| Stool | 109 | ||
| Labeling and Requisitions | 109 | ||
| Safety | 110 | ||
| Preservation, Storage, and Transport of Specimens | 110 | ||
| Specimen Storage | 110 | ||
| Preservatives | 110 | ||
| Anticoagulants | 110 | ||
| Holding or Transport Media | 111 | ||
| Shipping Infectious Substances | 111 | ||
| Specimen Receipt and Processing | 112 | ||
| Specimen Priority | 112 | ||
| Unacceptable Specimens and Specimen Rejection | 113 | ||
| Macroscopic Observation | 113 | ||
| Microscopic Observation | 113 | ||
| Primary Inoculation | 114 | ||
| Types of Culture Media | 114 | ||
| Culture Media Selection | 114 | ||
| Specimen Preparation | 114 | ||
| Isolation Techniques | 114 | ||
| Incubation | 116 | ||
| Culture Workup | 116 | ||
| Nonroutine Specimens | 118 | ||
| Communication of Laboratory Findings | 118 | ||
| Bibliography | 120 | ||
| 7 Microscopic Examination of Materials From Infected Sites | 121 | ||
| Chapter Outline | 121 | ||
| Objectives | 121 | ||
| Key Terms | 122 | ||
| Preparation of Samples | 122 | ||
| Smears from Swabs | 122 | ||
| Smears from Thick Liquids or Semisolids | 122 | ||
| Smears from Thick, Granular, or Mucoid Materials | 123 | ||
| Smears from Thin Fluids | 123 | ||
| Cytocentrifuge Preparations | 123 | ||
| Cytocentrifuge Technique | 123 | ||
| Stains | 123 | ||
| Microscopes | 124 | ||
| Terminology for Direct Examinations | 125 | ||
| Examination of Prepared Material | 126 | ||
| Characterization of Background Materials | 127 | ||
| Search for Microorganisms | 127 | ||
| Grading or Classifying Materials | 128 | ||
| Contaminating Materials | 129 | ||
| II Laboratory Identification of Significant Isolates | 306 | ||
| 14 Staphylococci | 307 | ||
| Chapter Outline | 307 | ||
| Objectives | 307 | ||
| Key Terms | 308 | ||
| General Characteristics | 308 | ||
| Clinically Significant Species | 309 | ||
| Staphylococcus aureus | 309 | ||
| Virulence Factors | 309 | ||
| Enterotoxins. | 309 | ||
| Toxic Shock Syndrome Toxin-1. | 309 | ||
| Exfoliative Toxin. | 309 | ||
| Cytolytic Toxins. | 310 | ||
| Enzymes. | 310 | ||
| Protein A. | 310 | ||
| Epidemiology | 310 | ||
| Infections Caused by Staphylococcus aureus | 310 | ||
| Skin and Wound Infections. | 311 | ||
| Scalded Skin Syndrome. | 311 | ||
| Toxic Shock Syndrome. | 312 | ||
| Food Poisoning. | 312 | ||
| Other Infections. | 312 | ||
| Staphylococcus epidermidis | 312 | ||
| Staphylococcus saprophyticus | 312 | ||
| Staphylococcus lugdunensis | 313 | ||
| Other Coagulase-Negative Staphylococci | 313 | ||
| Laboratory Diagnosis | 313 | ||
| Specimen Collection and Handling | 313 | ||
| Microscopic Examination | 313 | ||
| Isolation and Identification | 313 | ||
| Cultural Characteristics | 313 | ||
| Identification Methods | 314 | ||
| Rapid Methods of Identification | 316 | ||
| Antimicrobial Susceptibility | 318 | ||
| Methicillin-Resistant Staphylococci | 318 | ||
| Vancomycin-Resistant Staphylococci | 319 | ||
| Macrolide Resistance | 319 | ||
| Bibliography | 320 | ||
| 15 Streptococcus, Enterococcus, and Other Catalase-Negative, Gram-Positive Cocci | 322 | ||
| Chapter Outline | 322 | ||
| Objectives | 322 | ||
| Key Terms | 323 | ||
| General Characteristics | 323 | ||
| Cell Wall Structure | 323 | ||
| Hemolysis | 324 | ||
| Clinically Significant Streptococci and Streptococcus-Like Organisms | 324 | ||
| Streptococcus pyogenes | 325 | ||
| Antigenic Structure | 325 | ||
| Virulence Factors | 325 | ||
| Clinical Infections | 326 | ||
| Bacterial Pharyngitis. | 326 | ||
| Pyodermal Infections. | 326 | ||
| Necrotizing Fasciitis. | 326 | ||
| Streptococcal Toxic Shock Syndrome. | 327 | ||
| Poststreptococcal Sequelae. | 327 | ||
| Laboratory Diagnosis | 327 | ||
| Streptococcus agalactiae | 329 | ||
| Antigenic Structure | 329 | ||
| Virulence Factors | 329 | ||
| Clinical Infections | 329 | ||
| Laboratory Diagnosis | 329 | ||
| Group C and G Streptococci | 330 | ||
| Streptococcus pneumoniae | 330 | ||
| Antigenic Structure | 330 | ||
| Virulence Factors | 330 | ||
| Clinical Infections | 331 | ||
| Laboratory Diagnosis | 331 | ||
| Antimicrobial Resistance | 332 | ||
| Viridans Streptococci | 332 | ||
| Clinical Infections | 332 | ||
| Virulence Factors | 333 | ||
| Laboratory Diagnosis | 333 | ||
| Enterococcus | 334 | ||
| Virulence Factors | 334 | ||
| Clinical Infections | 334 | ||
| Laboratory Diagnosis | 335 | ||
| Antimicrobial Resistance | 335 | ||
| Streptococcus-Like Organisms | 335 | ||
| Abiotrophia and Granulicatella | 335 | ||
| Aerococcus | 336 | ||
| Gemella | 336 | ||
| Lactococcus | 336 | ||
| Leuconostoc | 336 | ||
| Pediococcus | 336 | ||
| Laboratory Diagnosis | 337 | ||
| Classification Schemes | 337 | ||
| Hemolytic Patterns | 337 | ||
| Physiologic Characteristics | 337 | ||
| Lancefield Classification Scheme | 337 | ||
| Biochemical Identification | 337 | ||
| Bacitracin Susceptibility. | 337 | ||
| CAMP Test. | 337 | ||
| Hippurate Hydrolysis. | 338 | ||
| Pyrrolidonyl-α-Naphthylamide Hydrolysis. | 338 | ||
| Leucine Aminopeptidase. | 338 | ||
| Voges-Proskauer Test. | 338 | ||
| β-d-Glucuronidase. | 340 | ||
| Bile Esculin and Salt Tolerance. | 340 | ||
| Optochin Susceptibility. | 340 | ||
| Bile Solubility. | 340 | ||
| Noncultural Identification | 340 | ||
| Immunoassays | 340 | ||
| Nucleic Acid Probes | 341 | ||
| Susceptibility Testing | 341 | ||
| Bibliography | 342 | ||
| 16 Aerobic Gram-Positive Bacilli | 344 | ||
| Chapter Outline | 344 | ||
| Objectives | 344 | ||
| Key Terms | 345 | ||
| Non–Spore-Forming, Nonbranching, Catalase-Positive Bacilli | 345 | ||
| Corynebacterium | 345 | ||
| General Characteristics | 345 | ||
| Corynebacterium diphtheriae | 345 | ||
| Virulence Factors. | 345 | ||
| Clinical Infections. | 346 | ||
| Laboratory Diagnosis | 347 | ||
| Microscopy. | 347 | ||
| Culture Characteristics. | 347 | ||
| Identification. | 348 | ||
| Test for Toxigenicity. | 348 | ||
| Treatment. | 348 | ||
| Other Corynebacteria | 350 | ||
| Corynebacterium amycolatum. | 350 | ||
| Corynebacterium jeikeium. | 350 | ||
| Corynebacterium pseudodiphtheriticum. | 350 | ||
| Corynebacterium pseudotuberculosis. | 350 | ||
| Corynebacterium striatum. | 350 | ||
| Corynebacterium ulcerans. | 350 | ||
| Corynebacterium urealyticum. | 351 | ||
| Identification of Coryneform Bacteria | 351 | ||
| Rothia | 351 | ||
| Related Genera and Undesignated CDC Coryneform Groups | 351 | ||
| Listeria monocytogenes | 351 | ||
| General Characteristics. | 351 | ||
| Virulence Factors. | 352 | ||
| Clinical Infections. | 352 | ||
| Disease in Pregnant Women. | 352 | ||
| Disease in the Newborn. | 352 | ||
| Disease in the Immunosuppressed Host. | 352 | ||
| Laboratory Diagnosis | 352 | ||
| Microscopy. | 352 | ||
| Cultural Characteristics. | 353 | ||
| Identification. | 353 | ||
| Non–Spore-Forming, Nonbranching, Catalase-Negative Bacilli | 354 | ||
| Erysipelothrix rhusiopathiae | 354 | ||
| General Characteristics | 354 | ||
| Clinical Infections | 354 | ||
| Laboratory Diagnosis | 354 | ||
| Microscopy. | 354 | ||
| Culture Characteristics. | 354 | ||
| Identification. | 355 | ||
| Arcanobacterium and Trueperella | 355 | ||
| Gardnerella vaginalis | 356 | ||
| General Characteristics | 356 | ||
| Clinical Infections | 356 | ||
| Laboratory Diagnosis | 356 | ||
| Microscopy. | 356 | ||
| Additional Identification Methods. | 356 | ||
| Culture Characteristics. | 357 | ||
| Identification. | 357 | ||
| Non–Spore-Forming, Branching, Aerobic Actinomycetes | 357 | ||
| Nocardia | 357 | ||
| General Characteristics | 357 | ||
| Virulence Factors | 357 | ||
| Clinical Infections | 357 | ||
| Pulmonary Infections. | 358 | ||
| Cutaneous Infections. | 358 | ||
| Laboratory Diagnosis | 358 | ||
| Microscopy. | 358 | ||
| Culture Characteristics. | 358 | ||
| Identification. | 359 | ||
| Treatment. | 359 | ||
| Other Actinomycetes | 359 | ||
| Actinomadura | 359 | ||
| Streptomyces | 360 | ||
| Gordonia | 360 | ||
| Rhodococcus | 360 | ||
| Tropheryma whipplei | 360 | ||
| Spore-Forming, Nonbranching, Catalase-Positive Bacilli | 360 | ||
| Bacillus | 360 | ||
| General Characteristics | 360 | ||
| Bacillus anthracis | 361 | ||
| Virulence Factors. | 361 | ||
| Clinical Infections. | 361 | ||
| Cutaneous Anthrax. | 361 | ||
| Inhalation Anthrax. | 362 | ||
| Gastrointestinal Anthrax. | 362 | ||
| Injectional Anthrax. | 362 | ||
| Complications. | 362 | ||
| Laboratory Diagnosis | 362 | ||
| Microscopy. | 362 | ||
| Cultural Characteristics. | 362 | ||
| Identification. | 363 | ||
| Treatment. | 363 | ||
| Bacillus cereus | 363 | ||
| Other Bacillus Species | 364 | ||
| Bibliography | 366 | ||
| 17 Neisseria Species and Moraxella catarrhalis | 367 | ||
| Chapter Outline | 367 | ||
| Objectives | 367 | ||
| Key Terms | 368 | ||
| General Characteristics | 368 | ||
| Pathogenic Neisseria Species | 369 | ||
| Virulence Factors | 369 | ||
| Neisseria gonorrhoeae | 369 | ||
| Epidemiology | 369 | ||
| Clinical Infections | 370 | ||
| Laboratory Diagnosis | 370 | ||
| Specimen Collection and Transport. | 370 | ||
| Direct Microscopic Examination. | 371 | ||
| Culture. | 371 | ||
| Incubation. | 372 | ||
| Presumptive Identification | 372 | ||
| Colony Morphology. | 372 | ||
| Microscopic Morphology. | 372 | ||
| Oxidase Test. | 372 | ||
| Definitive Identification. | 372 | ||
| Carbohydrate Utilization. | 372 | ||
| Chromogenic Substrates. | 373 | ||
| Multitest Methods. | 373 | ||
| Immunologic Assays. | 374 | ||
| Matrix-Assisted Laser Desorption/Ionization–Time-of-Flight Mass Spectrometry. | 374 | ||
| Nucleic Acid Amplification Tests. | 374 | ||
| Antimicrobial Resistance | 375 | ||
| Treatment | 375 | ||
| Neisseria meningitidis | 376 | ||
| Epidemiology | 376 | ||
| Clinical Infections | 376 | ||
| Laboratory Diagnosis | 377 | ||
| Specimen Collection and Transport. | 377 | ||
| Direct Microscopic Examination. | 377 | ||
| Culture and Incubation. | 377 | ||
| Identification. | 377 | ||
| Laboratory-Acquired Disease | 378 | ||
| Treatment | 378 | ||
| Vaccine | 378 | ||
| Moraxella catarrhalis | 378 | ||
| Clinical Infections | 378 | ||
| Laboratory Diagnosis | 378 | ||
| Specimen Collection and Identification. | 378 | ||
| Commensal Neisseria Species | 379 | ||
| Identification | 379 | ||
| Neisseria cinerea | 379 | ||
| Neisseria lactamica | 380 | ||
| Neisseria mucosa | 380 | ||
| Neisseria sicca | 381 | ||
| Neisseria subflava | 381 | ||
| Neisseria elongata | 381 | ||
| Neisseria weaveri | 382 | ||
| Bibliography | 383 | ||
| 18 Haemophilus, HACEK, Legionella, and Other Fastidious Gram-Negative Bacilli | 384 | ||
| A. Haemophilus, HACEK Group, and Similar Microorganisms | 384 | ||
| Chapter Outline | 384 | ||
| Objectives | 384 | ||
| Key Terms | 385 | ||
| Haemophilus | 385 | ||
| General Characteristics | 385 | ||
| Haemophilus influenzae | 386 | ||
| Historic Perspective | 386 | ||
| Virulence Factors | 386 | ||
| Capsule. | 386 | ||
| Immunoglobulin A Proteases. | 386 | ||
| Adherence Mechanisms. | 386 | ||
| Outer Membrane Components. | 386 | ||
| Clinical Manifestations of Haemophilus influenzae Infections | 386 | ||
| Meningitis. | 387 | ||
| Epiglottitis. | 387 | ||
| Bacterial Tracheitis. | 387 | ||
| Infections Associated with Other Haemophilus Species | 387 | ||
| Haemophilus aegyptius | 387 | ||
| Haemophilus influenzae biogroup aegyptius | 387 | ||
| Haemophilus ducreyi | 387 | ||
| Miscellaneous Species | 388 | ||
| Laboratory Diagnosis | 388 | ||
| Specimen Processing and Isolation | 388 | ||
| Colony Morphology | 388 | ||
| Microscopic Morphology | 389 | ||
| Laboratory Identification | 389 | ||
| X Factor and V Factor Requirements. | 389 | ||
| Porphyrin Test. | 390 | ||
| Biochemical Tests. | 390 | ||
| Treatment | 390 | ||
| HACEK Group | 392 | ||
| Aggregatibacter aphrophilus | 393 | ||
| Aggregatibacter actinomycetemcomitans | 393 | ||
| Cardiobacterium hominis | 394 | ||
| Eikenella corrodens | 395 | ||
| Kingella | 396 | ||
| Capnocytophaga | 396 | ||
| Pasteurella | 397 | ||
| Brucella | 397 | ||
| Francisella | 399 | ||
| Bibliography | 401 | ||
| B. Legionella and Bordetella | 401 | ||
| Chapter Outline | 401 | ||
| Objectives | 402 | ||
| Key Terms | 402 | ||
| Legionella | 402 | ||
| General Characteristics | 402 | ||
| Virulence Factors | 402 | ||
| Infections Caused by Legionella | 403 | ||
| Legionnaires’ Disease | 403 | ||
| Pontiac Fever | 403 | ||
| Epidemiology | 403 | ||
| Laboratory Diagnosis | 404 | ||
| Specimen Collection and Handling | 404 | ||
| Microscopic Examination | 404 | ||
| Isolation and Identification | 404 | ||
| Isolation Methods | 404 | ||
| Colony Morphology | 405 | ||
| Identification Methods | 406 | ||
| Conventional Methods. | 406 | ||
| Rapid Methods | 407 | ||
| Urine Antigen Test. | 407 | ||
| Serologic Testing | 407 | ||
| Antimicrobial Susceptibility | 407 | ||
| Bordetella | 407 | ||
| General Characteristics | 407 | ||
| Clinically Significant Species | 407 | ||
| Bordetella pertussis and Bordetella parapertussis | 407 | ||
| Virulence Factors. | 407 | ||
| Clinical Manifestations. | 408 | ||
| Epidemiology. | 408 | ||
| Miscellaneous Species | 408 | ||
| Laboratory Diagnosis | 408 | ||
| Specimen Collection and Handling | 408 | ||
| Nucleic Acid Detection | 408 | ||
| Isolation and Identification | 409 | ||
| Isolation Methods. | 409 | ||
| Colony Morphology. | 409 | ||
| Identification Methods. | 409 | ||
| Serologic Testing | 409 | ||
| Antimicrobial Susceptibility | 410 | ||
| Bibliography | 410 | ||
| 19 Enterobacteriaceae | 412 | ||
| Chapter Outline | 412 | ||
| Objectives | 412 | ||
| Key Terms | 413 | ||
| General Characteristics | 413 | ||
| Microscopic and Colony Morphology | 413 | ||
| Classification | 413 | ||
| Virulence and Antigenic Factors | 415 | ||
| Clinical Significance | 415 | ||
| Antimicrobial Resistance in the Enterobacteriaceae | 415 | ||
| Opportunistic Members of the Family Enterobacteriaceae and Associated Infections | 416 | ||
| Escherichia coli | 416 | ||
| Uropathogenic Escherichia coli | 416 | ||
| Gastrointestinal Pathogens | 417 | ||
| Enterotoxigenic Escherichia coli. | 417 | ||
| Enteropathogenic Escherichia coli. | 418 | ||
| Enteroinvasive Escherichia coli. | 418 | ||
| Enterohemorrhagic Escherichia coli. | 418 | ||
| Enteroadherent Escherichia coli. | 419 | ||
| Extraintestinal Infections | 420 | ||
| Other Escherichia Species | 420 | ||
| Klebsiella and Raoultella | 420 | ||
| Enterobacter, Cronobacter Raoultella, and Pantoea | 421 | ||
| Serratia | 422 | ||
| Hafnia | 423 | ||
| Proteus | 423 | ||
| Morganella | 424 | ||
| Providencia | 424 | ||
| Edwardsiella | 424 | ||
| Citrobacter | 425 | ||
| Plesiomonas | 425 | ||
| Primary Intestinal Pathogens of the Family Enterobacteriaceae | 426 | ||
| Salmonella | 426 | ||
| Classification | 426 | ||
| Virulence Factors | 426 | ||
| Antigenic Structures | 426 | ||
| Clinical Infections | 427 | ||
| Gastroenteritis. | 427 | ||
| Enteric Fevers. | 427 | ||
| Bacteremia. | 428 | ||
| Carrier State. | 428 | ||
| Shigella | 428 | ||
| Antigenic Structures | 429 | ||
| Clinical Infections | 429 | ||
| Yersinia | 430 | ||
| Yersinia pestis | 430 | ||
| Yersinia enterocolitica | 430 | ||
| Yersinia pseudotuberculosis | 431 | ||
| Other Genera of the Family Enterobacteriaceae | 431 | ||
| Budivicia | 431 | ||
| Buttiauxella | 431 | ||
| Cedecea | 431 | ||
| Ewingella | 431 | ||
| Kluyvera | 431 | ||
| Leclercia | 433 | ||
| Leminorella | 433 | ||
| Moellerella | 433 | ||
| Photorhabdus | 433 | ||
| Rahnella | 433 | ||
| Tatumella | 433 | ||
| Trabulsiella | 433 | ||
| Yokenella | 433 | ||
| Laboratory Diagnosis of Enterobacteriaceae | 433 | ||
| Specimen Collection and Transport | 433 | ||
| Isolation and Identification | 433 | ||
| Direct Microscopic Examination | 434 | ||
| Culture | 434 | ||
| Screening Stool Cultures for Pathogens | 434 | ||
| Identification | 435 | ||
| Plesiomonas shigelloides | 436 | ||
| Serologic Grouping | 436 | ||
| Salmonella | 436 | ||
| Shigella | 436 | ||
| Bibliography | 446 | ||
| 20 Vibrio, Aeromonas, and Campylobacter Species | 448 | ||
| Chapter Outline | 448 | ||
| Objectives | 448 | ||
| Key Terms | 449 | ||
| Vibrio | 449 | ||
| General Characteristics | 449 | ||
| Clinical Manifestations | 449 | ||
| Microscopic Morphology | 449 | ||
| Physiology | 449 | ||
| Antigenic Structure | 451 | ||
| Vibrio cholerae | 451 | ||
| Epidemiology | 451 | ||
| Clinical Manifestations | 451 | ||
| Vibrio parahaemolyticus | 452 | ||
| Epidemiology | 452 | ||
| Clinical Manifestations | 453 | ||
| Vibrio vulnificus | 453 | ||
| Vibrio alginolyticus | 453 | ||
| Laboratory Diagnosis | 453 | ||
| Specimen Collection and Transport | 453 | ||
| Culture Media | 453 | ||
| Presumptive Identification | 454 | ||
| Definitive Identification | 454 | ||
| Rapid and Semiautomated Identification Systems. | 454 | ||
| Molecular Typing. | 454 | ||
| Serology. | 454 | ||
| Antimicrobial Susceptibility | 454 | ||
| Aeromonas | 456 | ||
| General Characteristics | 456 | ||
| Clinical Manifestations | 456 | ||
| Intestinal Infections | 456 | ||
| Extraintestinal Infections | 457 | ||
| Laboratory Diagnosis | 457 | ||
| Culture Media | 457 | ||
| Presumptive Identification | 458 | ||
| Definitive Identification | 458 | ||
| Antimicrobial Susceptibility | 459 | ||
| Campylobacter and Campylobacter-Like Species | 459 | ||
| Epidemiology | 459 | ||
| Clinical Manifestations | 460 | ||
| Campylobacter | 460 | ||
| Helicobacter pylori | 460 | ||
| Laboratory Diagnosis | 461 | ||
| Specimen Collection and Transport | 461 | ||
| Culture Media | 461 | ||
| Incubation | 461 | ||
| Presumptive Identification | 461 | ||
| Microscopic Morphology. | 461 | ||
| Colony Morphology. | 462 | ||
| Definitive Identification | 462 | ||
| Immunologic Assays | 463 | ||
| Antimicrobial Susceptibility | 463 | ||
| Bibliography | 464 | ||
| 21 Nonfermenting and Miscellaneous Gram-Negative Bacilli | 465 | ||
| Chapter Outline | 465 | ||
| Objectives | 465 | ||
| Key Terms | 466 | ||
| General Characteristics of Nonfermenters | 466 | ||
| Clinical Infections | 466 | ||
| Biochemical Characteristics and Identification | 466 | ||
| Clinically Significant Nonfermentative, Gram-Negative Bacilli | 469 | ||
| Pseudomonas Fluorescent Group | 472 | ||
| Pseudomonas aeruginosa | 472 | ||
| Virulence Factors. | 472 | ||
| Identifying Characteristics. | 472 | ||
| Treatment. | 473 | ||
| Pseudomonas fluorescens and Pseudomonas putida | 473 | ||
| Pseudomonas Nonfluorescent Group | 474 | ||
| Pseudomonas stutzeri | 474 | ||
| Pseudomonas mendocina | 474 | ||
| Pseudomonas pseudoalcaligenes and Pseudomonas alcaligenes | 475 | ||
| Pseudomonas luteola and Pseudomonas oryzihabitans | 475 | ||
| Acinetobacter | 475 | ||
| Clinical Infections | 475 | ||
| III Laboratory Diagnosis of Infectious Diseases: an Organ System Approach to Diagnostic Microbiology | 756 | ||
| 32 Upper and Lower Respiratory Tract Infections | 757 | ||
| Chapter Outline | 757 | ||
| Objectives | 757 | ||
| Key Terms | 758 | ||
| General Concepts of Infectious Diseases of The Respiratory Tract | 758 | ||
| Anatomy of the Respiratory Tract | 758 | ||
| Barriers to Infection | 758 | ||
| The Role of Normal Biota | 758 | ||
| Distinguishing among Normal Biota, Colonizing, and Pathogenic Microorganisms | 759 | ||
| Host Risk Factors | 760 | ||
| Immune Status of the Host | 760 | ||
| Age as a Risk Factor | 760 | ||
| Reduced Clearance of Secretions | 761 | ||
| Infection-Induced Airway Obstruction | 761 | ||
| Seasonal and Community Trends in Infections | 761 | ||
| Empiric Antimicrobial Therapy | 761 | ||
| Virulence Factors of Pathogenic Organisms | 761 | ||
| Adherence | 761 | ||
| Toxin Elaboration | 762 | ||
| Evasion of Host Defenses | 762 | ||
| Upper Respiratory Tract Infections | 762 | ||
| Pharyngitis | 762 | ||
| Epidemiology | 762 | ||
| Causes | 762 | ||
| Pathogenesis | 762 | ||
| Clinical Manifestations | 763 | ||
| Complications | 763 | ||
| Laboratory Diagnosis | 764 | ||
| Treatment | 764 | ||
| Sinusitis | 765 | ||
| Epidemiology | 765 | ||
| Causes | 765 | ||
| Pathogenesis | 765 | ||
| Clinical Manifestations | 765 | ||
| Complications | 766 | ||
| Laboratory Diagnosis | 766 | ||
| Treatment | 766 | ||
| Otitis Media | 767 | ||
| Epidemiology | 767 | ||
| Causes | 767 | ||
| Pathogenesis | 767 | ||
| Clinical Manifestations | 767 | ||
| Complications | 767 | ||
| Laboratory Diagnosis | 767 | ||
| Treatment | 768 | ||
| Epiglottitis | 768 | ||
| Epidemiology | 768 | ||
| Causes | 768 | ||
| Pathogenesis | 768 | ||
| Clinical Manifestations | 768 | ||
| Complications | 769 | ||
| Laboratory Diagnosis | 769 | ||
| Treatment | 769 | ||
| Pertussis | 769 | ||
| Epidemiology | 769 | ||
| Causes | 769 | ||
| Pathogenesis | 769 | ||
| Clinical Manifestations | 770 | ||
| Complications | 770 | ||
| Laboratory Diagnosis | 770 | ||
| Treatment | 770 | ||
| Lower Respiratory Tract Infections | 770 | ||
| Bronchitis and Bronchiolitis | 771 | ||
| Epidemiology | 771 | ||
| Causes | 772 | ||
| Pathogenesis | 772 | ||
| Clinical Manifestations | 773 | ||
| Complications | 773 | ||
| Laboratory Diagnosis | 773 | ||
| Treatment | 773 | ||
| Influenza | 774 | ||
| Epidemiology | 774 | ||
| Causes | 774 | ||
| Pathogenesis | 774 | ||
| Clinical Manifestations | 774 | ||
| Complications | 774 | ||
| Diagnosis | 774 | ||
| Treatment | 774 | ||
| Emerging Viral Respiratory Tract Infections | 774 | ||
| Avian Influenzas: H5N1 and H7N9 | 774 | ||
| Pandemic H1N1 Influenza A | 775 | ||
| Severe Acute Respiratory Syndrome and Middle East Respiratory Syndrome | 775 | ||
| Adenovirus Infections: Reemergence in Military and Civilian Populations | 775 | ||
| Acute Pneumonia | 776 | ||
| Community-Acquired Pneumonia | 776 | ||
| Epidemiology. | 776 | ||
| Causes. | 776 | ||
| Pathogenesis. | 777 | ||
| Clinical Manifestations. | 777 | ||
| Complications. | 777 | ||
| Laboratory Diagnosis. | 777 | ||
| Treatment. | 779 | ||
| Hospital-Acquired and Ventilator-Associated Pneumonias | 780 | ||
| Epidemiology. | 780 | ||
| Causes. | 780 | ||
| Pathogenesis. | 780 | ||
| Clinical Manifestations. | 780 | ||
| Complications. | 780 | ||
| Laboratory Diagnosis. | 781 | ||
| Treatment. | 781 | ||
| Empyema | 782 | ||
| Epidemiology | 782 | ||
| Causes | 782 | ||
| Pathogenesis | 782 | ||
| Clinical Manifestations | 782 | ||
| Complications | 782 | ||
| Laboratory Diagnosis | 783 | ||
| Treatment | 783 | ||
| Tuberculosis and Other Chronic Pneumonias | 783 | ||
| Epidemiology and Causes | 783 | ||
| Pathogenesis | 784 | ||
| Clinical Manifestations | 784 | ||
| Complications | 784 | ||
| Laboratory Diagnosis | 784 | ||
| Treatment | 786 | ||
| Aspiration Pneumonia | 786 | ||
| Epidemiology. | 786 | ||
| Causes. | 786 | ||
| Pathogenesis. | 786 | ||
| Clinical Manifestations. | 787 | ||
| Complications. | 787 | ||
| Diagnosis. | 787 | ||
| Treatment. | 787 | ||
| Respiratory Tract Infections in the Immunocompromised Host | 787 | ||
| Patients with Human Immunodeficiency Virus | 787 | ||
| Epidemiology | 788 | ||
| Clinical Manifestations | 788 | ||
| Laboratory Diagnosis | 789 | ||
| Treatment | 789 | ||
| Patients with Other Immunocompromised States | 790 | ||
| Epidemiology and Causes | 790 | ||
| Clinical Manifestations | 791 | ||
| Laboratory Diagnosis | 791 | ||
| Treatment | 791 | ||
| Bioterrorism and Respiratory Infections | 792 | ||
| References | 793 | ||
| 33 Skin and Soft Tissue Infections | 795 | ||
| Chapter Outline | 795 | ||
| Objectives | 795 | ||
| Key Terms | 796 | ||
| Anatomy of the Skin | 796 | ||
| Skin Biota | 796 | ||
| Localized Bacterial and Fungal Skin Infections | 796 | ||
| Dermatitis | 798 | ||
| Intertrigo and Superficial Candidiasis | 798 | ||
| Erythrasma | 799 | ||
| Dermatophytoses | 799 | ||
| Pyoderma | 800 | ||
| Impetigo | 800 | ||
| Erysipelas | 801 | ||
| Erysipeloid | 801 | ||
| Anthrax | 801 | ||
| Cellulitis | 802 | ||
| Recurrent Cellulitis. | 802 | ||
| Methicillin-Resistant Staphylococcus aureus Infections | 802 | ||
| Paronychia. | 802 | ||
| Folliculitis. | 802 | ||
| Furuncles and Carbuncles. | 802 | ||
| Hidradenitis Suppurativa. | 803 | ||
| Other Soft Tissue Infections | 803 | ||
| Bite Infections | 803 | ||
| Diabetic Foot Infections | 803 | ||
| Necrotizing Soft Tissue Infection | 804 | ||
| Mycetoma | 804 | ||
| Chromoblastomycosis | 805 | ||
| Other Uncommon Fungi | 806 | ||
| Nodular Lymphangitis | 807 | ||
| Sporotrichosis | 807 | ||
| Nocardiosis | 807 | ||
| Mycobacterial Infection | 808 | ||
| Nontuberculous Mycobacteria. | 808 | ||
| Mycobacterium Tuberculosis. | 808 | ||
| Actinomycosis | 808 | ||
| Dermatologic Manifestations of Systemic Bacterial and Fungal Infections | 808 | ||
| Bacteria | 809 | ||
| Pseudomonas Infection | 809 | ||
| Vibrio and Aeromonas Infections | 809 | ||
| Borreliosis | 809 | ||
| Treponema Infection | 810 | ||
| Zoonoses | 810 | ||
| Rickettsiosis. | 810 | ||
| Leptospirosis. | 811 | ||
| Bartonellosis. | 811 | ||
| Rat Bite Fever. | 811 | ||
| Tularemia. | 811 | ||
| Mycobacteria | 812 | ||
| Nontuberculous Mycobacteria and Tuberculosis. | 812 | ||
| Leprosy. | 812 | ||
| Fungi | 813 | ||
| Candidiasis | 813 | ||
| Systemic Dimorphic Fungi and Molds | 813 | ||
| Viral Infections | 814 | ||
| Rubeola | 814 | ||
| Rubella | 814 | ||
| Parvovirus B19 Infection | 814 | ||
| Enteroviral Infections | 815 | ||
| Herpesviridae | 815 | ||
| Varicella-Zoster Viral Infections | 815 | ||
| Herpes Simplex Viral Infection | 815 | ||
| Other Herpesviruses | 816 | ||
| Molluscum Contagiosum | 817 | ||
| Orf and Milker’s Nodule | 817 | ||
| Human Papillomavirus | 817 | ||
| Alphaviruses | 818 | ||
| Hemorrhagic Fever Viruses | 818 | ||
| Parasitic Infections | 819 | ||
| Helminths | 819 | ||
| Schistosomiasis | 819 | ||
| Strongyloides Infection | 819 | ||
| Filariasis | 819 | ||
| Hookworm Infection | 820 | ||
| Leishmaniasis | 820 | ||
| Ectoparasites | 821 | ||
| Immune- or Toxin-Mediated Dermatologic Manifestations of Infectious Agents | 821 | ||
| Immune-Mediated Cutaneous Disease | 821 | ||
| Disseminated Intravascular Coagulation | 821 | ||
| Vasculitis | 822 | ||
| Toxin-Mediated Cutaneous Disease | 822 | ||
| Staphylococcal Scalded Skin Syndrome | 823 | ||
| Toxic Shock Syndrome | 823 | ||
| Scarlet Fever | 823 | ||
| Laboratory Diagnosis | 823 | ||
| Bibliography | 825 | ||
| 34 Gastrointestinal Infections and Food Poisoning | 829 | ||
| Chapter Outline | 829 | ||
| Objectives | 829 | ||
| Key Terms | 830 | ||
| Evaluating Gastrointestinal Infections and Food Poisoning | 830 | ||
| Anatomic Considerations | 830 | ||
| Approach to Diagnosis of the Patient with Diarrhea | 831 | ||
| History | 831 | ||
| Physical Examination | 832 | ||
| Laboratory Studies | 833 | ||
| Clinical Presentation and Pathogenic Mechanisms of Acute Diarrhea | 833 | ||
| Enterotoxin-Mediated Diarrhea | 833 | ||
| Diarrhea Mediated by Invasion of the Bowel Mucosal Surface | 834 | ||
| Diarrhea Mediated by Invasion of Full-Bowel Thickness with Lymphatic Spread | 834 | ||
| Common Viral, Bacterial, and Parasitic Pathogens | 834 | ||
| Viral Pathogens | 835 | ||
| Rotaviruses | 835 | ||
| Enteric Adenoviruses | 835 | ||
| Caliciviruses | 835 | ||
| Astroviruses | 835 | ||
| Bacterial Pathogens | 835 | ||
| Campylobacter jejuni | 835 | ||
| Salmonella Species | 836 | ||
| Gastroenteritis and Food Poisoning. | 836 | ||
| Enteric Fever. | 836 | ||
| Shigella Species | 836 | ||
| Escherichia coli | 836 | ||
| Enterotoxigenic Escherichia coli. | 836 | ||
| Enteroinvasive Escherichia coli. | 836 | ||
| Enterohemorrhagic Escherichia coli. | 836 | ||
| Enteropathogenic Escherichia coli. | 837 | ||
| Enteroaggregative Escherichia coli. | 837 | ||
| Diffusely-adherent Escherichia coli. | 837 | ||
| Vibrio Species | 837 | ||
| Yersinia enterocolitica | 837 | ||
| Clostridioides (Clostridium) difficile. | 838 | ||
| Listeria monocytogenes | 838 | ||
| Helicobacter Species | 838 | ||
| Other Bacterial Pathogens | 838 | ||
| Parasitic Pathogens | 838 | ||
| Giardia lamblia | 838 | ||
| Entamoeba histolytica | 839 | ||
| Cryptosporidium parvum and Cryptosporidium hominis | 839 | ||
| Cyclospora cayetanensis and Cystoisospora belli | 840 | ||
| Microsporidia | 840 | ||
| Other Parasitic Infections | 840 | ||
| Diarrhea in Special Circumstances | 840 | ||
| Toxic Agents of Food Poisoning | 840 | ||
| Returning Travelers | 840 | ||
| Immunocompromised Hosts | 842 | ||
| Laboratory Diagnosis of Gastrointestinal Pathogens | 843 | ||
| Specimen Collection and Handling | 843 | ||
| Direct Microscopic Examination | 843 | ||
| Culture | 843 | ||
| Campylobacter jejuni | 843 | ||
| Salmonella | 843 | ||
| Shigella Species | 843 | ||
| Escherichia coli | 845 | ||
| Yersinia Species | 845 | ||
| Vibrio Species | 845 | ||
| Clostridioides difficile | 845 | ||
| Treatment and Prevention of Diarrhea | 845 | ||
| Bibliography | 846 | ||
| 35 Infections of the Central Nervous System | 848 | ||
| Chapter Outline | 848 | ||
| Objectives | 848 | ||
| Key Terms | 848 | ||
| General Concepts Related to Infections of the Central Nervous System | 849 | ||
| Anatomic Organization | 849 | ||
| Cerebrospinal Fluid Characteristics | 850 | ||
| Host-Pathogen Relationships | 850 | ||
| Central Nervous System Infections | 850 | ||
| Meningitis | 850 | ||
| Bacterial Meningitis | 850 | ||
| Pathogenesis. | 850 | ||
| Other Bacteria. | 851 | ||
| Shunt Infections. | 852 | ||
| Viral Infections | 852 | ||
| Enteroviruses. | 853 | ||
| Arboviruses. | 853 | ||
| Mumps Virus. | 853 | ||
| Lymphocytic Choriomeningitis Virus. | 853 | ||
| Herpesvirus. | 853 | ||
| Human Immunodeficiency Virus. | 853 | ||
| Mycobacterial Infections | 854 | ||
| Spirochetal Infections | 854 | ||
| Fungal Infections | 854 | ||
| Parasitic Infections | 855 | ||
| Protozoa. | 855 | ||
| Helminths. | 856 | ||
| Meningoencephalitis and Encephalitis | 856 | ||
| Brain Abscesses | 857 | ||
| Bacterial Pathogens | 857 | ||
| Fungal Pathogens | 857 | ||
| Laboratory Diagnosis | 858 | ||
| Cerebrospinal Fluid Transport and Analysis | 858 | ||
| Culture | 858 | ||
| Molecular Diagnostics | 858 | ||
| Bacterial Infections | 859 | ||
| Viral Infections | 859 | ||
| Mycobacterial Infections | 860 | ||
| Spirochetal Infections | 860 | ||
| Fungal Infections | 860 | ||
| Parasitic Infections | 860 | ||
| Bibliography | 861 | ||
| 36 Bacteremia and Sepsis | 862 | ||
| Chapter Outline | 862 | ||
| Objectives | 862 | ||
| Key Terms | 863 | ||
| General Concepts Related to Bacteremic Infections | 863 | ||
| Definitions | 863 | ||
| Classification of Bacteremia | 863 | ||
| Site of Origin | 863 | ||
| Causative Agent | 864 | ||
| Place of Acquisition | 864 | ||
| Duration | 864 | ||
| Epidemiology | 864 | ||
| Incidence and Mortality | 864 | ||
| Risk Factors | 864 | ||
| Decreased Immune Competency of Selected Patient Populations | 865 | ||
| Increased Use of Invasive Procedures | 865 | ||
| Age of the Patient | 865 | ||
| Antimicrobial Resistance | 865 | ||
| Diagnostic Criteria and Coding Practices | 865 | ||
| Causes | 865 | ||
| Pathogenesis | 866 | ||
| Clinical Aspects of Bacteremia | 867 | ||
| Syndromes Associated with Bacteremia | 867 | ||
| Catheter-Related Bloodstream Infections | 867 | ||
| Urinary Tract Infections | 867 | ||
| Pneumonias | 867 | ||
| Intraabdominal Infections | 867 | ||
| Skin Infections | 867 | ||
| Infective Endocarditis | 868 | ||
| Musculoskeletal Infections | 868 | ||
| Central Nervous System Infections | 868 | ||
| Signs and Symptoms | 868 | ||
| Laboratory Diagnosis | 868 | ||
| Specimen Collection | 868 | ||
| Determining the Volume, Frequency, and Number of Blood Cultures | 869 | ||
| Density of Bacteremia in Adults Versus Neonates. | 869 | ||
| Frequency of Bacteremic Episodes Versus Time and Frequency of Collection. | 870 | ||
| Rationale for Multiple Blood Collections. | 870 | ||
| Blood Culture Methods | 871 | ||
| Culture Media Used in Conventional Broth Systems | 871 | ||
| Neutralization of Inhibitors. | 871 | ||
| Anticoagulants and Other Additives. | 871 | ||
| Incubation Conditions. | 871 | ||
| Blood Culture Systems | 871 | ||
| Manual Systems | 871 | ||
| Examination of Blood Culture Bottles in a Manual System | 872 | ||
| Continuous-Monitoring Blood Culture Systems | 872 | ||
| BACTEC 9000 Series and BD FX. | 872 | ||
| VersaTREK. | 872 | ||
| BacT/ALERT 3D System. | 872 | ||
| Recovery of Other Types of Organisms from Blood | 872 | ||
| Francisella tularensis. | 873 | ||
| Leptospira spp. | 873 | ||
| Brucella spp. | 873 | ||
| Nutritionally Variant Streptococci. | 873 | ||
| Campylobacter spp. | 873 | ||
| Coxiella burnetii. | 873 | ||
| Bartonella spp. | 874 | ||
| HACEK Group of Gram-Negative Bacilli. | 874 | ||
| Mycobacteria from Blood. | 874 | ||
| Fungemia. | 874 | ||
| Viremia. | 874 | ||
| Contamination in Blood Cultures | 874 | ||
| Rapid Identification of Microorganisms Growing in Blood Cultures | 874 | ||
| Direct Tube Coagulase Test. | 874 | ||
| Other Rapid Diagnostic Tests. | 875 | ||
| Fluorescence In Situ Hybridization. | 875 | ||
| Nucleic Acid Amplification Methods. | 875 | ||
| Matrix-Assisted Laser Desorption/Ionization–Time-of-Flight (MALDI TOF). | 875 | ||
| Biomarkers | 875 | ||
| Treatment | 876 | ||
| Antimicrobial Therapy | 876 | ||
| Antisepsis Therapy | 877 | ||
| Physiologic Support | 877 | ||
| Anticoagulation Agents | 877 | ||
| Glucocorticoids | 877 | ||
| Anticytokine Therapies | 877 | ||
| Prevention | 877 | ||
| Bibliography | 878 | ||
| 37 Urinary Tract Infections | 880 | ||
| Chapter Outline | 880 | ||
| Objectives | 880 | ||
| Key Terms | 880 | ||
| Introduction | 881 | ||
| The Urinary System | 882 | ||
| Epidemiology and Risk Factors | 882 | ||
| Age | 882 | ||
| Children | 882 | ||
| Adults to Age 65 Years | 883 | ||
| Geriatric Population | 883 | ||
| Institutionalized Care | 884 | ||
| Pregnancy | 884 | ||
| Renal Transplantation | 884 | ||
| Bladder Catheterization | 884 | ||
| Clinical Signs and Symptoms | 884 | ||
| Causes of Urinary Tract Infections | 885 | ||
| Pathogenesis | 885 | ||
| Causative Agents | 886 | ||
| Gram-Negative Bacilli | 886 | ||
| Gram-Positive Cocci | 886 | ||
| Gram-Positive Bacilli | 887 | ||
| Fungi | 887 | ||
| Other Agents of Urinary Tract Infections | 887 | ||
| Laboratory Diagnosis | 888 | ||
| Significance of Colony Counts: Historical Background | 888 | ||
| Specimen Collection | 889 | ||
| Voided Midstream Specimen Collection | 889 | ||
| Catheterized Specimen Collection | 889 | ||
| Suprapubic Aspiration | 889 | ||
| Other Considerations | 889 | ||
| Urine Volume. | 889 | ||
| Number of Specimens and Timing of Collection. | 890 | ||
| Additives | 890 | ||
| Specimen Transport | 890 | ||
| Microbial Detection | 890 | ||
| Specimen Screening: Rapid Nonculture Methods | 890 | ||
| Manual Urine Screening Methods | 891 | ||
| Microscopy | 891 | ||
| Detection of Bacteria When Pyelonephritis Is Suspected. | 891 | ||
| Detection of Pyuria. | 891 | ||
| Detection of Fungi and Mycobacteria. | 891 | ||
| Chemical Methods. | 891 | ||
| Automated Urine Screening Methods | 892 | ||
| Rejection Criteria | 892 | ||
| Culture for Causative Agents of Urinary Tract Infections | 892 | ||
| Asymptomatic Bacteriuria | 893 | ||
| Pyelonephritis | 893 | ||
| Lower Urinary Tract Infections | 893 | ||
| Suprapubic Aspirates | 893 | ||
| Catheterized Specimens | 893 | ||
| Prostatic Secretions | 893 | ||
| Interpretation of Results | 893 | ||
| Susceptibility Reporting | 894 | ||
| Urinary Tract Infection Antibiograms | 895 | ||
| Bibliography | 896 | ||
| 38 Genital Infections and Sexually Transmitted Infections | 897 | ||
| Chapter Outline | 897 | ||
| Objectives | 897 | ||
| Key Terms | 898 | ||
| Urethritis | 899 | ||
| Causes | 899 | ||
| Epidemiology | 900 | ||
| Clinical Manifestations | 900 | ||
| Laboratory Diagnosis | 901 | ||
| Treatment | 902 | ||
| Cervicitis | 902 | ||
| Causes | 902 | ||
| Epidemiology | 902 | ||
| Clinical Manifestations | 903 | ||
| Laboratory Diagnosis | 903 | ||
| Treatment | 904 | ||
| Vulvovaginitis | 904 | ||
| Causes | 904 | ||
| Bacterial Vaginosis | 904 | ||
| Epidemiology | 904 | ||
| Clinical Manifestations | 904 | ||
| Laboratory Diagnosis | 904 | ||
| Treatment | 905 | ||
| Trichomoniasis | 905 | ||
| Epidemiology | 905 | ||
| Clinical Manifestations | 905 | ||
| Laboratory Diagnosis | 906 | ||
| Appendix A Selected Bacteriologic Culture Media | 974 | ||
| Acetate Agar | 974 | ||
| Alkaline Peptone Water | 974 | ||
| American Trudeau Society Medium | 974 | ||
| Bacteroides Bile Esculin Agar | 974 | ||
| Bile Esculin Agar | 974 | ||
| Bismuth Sulfite Agar | 975 | ||
| Blood Agar, Anaerobic, Brucella Base, Wadsworth | 975 | ||
| Blood Agar, Anaerobic, CDC | 975 | ||
| Blood Agar, Anaerobic, Laked, With Kanamycin, Vancomycin, and Vitamin K | 975 | ||
| Blood Agar, Anaerobic, With Kanamycin and Vancomycin | 975 | ||
| Blood Agar, Rabbit | 975 | ||
| Blood Agar, Sheep | 975 | ||
| Blood Phenylethyl Alcohol Agar, Anaerobic, CDC | 975 | ||
| Bordet-Gengou Blood Agar | 976 | ||
| Brain-Heart Infusion Broth | 976 | ||
| Buffered Charcoal Yeast Extract Agar | 976 | ||
| Burkholderia cepacia Agar | 976 | ||
| Burkholderia cepacia Selective Agar | 976 | ||
| Campylobacter Blood Agar (Campy-BA) | 977 | ||
| Campylobacter Charcoal Differential Agar | 977 | ||
| Campylobacter Thioglycolate Broth | 977 | ||
| Cefsulodin-Irgasan-Novobiocin | 977 | ||
| Cetrimide Agar | 977 | ||
| Chocolate Agar | 977 | ||
| CHROMagars | 977 | ||
| Citrate Agar, Simmons | 977 | ||
| Columbia Agar With and Without 5% Sheep Blood | 978 | ||
| Cooked Meat (Chopped Meat Glucose) Medium | 978 | ||
| Cycloserine Cefoxitin Fructose Agar | 978 | ||
| Cystine Tryptic Agar With Sugar | 978 | ||
| Decarboxylase Test Medium (Moeller) | 978 | ||
| Deoxyribonuclease (DNase) Test Agar | 979 | ||
| Dilute Gelatin Medium (0.4%) | 979 | ||
| Egg Yolk Agar, CDC Formulation | 979 | ||
| Eosin–Methylene Blue Agar | 979 | ||
| Esculin Agar | 979 | ||
| Fletcher Semisolid Medium for Leptospira | 979 | ||
| Gelatin Medium (Nutrient) | 980 | ||
| Gram-Negative Broth | 980 | ||
| Haemophilus Test Medium | 980 | ||
| Hektoen Enteric Agar | 980 | ||
| Hippurate Broth | 980 | ||
| Hydrogen Sulfide, Lead Acetate | 980 | ||
| Kligler Iron Agar | 980 | ||
| Lim Broth | 981 | ||
| Loeffler Coagulated Serum Slant | 981 | ||
| Löwenstein-Jensen Medium | 981 | ||
| Lysine Iron Agar | 982 | ||
| MacConkey Agar | 982 | ||
| MacConkey Sorbitol Agar | 982 | ||
| Malonate Broth | 982 | ||
| Mannitol Salt Agar | 983 | ||
| Methyl Red Voges-Proskauer Medium | 983 | ||
| Middlebrook 7H10 and 7H11 Agars | 983 | ||
| Mitchison 7H11 Selective Agar | 983 | ||
| Modified Thayer-Martin Agar | 983 | ||
| Motility Test Medium | 984 | ||
| Mueller-Hinton Agar | 984 | ||
| Mueller-Hinton Agar With 2% NaCl | 984 | ||
| Mueller-Hinton Agar With 4% NaCl and 6 µg Oxacillin | 984 | ||
| New York City Medium | 984 | ||
| Nitrate Reduction Broth | 985 | ||
| Nutrient Agar | 985 | ||
| Oxidative-Fermentative Medium (Hugh and Leifson Formulation) | 985 | ||
| Oxidative-Fermentative Polymyxin B–Bacitracin-Lactose Agar | 985 | ||
| Peptone–Yeast Extract–Glucose Broth | 985 | ||
| Phenylalanine Deaminase Agar | 985 | ||
| Phenylethyl Alcohol Agar | 986 | ||
| Potassium Tellurite Blood Agar | 986 | ||
| PPLO Agar | 986 | ||
| Regan-Lowe Medium | 986 | ||
| Salmonella-Shigella Agar | 986 | ||
| Schaedler Agar | 987 | ||
| Selenite Broth | 987 | ||
| Sodium Chloride Broth, 6.5% | 987 | ||
| SP-4 Broth and SP-4 Agar | 987 | ||
| Streptococcus-Selective Agar | 987 | ||
| Tetrathionate Broth | 987 | ||
| Thioglycollate Broth, Basal and Enriched | 988 | ||
| Thiosulfate Citrate Bile Salts Sucrose Agar | 988 | ||
| Tinsdale Agar | 988 | ||
| Todd-Hewitt Broth With Gentamicin and Nalidixic Acid | 988 | ||
| Triple Sugar Iron Agar | 989 | ||
| Trypticase Soy Agar | 989 | ||
| Trypticase Soy Broth | 989 | ||
| Tryptophan Broth, 1% | 989 | ||
| Urea Agar and Broth | 989 | ||
| Vaginalis Agar | 990 | ||
| Xylose-Lysine-Desoxycholate Agar | 990 | ||
| Bibliography | 990 | ||
| Appendix B Selected Mycology Media, Fluids, and Stains | 991 | ||
| Fungal Media | 991 | ||
| Antifungal Susceptibility Testing Media | 991 | ||
| Assimilation Base for Carbohydrates | 991 | ||
| Birdseed Agar | 991 | ||
| Brain-Heart Infusion Agar | 991 | ||
| Canavanine-Glycine–Bromothymol Blue Agar | 991 | ||
| Chromogenic Agar for Candida | 991 | ||
| Cornmeal Agar | 992 | ||
| Dermatophyte Test Medium | 992 | ||
| Inhibitory Mold Agar | 992 | ||
| Littman Oxgall Agar | 992 | ||
| Modified Potassium Nitrate Assimilation Medium | 992 | ||
| Mycosel/Mycobiotic Agar | 992 | ||
| Potato Dextrose Agar | 992 | ||
| Potato Flake Agar | 992 | ||
| Rice Extract Agar | 992 | ||
| Rice Grains Medium | 992 | ||
| Sabouraud-Brain-Heart Infusion Agar | 992 | ||
| Sabouraud Dextrose Agar or Broth (Emmons Modification) | 993 | ||
| Trichophyton Agars 1–7 | 993 | ||
| Fungal Mounting Fluid | 993 | ||
| KOH-Glycerin | 993 | ||
| Fungal Stains | 993 | ||
| Calcofluor White Stain | 993 | ||
| India Ink | 993 | ||
| Lactophenol Cotton Blue | 993 | ||
| Bibliography | 993 | ||
| Appendix C Selected Procedures | 994 | ||
| Appendix D Answers to Learning Assessment Questions | 1003 | ||
| Chapter 1 | 1003 | ||
| Chapter 2 | 1003 | ||
| Chapter 3 | 1004 | ||
| Chapter 4 | 1004 | ||
| Chapter 5 | 1005 | ||
| Chapter 6 | 1005 | ||
| Chapter 7 | 1006 | ||
| Chapter 8 | 1006 | ||
| Chapter 9 | 1006 | ||
| Chapter 10 | 1006 | ||
| Chapter 11 | 1007 | ||
| Chapter 12 | 1007 | ||
| Chapter 13 | 1007 | ||
| Chapter 14 | 1008 | ||
| Chapter 15 | 1008 | ||
| Chapter 16 | 1009 | ||
| Chapter 17 | 1009 | ||
| Chapter 18 | 1009 | ||
| Section A | 1009 | ||
| Section B | 1009 | ||
| Chapter 19 | 1010 | ||
| Chapter 20 | 1010 | ||
| Chapter 21 | 1010 | ||
| Chapter 22 | 1011 | ||
| Chapter 23 | 1011 | ||
| Chapter 24 | 1011 | ||
| Chapter 25 | 1012 | ||
| Chapter 26 | 1012 | ||
| Chapter 27 | 1013 | ||
| Chapter 28 | 1014 | ||
| Chapter 29 | 1015 | ||
| Chapter 30 | 1015 | ||
| Chapter 31 | 1017 | ||
| Chapter 32 | 1018 | ||
| Chapter 33 | 1018 | ||
| Chapter 34 | 1019 | ||
| Chapter 35 | 1020 | ||
| Chapter 36 | 1020 | ||
| Chapter 37 | 1021 | ||
| Chapter 38 | 1021 | ||
| Chapter 39 | 1022 | ||
| Chapter 40 | 1023 | ||
| Chapter 41 | 1023 | ||
| Glossary | 1024 | ||
| A | 1024 | ||
| B | 1025 | ||
| C | 1026 | ||
| D | 1028 | ||
| E | 1029 | ||
| F | 1031 | ||
| G | 1031 | ||
| H | 1032 | ||
| I | 1032 | ||
| J | 1033 | ||
| K | 1033 | ||
| L | 1034 | ||
| M | 1034 | ||
| N | 1036 | ||
| O | 1036 | ||
| P | 1037 | ||
| Q | 1039 | ||
| R | 1039 | ||
| S | 1040 | ||
| T | 1042 | ||
| U | 1043 | ||
| V | 1043 | ||
| W | 1043 | ||
| X | 1044 | ||
| Y | 1044 | ||
| Z | 1044 | ||
| Index | 1045 | ||
| A | 1045 | ||
| B | 1047 | ||
| C | 1049 | ||
| D | 1052 | ||
| E | 1053 | ||
| F | 1054 | ||
| G | 1055 | ||
| H | 1056 | ||
| I | 1057 | ||
| J | 1058 | ||
| K | 1058 | ||
| L | 1058 | ||
| M | 1059 | ||
| N | 1061 | ||
| O | 1062 | ||
| P | 1063 | ||
| Q | 1065 | ||
| R | 1065 | ||
| S | 1066 | ||
| T | 1069 | ||
| U | 1071 | ||
| V | 1071 | ||
| W | 1072 | ||
| X | 1072 | ||
| Y | 1072 | ||
| Z | 1072 |