I Basic Principles General Aspects of Medical 1 Microbiology Basic Principles of Immunology 2 II Bacteriology General Bacteriology 3 Bacteria as Human Pathogens 4 III Mycology General Mycology 5 Fungi as Human Pathogens 6 IV Virology General Virology 7 Viruses as Human Pathogens 8 V Parasitology Protozoa 9 Helminths 10 Arthropods 11 VI Organ System Etiological and Laboratory 12 Infections Diagnostic Summaries in Tabular Form http://www.bestmedbook.com/ II At a Glance… Thebookisdividedintosixmainsections.Thecolor-codedreferenceguide onthefirstpagewillhelpyoufindwhatyouneed. Theaspectsofeachpathogenarecoveredsystematically,usingthefollowing orderwhereverpracticable: & Classification & PathogenesisandClinicalPicture & Localization & Diagnosis & MorphologyandCulturing & Therapy & DevelopmentalCycle & EpidemiologyandProphylaxis & Asummaryatthebeginningofachapterorsectionprovidesaquickover- viewofwhatthemaintextcovers.Studentscanusethesummariestoobtain aquickrecapitulationofthemainpoints. & TheMainSectionsataGlance a The many colored illustrations serve to clarify complex topics or provide definitive impressions of pathogenmorphology. bTheheadercaptionaboveeach illustrationgivesthereaderthees- senceofwhatisshown. cThedetailedlegendsexplainthe illustrations independently of the maintext. Additionalinformation In-depth expositions and supplementary knowledge are framed in boxes inter- spersedthroughoutthemainbodyoftext.Theheadingsoutlinethetopiccovered, enablingthereadertodecidewhetherthespecificmaterialisneededatthepresent time. Medical Microbiology Fritz H. Kayser, M.D. EmeritusProfessorofMedicalMicrobiology InstituteofMedicalMicrobiology UniversityofZurich Zurich,Switzerland Kurt A. Bienz, Ph.D. EmeritusProfessorofVirology InstituteofMedicalMicrobiology UniversityofBasle Basle,Switzerland Johannes Eckert, D.V.M. EmeritusProfessorofParasitology InstituteofParasitology UniversityofZurich Zurich,Switzerland Rolf M. Zinkernagel, M.D. Professor InstituteofExperimentalImmunology DepartmentofPathology Zurich,Switzerland 177illustrations 97tables Thieme Stuttgart New York ! LibraryofCongressCataloging-in- Importantnote:Medicineisanever-chan- PublicationData gingscienceundergoingcontinualdevelop- MedizinischeMikrobiologie.English. ment. Research and clinical experience are Medicalmicrobiology/FritzH.Kayser... continually expanding our knowledge, in [etal.]. p.;cm. particular our knowledge of proper treat- ISBN3-13-131991-7(GTV:alk.paper)– ment and drug therapy. Insofar as this ISBN1-58890-245-5(TNY;alk.paper) book mentions any dosage or application, 1.Medicalmicrobiology. readers may rest assured that the authors, [DNLM: 1. Microbiology. QW 4 M491 editors, and publishers have made every 2005a]I.Kayser,F.H.(FritzH.)II.Title. efforttoensurethatsuchreferencesarein QR46.M488132005 accordance with the state of knowledge 616.9’041–dc22 2004021965 atthetimeofproductionofthebook. Nevertheless,thisdoesnotinvolve,imply, 1st Germanedition1969 orexpressanyguaranteeorresponsibilityon 2nd Germanedition1971 thepartofthepublishersinrespecttoany 3rd Germanedition1974 dosage instructions and forms of applica- 4th Germanedition1978 tionsstatedin the book. Every user is re- 5th Germanedition1982 questedtoexaminecarefullythemanufac- 6th Germanedition1986 turers’leafletsaccompanyingeachdrugand 7th Germanedition1989 tocheck,ifnecessaryinconsultationwitha 8th Germanedition1993 physicianorspecialist,whetherthedosage 9th Germanedition1998 schedulesmentionedthereinorthecontra- 1st Greekedition1995 indicationsstatedbythemanufacturersdif- ferfromthestatementsmadeinthepresent 1st Italianedition1996 book. Such examination is particularly im- 1st Japaneseedition1980 portant with drugs that are either rarely 1st Spanishedition1974 used or have been newly released on the 2nd Spanishedition1982 market. Every dosage schedule or every 1st Turkishedition2001 form of application used is entirely at the user’s own risk and responsibility. The Thisbookisanauthorizedandupdated authors and publishers request every user translationofthe10thGermanedition toreporttothepublishersanydiscrepancies publishedandcopyrighted2001 orinaccuraciesnoticed. byGeorgThiemeVerlag,Stuttgart, Someoftheproductnames,patents,and Germany.TitleoftheGermanedition: registered designs referred to in this book MedizinischeMikrobiologie areinfactregisteredtrademarksorproprie- tarynameseventhoughspecificreferenceto ª2005GeorgThiemeVerlag, this fact is not always made in the text. Ru¨digerstraße14,70469Stuttgart, Therefore,theappearanceofanamewithout Germany designationasproprietaryisnottobecon- http://www.thieme.de struedasarepresentationbythepublisher ThiemeNewYork,333SeventhAvenue, thatitisinthepublicdomain. NewYork,NY10001USA This book, including all parts thereof, is http://www.thieme.com legallyprotectedbycopyright.Anyuse,ex- ploitation,orcommercializationoutsidethe Coverdesign:Cyclus,Stuttgart narrow limits set by copyright legislation, TypesettingbyMitterweger&Partner without the publisher’s consent, is illegal GmbH,68723Plankstadt andliabletoprosecution.Thisappliesinpar- PrintedinGermanybyAppl,Wemding ticular to photostat reproduction, copying, ISBN3-13-131991-7(GTV) mimeographing, preparation of microfilms, ISBN1-58890-245-5(TNY) 12345 andelectronicdataprocessingandstorage. V Preface Medical Microbiology comprises and integrates the fields of immunology, bacteriology, virology, mycology, and parasitology, each of which has seen considerable independentdevelopmentinthepastfewdecades.Thecom- mon bond between them is the focus on the causes of infectious diseases and on the reactions of the host tothe pathogens. Although the adventof antibioticsandvaccineshascertainlytakenthedreadoutofmanyinfectious diseases,thethreatofinfectionisstillafactoflife:Newpathogensarecon- stantlybeingdiscovered;strainsof„old“oneshavedevelopedresistanceto antibiotics,makingtherapymoreandmoredifficult;incurableinfectiousdis- eases(AIDS,rabies)arestillwithus. Theobjectiveofthistextbookofmedicalmicrobiologyistoinstillabroad- basedknowledgeoftheetiologicorganismscausingdiseaseandthepatho- genetic mechanisms leading to clinically manifest infections into its users. This knowledge is a necessary prerequisite for the diagnosis, therapy, and prevention of infectious diseases. This book addresses primarily students ofmedicine,dentistry,andpharmacy.Beyondthisacademicpurpose,itsuse- fulnessextendstoallmedicalprofessionsandmostparticularlytophysicians workinginbothclinicalandprivatepracticesettings. Thisbookmakesthevastandcomplexfieldofmedicalmicrobiologymore accessiblebytheuseoffour-colorgraphicsandnumerousillustrationswith detailedexplanatorylegends.Themanytablespresentknowledgeinacogent andusefulform.Mostchaptersbeginwithaconcisesummary,andin-depth andsupplementaryknowledgeareprovidedinboxesseparatingthemfrom themainbodyoftext. This textbook has doubtless benefited from the extensive academic teachingand the profound researchexperienceof its authors,allof whom arerecognizedauthoritiesintheirfields. Theauthorswouldliketothankallcolleagueswhosecontributionsand advicehavebeenagreathelp andwhoweresogenerouswith illustration material. The authors are also grateful to the specialists at Thieme Verlag andtothegraphicdesignstafffortheircooperation. Zurich,fallof2004 Onbehalfoftheauthors FritzH.Kayser VII Abbreviations &ABC: antigen-bindingcell CCC: covalentlyclosedcircular ABS: antigen-bindingsite (DNA) ADA: adenosinedeaminase CD: clusterofdifferentiation/ ADCC: antibody-dependent clusterdeterminant cellularcytotoxicity CDR: complementarity-deter- ADE: antibody-dependent miningregions enhancement(ofviral CE: cysticechinococcosis infection) CEA: carcinoembryonicantigen AE: alveolarechinococcosis CFA: colonizingfactorantigen AFC: antibody-formingcell CFT: complementfixationtest AFP: alpha-fetoprotein CFU: colonyformingunits AIDS: acquiredimmune CJD: Creutzfeldt-Jakobdisease deficiencysyndrome CLIP: classII-inhibitingprotein ANA: antinuclearantibodies CMI: cell-mediatedimmunity APC: antigen-presentingcell CMV: cytomegalyvirus APO: apoptosisantigen (cytomegalovirus) aPV: acellularpertussisvaccine CNS: central nervous system/ ASLtiter:antistreptolysintiter coagulase-negative AZT: azidothymidine staphylococci ConA: concanavalinA &BAL: bronchoalveolarlavage CPE: cytopathiceffect BALT: bronchus-associated CPH: chronicpersistent lymphoidtissue hepatitis BCG: bacillusCalmette-Guerin CR: cistronregion BCGF: B-cellgrowthfactor CSF: colony-stimulatingfactor Bcl2: B-cellleukemia2antigen CTA: choleratoxinA BSE: bovinespongiformence- CTB: choleratoxinB phalopathy CTL: cytotoxicCD8+Tcell CTX: choleratoxin(element) &C: complement CAH: chronicaggressive &DAF: decayacceleratingfactor hepatitis DAG: diacylglycerol CAM: celladhesionmolecules DARC: Duffyantigenreceptor CAPD: continuousambulant forchemokines peritonealdialysis DC: dendriticcells VIII Abbreviations DHF: denguehemorrhagic virus fever EPEC: enteropathogenic DHPG: dihydroxypropoxy- E.coli methylguanine EPS: extracellularpolymer Dvaccine: substance diphtheriatoxoidvaccine ETEC: enterotoxicE.coli DNA: deoxyribonucleicacid EU: EuropeanUnion DNP: dinitrophenol DR: directrepeats &Ffactor: fertilityfactor ds: double-strandednucleic FA: Freund’sadjuvant acid FACS: fluorescence-activated DSS: dengueshocksyndrome cellsorter DTH: delayedtypehypersensi- Fas: Fantigen tivity FcR: Fcreceptor DtxR: diphtheriatoxinrepressor FDC: folliculardendriticcell FHA: filamentoushemagglutin &EA: earlyantigen FITC: fluoresceinisothiocyanate EAE: experimentalallergic FTA-ABS: fluorescenttreponemal encephalitis antibodyabsorptiontest EAF: EPECadhesionfactor EaggEC: enteroaggregative &G6PDD: glucose-6-phosphate Escherichiacoli dehydrogenasedeficiency EB: elementarybody GAE: granulomatousamebic EBNA: Epstein-Barrnuclear encephalitis antigen gag: group-specificantigen EBV: Epstein-Barrvirus GALT: gut-associatedlymphoid EDTA: ethylenediaminetetra- tissue aceticacid GC: guanine-cytosine/gas eEF2: eucaryoticelongation chromatography factor2 GM-CSF: granulocyte-macrophage EF: edemafactorinspotted colony-stimulatingfactor fevers GP: glycoprotein EHEC: enterohemorrhagic GSS: Gerstmann-Stra¨ussler- E.coli Scheinker(syndrome) EIA: enzymeimmunoassay GVH: graft-versus-host(reaction) EIEC: enteroinvasiveE.coli EITB: enzyme-linkedimmuno- &H: heavychain electrotransferblot HACEK: Haemophilus, Actinoba- ELISA: enzyme-linkedimmuno- cillus,Cardiobacterium, sorbentassay Eikenella,Kingella EM: electronmicroscopy HAT: hypoxanthine, EMB: ethambutol aminopterin,thymidine EMCV: encephalomyocarditis Hb: hemoglobin Abbreviations IX HBs: hepatitisBsurfaceantigen &IB: initialbody HBV: hepatitisBvirus IEP: immunoelectrophoresis HBvaccine: hepatitisBvaccine IFAT: indirect immunofluores- HCC: hepatocellularcarcinoma centantibodytest HCV: hepatitisCvirus/ IFN: interferon (humancoronavirus) Ig: immunoglobulin HDCV: humandiploidcell IHA: indirecthemagglutina- vaccine tion HDV: hepatitisDvirus (I)IF: (indirect)immunofluor- HEV: hepatitisEvirus/high escence endothelialvenules IL: interleukin Hfr: highfrequencyofrecom- In: integron bination INH: isoniazid(isonicotinic HGE: humangranulocytic acidhydrazide) ehrlichiosis IP : inositoltrisphosphate 3 HGV: hepatitisGvirus IPV: inactivatedpoliovaccine HHV: humanherpesvirus IR: invertedrepeats HI: hemagglutination Irgenes: immuneresponsegenes inhibition IS: insertionsequence/inter- Hib: Haemophilusinfluenzae, cistronspace typebserovar HIV: humanimmunodefi- &Kcells: killercells ciencyvirus &L: lightchain HME: humanmonocytic LA: latexagglutination ehrlichiosis lacoperon: lactoseoperon HPLC: high-pressureliquid LAK: lymphokine-activated chromatography killercells HPS: hantaviruspulmonary LB: leprosybacterium syndrome LCA: leukocytecommon HRF: homologousrestriction antigen factor(alsohistamine LCM(V): lymphocyticchorio- releasingfactor) meningitis(virus) HFRS: hemorrhagicfeverwith LE: lupuserythematosus renalsyndrome LFA: lymphocytefunction hsp70: heatshockprotein70 antigen HSV: herpessimplexvirus LGL: largegranular HTLV: humanTcellleukemia lymphocyte virus LIF: leukemiainhibitory HuCV: humancalicivirus factor HUS: hemolytic-uremic LL: lepromatousleprosy syndrome LM: lightmicroscopy HVG: host-versus-graft LMC: larvamigranscutanea (reaction) X Abbreviations LMV: larvamigransvisceralis MZM: marginalzonemacro- LOS: lipo-oligosaccharide phages LPS: lipopolysaccharide LT: heat-labileE.colientero- &NANB: nonA,nonBhepatitis toxin NCVP: noncapsidicviralprotein LTR: longterminalrepeats NE: Nephropathicaepidemica Nfa: nonfimbrialadhesin &MAC: membraneattack NGU: nongonococcalurethritis complex NIDEP: Germanstudyonassess- MAF: macrophageactivating mentandpreventionof factor nosocomialinfections MALT: mucosa-associated NKcells: naturalkillercells lymphoidtissue NTM: nontuberculous MBC: minimalbactericidal (atypical)mycobateria concentration (seeMOTT) MBP: majorbasicprotein/ NTR: nontranslatedregion myelinbasicprotein MCP: membranecofactor &OC: opencircular(DNA) protein OM: opportunisticmycosis M-CSF: macrophagecolony- OMP,Omp: outermembrane stimulatingfactor protein MF: merthiolate-formalin OPV: oralpoliovaccine Mf: microfilaria OSP,Osp:outersurfaceprotein MHC: major histocompatibility complex &P: promoter MIC: minimalinhibitory PAE: postantibioticeffect concentration PAIR: puncture, aspiration, in- MIF: migrationinhibitory jection,respiration factor/microimmune- PAS: para-aminosalicylic acid/ fluorescence periodicacid-Schiffstain MLC: mixedlymphocyte PAM: primaryamebic culture meningoencephalitis MLR: mixedlymphocyte PAP: pyelonephritis-associated reaction pili MMR: live,attenuated,trivalent PBL: peripheral blood lym- measles,mumps,and phocytes rubellavaccine PC: phosphoryl choline/pri- MMTV: murinemammarytumor mary(tuberculous) virus complex,Ghon’scomplex MOMP: majoroutermembrane PCA: passivecutaneous protein anaphylaxis MOTT: mycobacteriaotherthan PCR: polymerasechainreaction TB(seeNTM)
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