Oxford Textbook of Medicine

5518 Pages·2010·1.4 MB·English

by  David A. Warrell

OXFORD TEXTBOOK OF MEDICINE - 5th Ed. (2010)
Front Matter
Title Page
Oxford Textbook of Medicine
FIFTH EDITION
Edited by
David A. Warrell
Emeritus Professor of Tropical Medicine, Nuffield Department of Clinical Medicine; Honorary Fellow, St Cross College, University of Oxford, Oxford, UK
Timothy M. Cox
Professor of Medicine, University of Cambridge; Honorary Consultant Physician, Addenbrooke's Hospital, Cambridge, UK
John D. Firth
Consultant Physician and Nephrologist, Addenbrooke's Hospital, Cambridge, UK
Sub-editor Immunological Mechanisms and Disorders of the Skin
Graham S. Ogg
Reader in Cutaneous Immunology, MRC Senior Clinical Fellow; Consultant in Dermatology, Churchill Hospital, Oxford, UK
Copyright Page
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Picture
The title page of the 1492 edition of Rosa Anglica by John of Gaddesden (1280-1361), which was probably written in 1314. The author was a well known physician
attached to Merton College, Oxford in the early part of the 14th century. His famous book was probably the first 'Oxford Textbook of Medicine'. The author was the
model for the unsavoury Doctor of Physick in Chaucer's Canterbury Tales.
Foreword
by Professor Sir Aaron Klug OM FRS
Since it first appeared 25 years ago, the Oxford Textbook of Medicine has established itself as an authoritative source for doctors to consult in everyday practice,
particularly when questions arise outside their experience. The coverage is comprehensive and covers diseases and problems that occur anywhere in the world. It is very
respected and has become a standard reference in the United Kingdom for journalists and for legal disputes in the courts.
In a book with such wide coverage, it is important for the practising physician to be able to find the topic of current interest speedily. The book seems to me to be less
discursive than, say, Harrison's Principles of Internal Medicine. Indeed, the layout of the book is such that one can efficiently look up something specific. This is
facilitated by a good index, with the right degree of cross-referencing.
The book begins with the basic biological science underlying medicine, cell and molecular biology, and the genomic basis of medicine. Despite these big issues, the text
does not lose sight of the clinical implications of the science being presented, in keeping with the underlying philosophy of the book that the material must be of
practical value to the physician. Thus the advances in understanding the modification of proteins by kinases, which add phosphate groups to selected amino acids, has led
to the development of chemical inhibitors of the kinases. An example of such a successful designer drug is imatinib for chronic myologenous leukaemia.
A totally new modality for the treatment has appeared in recent years, namely monoclonal antibodies with high selectivity against protein targets. Originally developed
in mice, they could not be used in patients because of the anaphylactic response to a foreign protein, but over the years they have been 'humanized', i.e. their relatively
small, specific antigen- or immunogen-recognition regions have been fused to a human framework, which make up most of the antibody. Examples include palivizumab,
against respiratory syncytial virus, and bevacizumab, against colorectal cancer, now in widespread use. Even more striking is the development of fully human antibodies,
synthesized out of the cloned repertoire of the human genes making up the constituent antibody domains. The antibody adalimumab, released a few years ago, not only
relieves the pain of rheumatoid arthritis, but also stops the progress of the disease.
These new modalities are of course costly, as are many of the new anticancer drugs such as Herceptin: their introduction is changing the setting in which medicine is
practised, particularly in the United Kingdom where the National Health Service (NHS) is free at the point of delivery, and in the United States of America where the
Health Maintenance Organizations (HMOs) are insurance based. As recognized by David Weatherall in his foreword to the fourth edition of this textbook, none of the
richer countries has got to grips with the problem of financing the increasing number and costs of new treatments. In the United Kingdom where the decision to allow
the use of a licensed drug is made by the local Health Authority, there is no uniformity of practice, so leading to the term 'postcode availability' of a drug. There is also
the question of individuals receiving treatment under the NHS but wishing to top up privately with other or new drugs not available under the NHS. Despite much
controversy, this practice has recently been allowed by the NHS.
Another issue likely to arise out of the sequencing of the human genome is the prospect of personalized and preventive medicine. This is fast becoming a potential
reality with the decreasing cost of rapid DNA sequencing to determine an individual genome. The supporting clinical data to interpret individual susceptibility to disease
is likely to come from 'genome-wide association' studies. These represent a powerful approach to the identification of genetic variations involved in common human
diseases. In 2007, there appeared in the journal Nature a genomic study of seven common diseases, including coronary artery disease, type 1 and type 2 diabetes,
hypertension, and bipolar disorders. This large study involved 14 000 cases and 3000 shared controls. Similar studies have been carried out in several forms of cancer.
The association of a particular locus in the genome with a disease is still very modest. The overall increase in risk conferred by the genetic factors identified is of the
order of 1.2- to 1.5-fold, and so thus far does not provide a clinically useful prediction of disease. But the work must be recognized as an important first step towards
dissecting the genomic basis of common diseases. By the time of the next edition of the Oxford Textbook of Medicine, we may well see the results of these powerful
genomic tools becoming available or already in use.
Preface
"Naught for your comfort"
— Trevor Huddleston
The fruits of medical research
Publication of this new edition of the Oxford Textbook of Medicine prompts consideration of the precepts and practices of medicine in a world that faces unprecedented
challenges. There is much to celebrate, and—with many new contributors—we have sought throughout the book to reflect the revolutionary effects of discovery in the
medical sciences on clinical practice. Spectacular advances have been made at the most fundamental level and these continue to inspire our belief that improved
prevention, diagnosis and treatment of disease will eventually relieve suffering. The popular term, 'translational medicine', reflects the shared optimism of many research
agencies.
The Fifth edition has been rigorously revised and updated. It differs most blatantly from previous editions in having the gift of colour throughout and the inclusion of
'Essentials' (mostly written and all edited by John Firth) that summarize the main points of each chapter. The introductory Sections 2 and 3 include eight new chapters
on topics ranging from the future of clinical trials, the evaluation and provision of effective medicines, to health promotion. This expansion reflects the ever
burgeoning successes, constraints and frustrations of modern medicine. New sciences like stem cell biology, and emerging pathogens such as SARS, H1N1 and drug-
resistant bacteria and malaria parasites, are well represented in our pages, and we have introduced some highly topical themes, notably Darwinian Medicine and the
context of Human Disasters
Darwinian Medicine
Evolutionary medicine has a firm place in this book (Randolph Nesse and Richard Dawkins—Evolution: medicine's most basic science—Chapter 2.1.2), consistent with
the 200th anniversary of Charles Darwin's birth and the 150th anniversary of the publication of On the Origin of Species in 2009. Darwin's remarkable synthesis
(subtended in part by Gregor Mendel's later discoveries in heredity) has salient implications for understanding disease, rendering outmoded the crude analogy of the
diseased body as a 'broken machine'. Much illness results from conflict between a person and the external influences to which he or she is uniquely maladapted at a
particular time. Given that genetic and environmental variations are biological characteristics, the evolutionary concept has profound implications for any full
description and understanding of disease. But while we have prodigious methods for determining genetic variation, our ability to measure environmental changes and
interactions—or predict environmental disasters—is rudimentary.
Human disasters: political, sociological, and historical context
Human populations are dependent on the natural environment for food and water but exquisitely vulnerable to its storms, earthquakes and tsunamis. As demonstrated by
one of our Nobel Laureate authors, Amartya Sen (Human disasters—Chapter 3.5), the effects of natural disasters are, irrespective of their origin, invariably magnified by
dire socioeconomic circumstances resulting from human conquest. An agonising recent example was the seismic horror in Haiti, affecting a society dysfunctional and
impoverished as an historical consequence of the European slave trade and more recent political interferences. Such disasters, including those attributable to wars, are
also the province of medicine: in such catastrophes, doctors are needed to provide emergency treatment but, through proper involvement with governments, they are
also critical for public health planning and the restoration of appropriate infrastructure and clinical services. In response to another human tragedy, the AIDS pandemic,
and to mounting pressure on the industry, one of the world's largest pharmaceutical companies has recently agreed to cut the prices of its medicines in the poorest
countries and to donate some of its profits to local hospitals and clinics. This initiative might be a bit late but is a significant first step taking other 'Big Pharmas' in a
direction that improves access to treatments for stricken patients in poor countries.
The teaching and practice of medicine: a fine tradition betrayed
Irrespective of the political dimension of medicine, the care of patients and the prevention of disease depend on practising clinicians; the medicine of the future relies
not only on scientific advances but on the education of doctors. Since the last edition, leaders of our profession in Britain have presided over, and in some cases
acquiesced to the partial dismantling of arguably one of the finest systems of medical education. The implementation of a national process for the appointment of junior
doctors has disaffected many trainees and their clinical mentors, who feel that they have become pawns in a bureaucratic political game. More important, if they
understood the full implications, we believe that the British public and patients would be horrified. Within Europe, matters have been compounded by implementation of
the European Working Time Directive, which threatens the professional apprenticeship and mentoring relationships between junior and senior doctors that best nurture
young colleagues. The frequently heard mantra of the 'consultant-led service' is all very well, but the ideal will be short-lived if training is put in jeopardy.
We, the editors of this textbook, learnt how to practise as clinicians from such 'hands-on' apprenticeships and ask: how can young doctors accumulate adequate working
knowledge and acquire essential skills if their clinical work is restricted to 48 hours each week? One might pose the question: would a patient prefer to be treated by a
fully rested but inexperienced doctor whom they had never seen before, or a tired doctor with immense medical experience who knew them and their illness? We know
whom we would prefer, as does Christopher Booth (On being a patient—Chapter 1.1). Short hours and other radical changes in the organization of clinical teams impair
the continuity of medical care, an element of key importance for the patient but also critical for clinical education through time-honoured individual experience. Many
countries are seeking to improve their systems of medical education, but for those who might consider adopting the current UK training timetables, we humbly offer
advice—don't. It would be better to provide their medical students and young doctors with sufficient time and resources to acquaint themselves with the principles and
practice of modern scientific medicine that are emphasized in this book.
Decline and fall of clinical trials evidence
How the profession responds to these old and new threats to the practice of medicine will influence the translation of new knowledge and scientific understanding into
clinical benefit. Our contemporary environment is contaminated by countless man-made chemicals, including drugs and other medicinal products: many of the latter
have untested effects on human health. One foundation of good practice is the evidence provided by clinical trials, but this is under threat from powerful self-interest
groups. On one hand are those promoting alternative and so-called traditional treatments, which are ineffective and supported at best by what Robert Park has termed
'Voodoo Science', and who mount sustained attacks on anyone who might be brave enough to say so, including one of our authors, Edzard Ernst (Complementary and
alternative medicine—Chapter 2.5). On the other hand are those who promote expensive health care, of which they take a financial cut: scaremongering occurs at every
opportunity, and with the intensity that only billions of dollars can bring. Already most clinical trials are sponsored by pharmaceutical companies and instances where
prompt release of all the results has been suppressed for commercial reasons continue to scandalize the profession.
Clinical trials require proper regulation, but burgeoning bureaucracy has become disproportionate; it is stifling the discipline and greatly discourages investigator-led
clinical trials. Yet another vacuous meta-analysis, performed in the absence of sufficient data and therefore allowing of no conclusions, will be no substitute. We plead
also for simplification of the legal and regulatory framework in which therapeutic trials and medical research can be conducted by individual doctors; for without the
freedom ethically to test hypotheses prompted by the immediacy of clinical necessity, many imaginative advances will be thwarted.
Inalienable personal liberty versus the public good
The tension between the right to personal liberty and the desire for public good is ever more acute and is manifest in many ways. For the world as whole, population
control (or lack thereof), is the most pressing issue. Even when we thought medicine might have solved a problem, the activities of the anti-vaccination lobby that
resulted in the anti-MMR scandal reminded us that old battles sometimes need to be fought again. Many people in diverse populations are suffering because of this
phenomenon and from the misguided public assessment of risk and disregard for specialist advice.
Bureaucratic targets
Well chosen targets are a good way of managing complex systems, but there is grave danger when those who set targets for clinical practice are intrinsically suspicious of
doctors, take very selective advice, choose inappropriate limits, and compound the error by specifying crude and inappropriate mechanisms by which they should be
achieved. What is being measured becomes of overwhelming importance, and the patient with the most pressing clinical need may not get the priority that he or she
deserves. Many will suffer unless this state of affairs is remedied.
The future
Against a background of such uncertainty, we believe that sound clinical experience, combined with knowledge of the subject, based on authoritative books and peer-
reviewed publications, remain the rocks upon which clinical management is based. The doctor whom doctors want to see, when they or their family are ill, is the one
they recognize as having great knowledge, great experience, and good judgement, of patients and their disease. We have asked such doctors to write for this book, so that
it will be of most value to those seeking a 'higher medicine'. Despite the many adverse factors detailed above, we are reassured that many bright young men and women
training in medicine are motivated, hungry for knowledge, and prepared to challenge dogma in the struggle to provide the best care for their patients. We trust that this
edition of the book hits the mark and will help those who use it to achieve this aim.
Our debts
This edition is a tribute to our long-suffering but ever-patient contributors who, faced by delays in publication, had to update their work or risk instant obsolescence.
We remember with gratitude seven authors who have died since publication of the 4th edition, but who contributed to the present edition, Richard S. Doll (Chapter 6.1),
Ernest Beutler (Chapter 22.5.11), Philip A. Poole-Wilson (Chapter 16.1.2), Pauline de la Motte Hall (Chapter 15.22.7), Peter ('PK') Thomas (Chapter 24.16), M.
Monir Madkour (Chapter 7.6.21), and Richard Edwards (Chapter 24.24.4). Sir Richard S. Doll, who died in 2005, a giant of Oxford and World Medicine and a marvellous
friend and inspiration to many, was a great supporter of this book. As a guest of the popular radio programme 'Desert Island Discs', he delighted us by choosing the
Oxford Textbook of Medicine for his reading material.
Graham S. Ogg contributed his special skills and experience to the planning and editing of the sections on Immunological mechanisms and Disorders of the skin for which
we are most grateful. We thank our wives, Mary, Sue, and Helen, and dedicated secretaries, Eunice Berry and Joan Grantham. In the publication team, we are particularly
grateful to Helen Liepman, Anna Winstanley, Kate Wilson, Kathleen Lyle, and Aparna Shankar.
David A. Warrell
Timothy M. Cox
John D. Firth
Oxford and Cambridge
February 2010
Contents
Contributors… xxxi
SECTION 1 On being a patient
1.1 On being a patient… 3
Christopher Booth
SECTION 2 Modern medicine: foundations, achievements, and limitations
2.1 Scientific background to medicine… 9
2.1.1 Science in medicine: when, how, and what… 9
W.F. Bynum
2.1.2 Evolution: medicine's most basic science… 12
Randolph M. Nesse and Richard Dawkins
2.2 Medical ethics… 16
Tony Hope
2.3 Evidence-based medicine… 22
2.3.1 Bringing the best evidence to the point of care… 22
Paul P. Glasziou
2.3.2 Evidence-based medicine—does it apply to my particular patient?… 27
Louis R. Caplan
2.3.3 Large-scale randomized evidence: trials and meta-analyses of trials… 31
C. Baigent, R. Peto, R. Gray, S. Parish, and R. Collins
2.3.4 The future of clinical trials… 45
Perry Nisen and Patrick Vallance
2.4 Funding of health care… 48
2.4.1 The evaluation and provision of effective medicines… 48
Michael D. Rawlins
2.4.2 Reasonableness and its definition in the provision of health care… 54
Norman Daniels
2.4.3 Priority setting in developed and developing countries… 58
Nigel Crisp
2.4.4 Sustaining innovation in an era of specialized medicine… 60
Henri A. Termeer
2.5 Complementary and alternative medicine… 65
E. Ernst
SECTION 3 Global patterns of disease and medical practice
3.1 Global burden of disease: causes, levels, and intervention strategies… 73
Ramanan Laxminarayan and Dean Jamison
3.2 Human population size, environment, and health… 80
A.J. McMichael and J.W. Powles
3.3 Avoiding disease and promoting health… 86
3.3.1 Preventive medicine… 86
David Mant
3.3.2 Medical screening… 94
Nicholas Wald and Malcolm Law
3.3.3 The importance of mass communication in promoting positive health… 108
Thomas Lom
3.4 Influence of wealth… 112
3.4.1 The cost of health care in Western countries… 112
Joseph White
3.4.2 A sinister pathogen corrupts two disciplines: the demographic entrapment of Middle Africa… 116
Maurice King
3.5 Human disasters… 119
Amartya Sen
SECTION 4 Cell biology
4.1 The cell… 127
George Banting
4.2 Molecular biology… 135
4.2.1 The human genome sequence… 135
Sydney Brenner
4.2.2 The genomic basis of medicine… 136
Pawel Stankiewicz and James R. Lupski
4.3 Cytokines… 152
Iain B. McInnes
4.4 Ion channels and disease… 160
Frances M. Ashcroft
4.5 Intracellular signalling… 169
R. Andres Floto
4.6 Apoptosis in health and disease… 177
Andrew H. Wyllie and Mark J. Arends
4.7 Discovery of embryonic stem cells and the concept of regenerative medicine… 189
Martin J. Evans
4.8 Stem cells and regenerative medicine… 193
Alexis J. Joannides, Roger Pedersen, and Siddharthan Chandran
SECTION 5 Immunological mechanisms
Editor: Graham S. Ogg
5.1 Structure and function… 207
5.1.1 The innate immune system… 207
Paul Bowness
5.1.2 The complement system… 213
Marina Botto and Mark J. Walport
5.1.3 Adaptive immunity… 224
Paul Klenerman
5.2 Immunodeficiency… 235
D. Kumararatne
5.3 Allergy… 258
Pamela Ewan
5.4 Autoimmunity… 267
Antony Rosen
5.5 Principles of transplantation immunology… 280
Ross S. Francis and Kathryn J. Wood
SECTION 6 Principles of clinical oncology
6.1 Epidemiology of cancer… 299
A.J. Swerdlow, R. Peto, and Richard S. Doll
6.2 The nature and development of cancer… 333
John R. Benson and Siong-Seng Liau
6.3 The genetics of inherited cancers… 358
Rosalind A. Eeles
6.4 Cancer immunity and clinical oncology… 372
Maries van den Broek, Lotta von Boehmer, Kunle Odunsi, and Alexander Knuth
6.5 Cancer: clinical features and management… 380
R.L. Souhami
6.6 Cancer chemotherapy and radiation therapy… 396
Bruce A. Chabner and Jay Loeffler
SECTION 7 Infection
7.1 Pathogenic microorganisms and the host… 409
7.1.1 Biology of pathogenic microorganisms… 409
Duncan J. Maskell
7.1.2 Physiological changes, clinical features, and general management of infected patients… 413
Todd W. Rice and Gordon R. Bernard
7.2 The patient with suspected infection… 420
7.2.1 Clinical approach… 420
Christopher J. Ellis
7.2.2 Fever of unknown origin… 423
Steven Vanderschueren and Daniel Knockaert
7.2.3 Nosocomial infections… 428
I.C.J.W. Bowler
7.2.4 Infection in the immunocompromised host… 431
J. Cohen
7.2.5 Antimicrobial chemotherapy… 441
R.G. Finch
7.3 Immunization… 460
D. Goldblatt and M. Ramsay
7.4 Travel and expedition medicine… 465
C.P. Conlon and David A. Warrell
7.5 Viruses… 472
7.5.1 Respiratory tract viruses… 473
Malik Peiris
7.5.2 Herpesviruses (excluding Epstein-Barr virus)… 482
J.G.P. Sissons
7.5.3 Epstein-Barr virus… 501
M.A. Epstein and A.B. Rickinson
7.5.4 Poxviruses… 508
Geoffrey L. Smith
7.5.5 Mumps: epidemic parotitis… 513
B.K. Rima
7.5.6 Measles… 515
H.C. Whittle and P. Aaby
7.5.7 Nipah and Hendra virus encephalitides… 525
C.T. Tan
7.5.8 Enterovirus infections… 527
Philip Minor and Ulrich Desselberger
7.5.9 Virus infections causing diarrhoea and vomiting… 536
Philip Dormitzer and Ulrich Desselberger
7.5.10 Rhabdoviruses: rabies and rabies-related lyssaviruses… 541
M. J. Warrell and David A. Warrell
7.5.11 Colorado tick fever and other arthropod-borne reoviruses… 555
M.J. Warrell and David A. Warrell
7.5.12 Alphaviruses… 557
L.R. Petersen and D.J. Gubler
7.5.13 Rubella… 561
P.A. Tookey and J.M. Best
7.5.14 Flaviviruses excluding dengue… 564
L.R. Petersen and D.J. Gubler
7.5.15 Dengue… 575
Bridget Wills and Jeremy Farrar
7.5.16 Bunyaviridae… 579
J.W. LeDuc and Summerpal S. Kahlon
7.5.17 Arenaviruses… 588
J. ter Meulen
7.5.18 Filoviruses… 595
J. ter Meulen
7.5.19 Papillomaviruses and polyomaviruses… 600
Raphael P. Viscidi and Keerti V. Shah
7.5.20 Parvovirus B19… 607
Kevin E. Brown
7.5.21 Hepatitis viruses (excluding hepatitis C virus)… 609
N.V. Naoumov
7.5.22 Hepatitis C… 615
Paul Klenerman, K.J.M. Jeffery, and J. Collier
7.5.23 HIV/AIDS… 620
Graz A. Luzzi, T.E.A. Peto, P. Goulder, and C.P. Conlon
7.5.24 HIV in the developing world… 644
Alison D. Grant and Kevin M. De Cock
7.5.25 HTLV-1, HTLV-2, and associated diseases… 650
Kristien Verdonck and Eduardo Gotuzzo
7.5.26 Viruses and cancer… 653
R.A. Weiss
7.5.27 Orf… 655
David A. Warrell
7.5.28 Molluscum contagiosum… 657
David A. Warrell
7.5.29 Newly discovered viruses… 659
H.C. Hughes
7.6 Bacteria… 663
7.6.1 Diphtheria… 664
Delia B. Bethell and Tran Tinh Hien
7.6.2 Streptococci and enterococci… 670
Dennis L. Stevens
7.6.3 Pneumococcal infections… 679
Anthony Scott
7.6.4 Staphylococci… 693
Bala Hota and Robert A. Weinstein
7.6.5 Meningococcal infections… 709
P. Brandtzaeg
7.6.6 Neisseria gonorrhoeae… 722
D. Barlow, Jackie Sherrard, and C. Ison
7.6.7 Enterobacteria… 727
7.6.7.1 Enterobacteria and bacterial food poisoning… 727
Hugh Pennington
7.6.7.2 Pseudomonas aeruginosa… 735
G.C.K.W. Koh and S.J. Peacock
7.6.8 Typhoid and paratyphoid fevers… 738
C.M. Parry and Buddha Basnyat
7.6.9 Intracellular klebsiella infections (donovanosis and rhinoscleroma)… 745
J. Richens
7.6.10 Anaerobic bacteria… 748
Anilrudh A. Venugopal and David W. Hecht
7.6.11 Cholera… 754
Aldo A.M. Lima and Richard L. Guerrant
7.6.12 Haemophilus influenzae… 759
Derrick W. Crook
7.6.13 Haemophilus ducreyi and chancroid… 763
Nigel O'Farrell
7.6.14 Bordetella infection… 764
Cameron Grant
7.6.15 Melioidosis and glanders… 768
S.J. Peacock
7.6.16 Plague: Yersinia pestis… 772
Michael B. Prentice
7.6.17 Other Yersinia infections: yersiniosis… 776
Michael B. Prentice
7.6.18 Pasteurella… 777
Marina S. Morgan
7.6.19 Francisella tularensis infection… 780
Petra C.F. Oyston
7.6.20 Anthrax… 783
Arthur E. Brown and Thira Sirisanthana
7.6.21 Brucellosis… 789
M. Monir Madkour
7.6.22 Tetanus… 795
C.L. Thwaites and Lam Minh Yen
7.6.23 Clostridium difficile… 800
John G. Bartlett
7.6.24 Botulism, gas gangrene, and clostridial gastrointestinal infections… 803
Dennis L. Stevens, Michael J. Aldape, and Amy E. Bryant
7.6.25 Tuberculosis… 810
Richard E. Chaisson and Jean B. Nachega
7.6.26 Disease caused by environmental mycobacteria… 831
J.M. Grange and P.D.O. Davies
7.6.27 Leprosy (Hansen's disease)… 836
Diana N.J. Lockwood
7.6.28 Buruli ulcer: Mycobacterium ulcerans infection… 848
Wayne M. Meyers and Francoise Portaels
7.6.29 Actinomycoses… 850
K.P. Schaal
7.6.30 Nocardiosis… 856
Roderick J. Hay
7.6.31 Rat-bite fevers… 857
David A. Warrell
7.6.32 Lyme borreliosis… 860
Gary P. Wormser, John Nowakowski, and Robert B. Nadelman
7.6.33 Relapsing fevers… 866
David A. Warrell
7.6.34 Leptospirosis… 874
George Watt
7.6.35 Nonvenereal endemic treponematoses: yaws, endemic syphilis (bejel), and pinta… 879
David A. Warrell
7.6.36 Syphilis… 885
Basil Donovan and Linda Dayan
7.6.37 Listeriosis… 896
H. Hof
7.6.38 Legionellosis and legionnaires' disease… 899
J.T. Macfarlane and T.C. Boswell
7.6.39 Rickettsioses… 903
Philippe Parola and Didier Raoult
7.6.40 Scrub typhus… 919
George Watt
7.6.41 Coxiella burnetii infections (Q fever)… 923
T.J. Marrie
7.6.42 Bartonellas excluding B. bacilliformis… 926
Emmanouil Angelakis, Didier Raoult, and Jean-Marc Rolain
7.6.43 Bartonella bacilliformis infection… 934
A. Llanos-Cuentas and C. Maguina-Vargas
7.6.44 Chlamydial infections… 939
David Taylor-Robinson and David Mabey
7.6.45 Mycoplasmas… 950
David Taylor-Robinson and Jorgen Skov Jensen
7.6.46 A check list of bacteria associated with infection in humans… 961
J. Paul
7.7 Fungi (mycoses)… 998
7.7.1 Fungal infections… 998
Roderick J. Hay
7.7.2 Cryptococcosis… 1018
William G. Powderly
7.7.3 Coccidioidomycosis… 1020
Gregory M. Anstead and John R. Graybill
7.7.4 Paracoccidioidomycosis… 1023
M.A. Shikanai-Yasuda
7.7.5 Pneumocystis jirovecii… 1028
Robert F. Miller and Laurence Huang
7.7.6 Penicillium marneffei infection… 1032
Thira Sirisanthana
7.8 Protozoa… 1035
7.8.1 Amoebic infections… 1035
Richard Knight
7.8.2 Malaria… 1045
David A. Warrell, Janet Hemingway, Kevin Marsh, Robert E. Sinden, Geoffrey A. Butcher, and Robert W. Snow
7.8.3 Babesiosis… 1089
Philippe Brasseur
7.8.4 Toxoplasmosis… 1090
Oliver Liesenfeld and Eskild Petersen
7.8.5 Cryptosporidium and cryptosporidiosis… 1098
S.M. Caccio
7.8.6 Cyclospora and cyclosporiasis… 1105
R. Lainson
7.8.7 Sarcocystosis (sarcosporidiosis)… 1109
John E. Cooper
7.8.8 Giardiasis, balantidiasis, isosporiasis, and microsporidiosis… 1111
Martin F. Heyworth
7.8.9 Blastocystis hominis infection… 1118
Richard Knight
7.8.10 Human African trypanosomiasis… 1119
August Stich
7.8.11 Chagas disease… 1127
M.A. Miles
7.8.12 Leishmaniasis… 1134
A.D.M. Bryceson and Diana N.J. Lockwood
7.8.13 Trichomoniasis… 1142
Sharon Hillier
7.9 Nematodes (roundworms)… 1145
7.9.1 Cutaneous filariasis… 1145
Gilbert Burnham