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Oxford Textbook of Medicine Infection This page intentionally left blank Oxford Textbook of Medicine Infection Selected and updated chapters from the Oxford Textbook of Medicine, Fifth Edition Edited by D avid A. Warrell Emeritus Professor of Tropical Medicine, Nuffield Department of Clinical Medicine; Honorary Fellow, St Cross College, University of Oxford, Oxford, UK T imothy M. Cox Professor of Medicine, University of Cambridge; Honorary Consultant Physician, Addenbrooke’s Hospital, Cambridge, UK J ohn D. Firth Consultant Physician and Nephrologist, Addenbrooke’s Hospital, Cambridge, UK With guest editor Estée Török Senior Research Associate, University of Cambridge and Honorary Consultant in Infectious Diseases and Microbiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK 1 1 Great Clarendon Street, Oxford OX2 6DP United Kingdom Oxford University Press is a department of the University of Oxford. It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide. Oxford is a registered trade mark of Oxford University Press in the UK and in certain other countries © Oxford University Press 2012 The moral rights of the authors have been asserted Oxford Textbook of Medicine: Infection 2012 Updated material from Oxford Textbook of Medicine, fi fth edition, 2010 Impression: 1 A ll rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, by licence or under terms agreed with the appropriate reprographics rights organization. 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Except where otherwise stated, drug dosages and recommendations are for the non-pregnant adult who is not breastfeeding. Links to third party websites are provided by Oxford in good faith and for information only. Oxford disclaims any responsibility for the materials contained in any third party website referenced in this work. Foreword I t is a pleasure to be invited to write the Foreword for this selection countries is refl ected in the authoritative coverage of tropical of updated chapters on Infectious and Tropical Diseases from the diseases. Recently recognised infections are described in detail Oxford Textbook of Medicine . and the sections on immunisation and antimicrobial therapy are The Oxford Textbook of Medicine is one of the most comprehen- comprehensive. sive, respected, and widely read textbooks of medicine. Regularly The Oxford Textbook of Medicine: Infection , with chapters updated, it has become ever larger since it was fi rst published in written by authorities from around the world, encompasses all that 1983 as medical knowledge increased exponentially. a physician needs to know about infection. Wisely, a decision has been made to publish the infection section It is diffi cult, as I know from personal experience, to edit chapters of the textbook, one of the largest, as a stand-alone volume—the written by multiple contributors; the Editors have succeeded in Oxford Textbook of Medicine: Infection . doing so. During a life-time of clinical practice I have seen infectious dis- I greatly enjoyed reading the book and congratulate the Editors eases develop from a ‘behind closed doors’ speciality, principally on their endeavours. I wish that this book had been available when practised in isolation hospitals, to one of the most dynamic areas I practised infectious diseases. The on-line version will be espe- of medicine with major advances in the biology, pathogenesis, cially attractive. diagnosis, prevention, and treatment of microbial diseases. All of these aspects are dealt with in detail in this new book of over Alasdair Geddes 800 pages. Emeritus Professor of Infectious Diseases, The contents range from the classical infectious diseases of University of Birmingham. childhood to exotic infections originating in tropical countries. Past-President, International Society for Infectious Diseases. David Warrell’s vast experience of medicine in developing This page intentionally left blank Preface I nfectious diseases command increasing concern and attention in severe acute kidney injury, neurological complications, and western and tropical developing countries. The maintenance of mortality. global public health is challenged by uncontrolled population I n October 2010, ten months after the catastrophic Haitian growth; emergence and spread of new, virulent, or multidrug earthquake (Richter magnitude scale M 7.0), a massive epidemic w resistant pathogens—and tectonic displacement and climatic of cholera began, spreading rapidly throughout the country and to extremes create humanitarian disasters. Global warming enhances neighbouring Dominican Republic. By December 2011 a total of the vectorial capacity of mosquitoes and other vectors and reser- 543 767 cases and 7364 deaths had been reported. voirs and everywhere the problem of nosocomial and other health- Chikungunya virus appeared in western Indian Ocean islands in care-associated infections burgeons. Above all, it is the failures and early 2005 causing hundreds of thousands of cases. Selection of the derelictions by politicians and international organizations that A226V mutation allowed transmission by Aedes albopictus mosqui- hinder or disable attempts to meet these challenges by correcting toes conferred increased virulence. The pandemic spread to India inequities in the distribution of resources. A few examples will (1.42 million reported cases), elsewhere in South Asia, Africa, and illustrate the highly unstable and dynamic state of the contest in rural Emilia-Romagna in Italy, where autochthonous transmis- between pathogens and their human hosts in 2012. sion was established for a while in 2007. Globalisation of disease Emerging and re-emerging pathogens The unprecedented rise of international travel, for business, tour- Human encroachments on the natural environment have caused ism, religious pilgrimage, adventure, and migration, has promoted ecologic chaos and degradation associated with the emergence of the spread of pathogens far beyond their sites of origin and known lethal pathogens including fi loviruses, arenaviruses, henipaviruses/ endemic foci. Gram-negative Enterobacteriaceae with resistance to paramyxoviruses, rhabdoviruses, and coronaviruses. Growing evi- carbapenems conferred by the blaNDM-1 (New Delhi metallo- dence implicates distinctive mammalian vectors, many of which beta-lactamase) gene now pose a global threat. It is clear that many are bats, whose importance for human health is cause for increas- patients in the UK harbouring these strains had travelled to or been ing concern. in hospital in India and Pakistan. NDM-1 producing organisms Nosocomial and other healthcare-associated infections imported from the Indian subcontinent have also been reported in other European countries, North America, Japan, and Australia. The term ‘healthcare-associated infection’ (HCAI) was coined to Antibiotic resistant Acinetobacter baumannii-calcoaceticus complex refl ect the risk of iatrogenic infection acquired through medical bacteria were imported in military and civilian casualties from fi eld procedures performed outside hospitals (in the home, general hospitals in Iraq to USA and UK where they pose an increasing risk practice, and nursing home) as well as in hospitals (nosocomial to immuno compromised or severely ill patients in intensive care infections). One in ten patients admitted to hospitals are affected units. by HCAI causing much morbidity and mortality. Since the mid- 1980s the emergence and spread of epidemic strains of methicillin- Modern plagues resistant S taphylococcus aureus (MRSA) in UK hospitals prompted S tarting in May 2011, there was an outbreak of infections by the Department of Health to institute a number of control meas- an unusual Shiga-toxin-producing E scherichia coli 0104: H4 with ures, including screening, decolonisation, and mandatory report- extended-spectrum β lactamases in northern Germany. Almost ing of MRSA bloodstream infections. Subsequently, MRSA 4000 people were affected, of whom 800 developed haemolytic bloodstream infections have declined but it is not clear whether uraemic syndrome and 43 died. Differences from previous this is attributable more to infection control measures rather than enterohaemorrhagic E . coli epidemics included the higher propor- changes in circulating strains. MRSA has also become as an impor- tion of young and middle-aged women and the higher incidence of tant pathogen in community settings—in the USA the emergence viii preface an d spread of the USA 300 strain was characterised by outbreaks of Facing the challenges skin and soft tissue infection, necrotising pneumonia, and severe Application of molecular biology is revolutionizing the design sepsis. This strain has recently been reported in the UK potentially of new vaccines and drugs, diagnostic methods, and surveillance threatening the advances made in MRSA control. techniques; treatment and prevention of infectious diseases, as well I n the early 2000s, the emergence and spread of a new hyper- as the advice given to travellers and immunosuppressed patients, virulent strain of Clostridium diffi cile (B1/NAP1/027) resulted is already much improved. These advances are discussed fully in in dramatic increases in the incidence, severity and mortality of this freshly updated and revised edition of the infectious diseases C. diffi cile disease. Again, the UK Department of Health responded section of the O xford Textbook of Medicine, Fifth Edition. There by reinforcing implementation of infection control measures such is an urgent need to coordinate strategic efforts and safe and effec- as environmental cleaning and mandatory reporting of C . diffi cile tive management of resources by improving communication disease, following which, incidence has decreased. There has also between hospitals, politicians, academic institutions, donor agen- been progress in developing therapeutic antibodies and vaccines cies, and international organisations. In the interests of dissemi- against C . diffi cile t oxins. The dramatic success of the pigbel vac- nating reliable and up-to-date information among our broad cination campaign in Papua New Guinea against endemic enteritis constituency of readers, we trust that this new book, with its elec- necroticans caused by the β-toxin of Clostridium perfringens should tronic counterpart in the O xford Textbook of Medicine online, will surely encourage these efforts. hit the mark. D espite these improvements, understanding of the molecular epidemiology and transmission pathways of nosocomial pathogens at local, national and international levels remains incomplete, David A. Warrell and this hampers efforts towards their control. Timothy M. Cox I n developing countries, the emergence and spread of extensively John D. Firth drug resistant tuberculosis, particularly in hospitals, poses enor- M. Estée Török mous diffi culties for treatment and control that require substantial support from donor agencies and international organisations. February 2012 Contents Contributors xiii 5.5 Mumps: epidemic parotitis 111 B.K. Rima 1 Pathogenic microorganisms and the host 1 5.6 Measles 114 H .C. Whittle and P. Aaby 1.1 Biology of pathogenic microorganisms 1 Duncan J. Maskell 5.7 Nipah and Hendra virus encephalitides 124 C.T. Tan 1.2 Physiological changes, clinical features, and general management of infected patients 5 5.8 Enterovirus infections 126 T odd W. Rice and Gordon R. Bernard P hilip Minor and Ulrich Desselberger 5.9 Virus infections causing diarrhoea 2 The patient with suspected infection 13 and vomiting 136 2.1 Clinical approach 13 P hilip Dormitzer and Ulrich Desselberger Christopher J. Ellis 5.10 Rhabdoviruses: rabies and 2.2 Fever of unknown origin 16 rabies-related lyssaviruses 142 S teven Vanderschueren and Daniël Knockaert M . J. Warrell and David A. Warrell 2.3 Nosocomial infections 21 5.11 Colorado tick fever and other I.C.J.W. Bowler arthropod-borne reoviruses 156 2.4 Infection in the immunocompromised host 25 M .J. Warrell and David A. Warrell J. Cohen 5.12 Alphaviruses 158 2.5 Antimicrobial chemotherapy 34 E .E. Ooi, L.R. Petersen, and D.J. Gubler R.G. Finch 5.13 Rubella 163 3 Immunization 54 P .A. Tookey and J.M. Best D. Goldblatt and M. Ramsay 5.14 Flaviviruses (excluding dengue) 166 E .E. Ooi, L.R. Petersen, and D.J. Gubler 4 Travel and expedition medicine 60 5.15 Dengue 177 C.P. Conlon and David A. Warrell B ridget Wills and Jeremy Farrar 5 Viruses 69 5.16 Bunyaviridae 182 5.1 Respiratory tract viruses 70 J .W. LeDuc and Summerpal S. Kahlon Malik Peiris 5.17 Arenaviruses 191 5.2 Herpesviruses (excluding Epstein–Barr virus) 80 J. ter Meulen J.G.P. Sissons 5.18 Filoviruses 199 5.3 Epstein–Barr virus 99 J. ter Meulen M .A. Epstein and A.B. Rickinson 5.19 Papillomaviruses and polyomaviruses 203 5.4 Poxviruses 106 R aphael P. Viscidi and Keerti V. Shah Geoffrey L. Smith