Netter’s Infectious Diseases ELAINE C. JONG, MD Clinical Professor of Medicine Emeritus Divisions of Emergency Medicine and Allergy and Infectious Diseases University of Washington School of Medicine Seattle, Washington DENNIS L. STEVENS, PhD, MD Chief, Infectious Diseases Section Veterans Affairs Medical Center Boise, Idaho; Professor of Medicine University of Washington School of Medicine Seattle, Washington Illustrations by Frank H. Netter, MD CONTRIBUTING ILLUSTRATORS: Carlos A.G. Machado, MD John A. Craig, MD James A. Perkins, MS, MFA Tiffany S. DaVanzo, MA, CMI Anita Impagliazzo, MA, CMI 1600 John F. Kennedy Blvd. Ste 1800 Philadelphia, PA 19103-2899 NETTER’S INFECTIOUS DISEASES ISBN: 978-1-4377-0126-5 Copyright © 2012 by Saunders, an imprint of Elsevier Inc. Permissions for Netter Art figures may be sought directly from Elsevier’s Health Science Licensing Department in Philadelphia PA, USA: phone 1-800-523-649, ext. 3276 or (215) 239-3276; or email [email protected]. 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Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility. With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. Library of Congress Cataloging-in-Publication Data Netter’s infectious diseases / [edited by] Elaine C. Jong, Dennis L. Stevens ; Illustrations by Frank H. Netter ; contributing Illustrators, Carlos A.G. Machado … [et al.]. p. ; cm. Infectious diseases Includes bibliographical references and index. ISBN 978-1-4377-0126-5 (hardcover : alk. paper) 1. Communicable diseases. I. Jong, Elaine C. II. Stevens, Dennis L. III. Netter, Frank H. (Frank Henry), 1906-1991. IV. Title: Infectious diseases. [DNLM: 1. Communicable Diseases. WC 100] RC111.N38 2012 362.196′9—dc23 2011020530 Acquisitions Editor: Elyse O’Grady Developmental Editor: Andrea Vosburgh Publishing Services Manager: Anne Altepeter Senior Project Manager: Cheryl A. Abbott Project Manager: Cindy Thoms Working together to grow Design Direction: Steven Stave libraries in developing countries Printed in China www.elsevier.com | www.bookaid.org | www.sabre.org Last digit is the print number: 9 8 7 6 5 4 3 2 1 About the Artists Frank H. Netter, MD anatomy atlas of choice among medical and health profession Frank H. Netter was born in 1906 in New York City. He studied students the world over. art at the Art Student’s League and the National Academy of The Netter illustrations are appreciated not only for their Design before entering medical school at New York University, esthetic qualities but, more important, for their intellectual where he received his MD degree in 1931. During his student content. As Dr. Netter wrote in 1949, “… clarification of a years, Dr. Netter’s notebook sketches attracted the attention of subject is the aim and goal of illustration. No matter how beauti- the medical faculty and other physicians, allowing him to fully painted, how delicately and subtly rendered a subject may augment his income by illustrating articles and textbooks. He be, it is of little value as a medical illustration if it does not serve continued illustrating as a sideline after establishing a surgical to make clear some medical point.” Dr. Netter’s planning, con- practice in 1933, but he ultimately opted to give up his practice ception, point of view, and approach are what inform his paint- in favor of a full-time commitment to art. After service in the ings and what makes them so intellectually valuable. U.S. Army during World War II, Dr. Netter began his long Frank H. Netter, MD, physician and artist, died in 1991. collaboration with the CIBA Pharmaceutical Company (now Learn more about the physician-artist whose work has Novartis Pharmaceuticals). This 45-year partnership resulted in inspired the Netter Reference Collection at www.netterimages. the production of the extraordinary collection of medical art com/artist/netter.htm. so familiar to physicians and other medical professionals worldwide. Carlos Machado, MD In 2005, Elsevier Inc. purchased the Netter Collection and Carlos Machado was chosen by Novartis to be Dr. Netter’s suc- all publications from Icon Learning Systems. There are now cessor. He continues to be the main artist who contributes to more than 50 publications featuring the art of Dr. Netter avail- the Netter Collection of medical illustrations. able through Elsevier Inc. (in the United States, www. Self-taught in medical illustration, cardiologist Carlos us.elsevierhealth.com/Netter; and outside the United States, Machado has contributed meticulous updates to some of Dr. www.elsevierhealth.com). Netter’s original plates and has created many paintings of his Dr. Netter’s works are among the finest examples of the use own in the style of Netter as an extension of the Netter Collec- of illustration in the teaching of medical concepts. The 13-book tion. Dr. Machado’s photorealistic expertise and his keen insight Netter Collection of Medical Illustrations, which includes the into the physician-patient relationship inform his vivid and greater part of the more than 20,000 paintings created by Dr. unforgettable visual style. His dedication to researching each Netter, became and remains one of the most famous medical topic and subject he paints places him among the premier works ever published. The Netter Atlas of Human Anatomy, first medical illustrators at work today. published in 1989, presents the anatomic paintings from the Learn more about his background and see more of his art at Netter Collection. Now translated into 16 languages, it is the www.netterimages.com/artist/machado.htm. vAi boSEuCTItON VtIIhI • ePar asEiticd Disieatseos rs Elaine C. Jong, MD, was born in New York City, graduated Dennis L. Stevens, PhD, MD, is chief of the Infectious Diseases from Wellesley College with a BA in biological sciences, and Section and Director of Research and Development of the Vet- later received her medical degree from the University of Cali- erans Affairs Medical Center in Boise, Idaho, and professor of fornia–San Diego School of Medicine in La Jolla. After com- medicine at the University of Washington’s School of Medicine pleting her residency in internal medicine at the University of in Seattle. Dr. Stevens obtained a bachelor of arts degree in Washington School of Medicine (UWSOM) Affiliated Hospi- microbiology from the University of Montana, a doctoral degree tals in Seattle and a fellowship in infectious diseases at UWSOM, in microbiology from Montana State University, and a medical she joined the faculty in the Department of Medicine in the degree from the University of Utah. He completed an internal Division of Allergy and Infectious Diseases. She also served as medicine residency at the University of Utah and performed his a faculty member in the Division of Emergency Medicine and fellowship in infectious diseases at Brooke Army Medical Center. became Clinical Professor of Medicine in 1994. During her Dr. Stevens’ major research interests have been the pathogenesis tenure at UWSOM, Dr. Jong founded and directed training of serious infections caused by toxin-producing gram-positive clinics for the practice of refugee and international health, and pathogens including Clostridium perfringens, Clostridium sordellii, travel and tropical medicine. She served as the director of the group A Streptococcus, and methicillin-resistant Staphylococcus UW Hall Health Primary Care Center, incorporating the UW aureus (MRSA). Dr. Stevens recently received the Infectious Dis- Student Health Service, and was the first medical director of the eases Society of America Citation for his work on group A strep- UW Campus Health Services, implementing programs for tococcal infections and the William Altemeier Award from the campus public health, occupational health, and employee health. Surgical Infections Society and was elected to membership in the Dr. Jong has a special interest in host defense mechanisms and Association of American Physicians. He has published more than has lectured and published widely on clinical topics in infectious 160 articles and 60 book chapters on serious invasive infections diseases, travel and tropical medicine, and disease control and caused by gram-positive organisms and has been visiting profes- prevention. She is co-editor of The Travel and Tropical Medicine sor at more than 70 national and 30 international institutions. He Manual, now in its fourth edition and recently translated into a is a member of the Centers for Disease Control and Prevention Chinese language edition, and is also co-editor of Travelers’ Vac- Working Group on Invasive Streptococcal Infections and a con- cines, edition 2. She is a fellow of the Infectious Diseases Society sultant to the World Health Organization, and he has been an of America, a past president of the clinical group of the Ameri- invited participant to the National Institutes of Health Work- can Society of Tropical Medicine and Hygiene, and the chair of force on severe group A streptococcal infection. He has testified the International Medical Advisory Board and co-director of the twice before the U.S. Congress on the importance of basic International Travel Medicine Education Program for the Inter- science research in infectious diseases and on invasive group A national Association for Medical Assistance to Travellers streptococcal infections. Dr. Stevens is the current chairman of (IAMAT). the Infectious Diseases Society of America’s Guideline Commit- tee for the Treatment of Skin and Skin Structure Infections. Acknowledgments Developing a new textbook of infectious diseases that would tap We are indebted to John Martines at the University of Wash- into the rich library of medical illustrations created by the late ington, whose communications with contributors and superb Dr. Frank Netter was a major undertaking not only for us organizational skills were invaluable. but also for our dedicated colleagues who contributed ideas We would especially like to acknowledge our families: our and chapters to this work. We thank everyone for devoting spouses—Dr. Britt Litchford and Dr. Amy E. Bryant—whose precious personal time to work on their contributions, and we encouragement and understanding throughout this project were acknowledge their expertise as well as their commitment to essential to the completion of this book; our children—Brian excellence. and Steven Riggs, and Marisa (Stevens) Keith, and Katie Gib- We are grateful that Elyse O’Grady, editor, Netter Products, bons—who remind us that memorable stories and images are recognized our passion for the genius of Frank Netter and not forgotten; and finally our parents—Arthur and Peggy Jong, invited us to serve as editors for this new Netter series volume and John and Alma Stevens—who believed that education brings on infectious diseases. We thank Marybeth Thiel, senior devel- immeasurable benefits and is something that endures through- opmental editor; Andrea Vosburgh, developmental editor; out one’s life. Cheryl Abbott, senior project manager; Cindy Thoms, project It is our hope that these illustrative Netter images, combined manager; and the superb staff in the editorial and production with evidence-based, cogent chapters, will provide valuable offices at Elsevier for their care and commitment in developing insights into the epidemiology, pathogenesis, diagnosis, and this new text. treatment of infections in all parts of the world. vPiii refSEaCTIcONe VIII • Parasitic Diseases As longtime colleagues in the Division of Allergy and Infectious readable, and clinically relevant chapters. In each chapter, Diseases at the School of Medicine, University of Washington, Dr. Netter’s medical illustrations, in some cases revised to Seattle, we were honored and challenged by the unique opportu- reflect new advances, are used to illustrate key points from the nity to create a new textbook of infectious diseases, with the goal text, augmented by radiographic and photographic images, of using the beautiful medical artwork created by the late Dr. tables, and graphs. For some topics, new artwork was created Frank Netter to teach and clarify important concepts in by Carlos A.G. Machado, MD; John A. Craig, MD; James A. infectious diseases. Mindful of existing textbooks, such as Perkins, MS, MFA; Tiffany S. DaVanzo, MA, CMI; and Anita Mandell’s Infectious Diseases, that are considered authoritative Impagliazzo—talented medical artists carrying on Dr. Netter’s as well as standards of excellence in the field, we set out to mission of using art as an educational icon. create a new resource with a strongly clinical orientation. The Although our academic interests, clinical activities, and purpose of this book is to provide healthcare providers, teaching commitments have kept us on different paths within both generalists and specialists, with up-to-date clinical our large division in the past, we were drawn together to work approaches to the broad spectrum of infectious diseases from the on this book by our mutual admiration for the work of Dr. Frank perspective of how these various infections may affect patients Netter. His understanding of anatomy, physiology, pathogene- as individuals, members of communities, and citizens of global sis, and clinical signs of disease are translated by his incredible society. artistic talent into visual images that are so powerful that they Reflecting the rapid accumulation of advances in the medical reduce complexities into simple concepts that remain embedded sciences, the infectious diseases specialty has many branches or in our memories for decades. It is difficult to express the appre- subspecialties, and we were fortunate in recruiting section ciation we have for how much his art contributed to our own editors Patch Dellinger (Surgical Infections), Thomas File enjoyment of medical education. We both had a strong desire (Respiratory Infections), Jo Hoffman (Emerging Infectious to extend this experience to our peers, trainees, and students Diseases), Jeanne Marrazzo (Sexually Transmitted Infections), through the creation of a new up-to-date resource for learning and ChrisAnna Mink (Vaccine-Preventable Infections of Chil- about infectious diseases. We hope that we have succeeded in dren and Adolescents) to join us for this ambitious project. A our goal and welcome your feedback, seeking further improve- superb roster of talented contributing authors, recruited from ments for future editions. our extended network of colleagues and friends, contributed Elaine C. Jong, MD their valuable time and expertise to writing concise, highly Dennis L. Stevens, PhD, MD Editors Elaine C. Jong, MD Jo Hofmann, MD Clinical Professor of Medicine Emeritus Clinical Assistant Professor Divisions of Emergency Medicine and Allergy Department of Public Health and Community Medicine and Infectious Diseases University of Washington; University of Washington School of Medicine Consultant Seattle, Washington Northwest Public Health Consulting Seattle, Washington Dennis L. Stevens, PhD, MD Chief, Infectious Diseases Section Jeanne M. Marrazzo, MD, MPH Veterans Affairs Medical Center Professor Boise, Idaho; Department of Medicine, Allergy and Infectious Diseases Professor of Medicine University of Washington; University of Washington School of Medicine Medical Director Seattle, Washington Seattle STD/HIV Prevention Training Center Seattle, Washington Section Editors ChrisAnna M. Mink, MD E. Patchen Dellinger, MD Clinical Professor of Pediatrics Professor, Vice Chairman, and Chief Department of Pediatrics Division of General Surgery, Department of Surgery David Geffen School of Medicine at UCLA University of Washington School of Medicine; Los Angeles, California; Chief of General Surgery Department of Pediatrics Associate Medical Director Harbor-UCLA Medical Center Department of General Surgery Torrance, California University of Washington Medical Center Seattle, Washington Thomas M. File, Jr., MD, MSc, MACP, FIDSA, FCCP Professor, Internal Medicine Master Teacher Head, Infectious Disease Section Northeastern Ohio Universities Colleges of Medicine and Pharmacy Rootstown, Ohio; Chief, Infectious Disease Service Director, HIV Research Summa Health System Akron, Ohio