REGISTER TODAY! To access your Student Resources, visit: http://evolve.elsevier.com/Mahon/microbiology/ Evolve Student Resources for Mahon: Textbook of Diagnostic Microbiology offers the following features Case Studies A set of 41 Case Studies relate chapter content to real-life scenarios encountered in the lab. WebLinks Links to places of interest on the Web specifically for diagnostic microbiology. Content Updates Find out the latest information on relevant issues in the field of microbiology. FOURTH EDITION Connie R. Mahon, MS Director, Staff College Center for Veterinary Medicine Food and Drug Administration Rockville, Maryland Adjunct Faculty Department of Clinical Laboratory Sciences School of Medicine and Health Sciences The George Washington University Washington, D.C. Donald C. Lehman, EdD, MT(ASCP), SM(NRM) Associate Professor Department of Medical Technology University of Delaware Newark, Delaware George Manuselis, MA, MT(ASCP) Emeritus Medical Technology Division The Ohio State University Columbus, Ohio Adjunct Faculty Department of Natural Sciences and Forensic Science Central Ohio Technical College Newark, Ohio 3251 Riverport Lane Maryland Heights, Missouri 63043 TEXTBOOK OF DIAGNOSTIC MICROBIOLOGY ISBN: 978-1-4160-6165-6 FOURTH EDITION Copyright © 2011 by W.B. Saunders Company All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission of the publisher. Notice Medicine is an ever-changing field. Standard safety precautions must be followed, but as new research and clinical experience broaden our knowledge, changes in treatment and drug therapy may become necessary or appropriate. Readers are advised to check the most current product information provided by the manufacturer of each drug to be administered to verify the recommended dose, the method and duration of administration, and contraindications. It is the responsibility of the treating physician, relying on experience and knowledge of the patient, to determine dosages and the best treatment for each individual patient. Neither the Publisher nor the editor assume any liability for any injury and/or damage to persons or property arising from this publication. Permission to photocopy or reproduce solely for internal or personal use is permitted for libraries or other users registered with the Copyright Clearance Center, provided that the base fee of $4.00 per chapter plus $.10 per page is paid directly to the Copyright Clearance Center, 222 Rosewood Drive, Danvers, MA, 01923. This consent does not extend to other kinds of copying, such as copying for general distribution, for advertising or promotional purposes, for creating new collected works, or for resale. Previous editions copyrighted 2007, 2000, 1995 Library of Congress Cataloging-in-Publication Data Textbook of diagnostic microbiology / [edited by] Connie R. Mahon, Donald C. Lehman, George Manuselis.—4th ed. p. ; cm. Includes bibliographical references and index. ISBN 978-1-4160-6165-6 (pbk. : alk. paper) 1. Diagnostic microbiology. I. Mahon, Connie R. II. Lehman, Donald C. III. Manuselis, George. [DNLM: 1. Microbiological Techniques. 2. Communicable Diseases—diagnosis. 3. Laboratory Techniques and Procedures. QW 25 T355 2011] QR67.T49 2011 616.9′041—dc22 2009036108 Publishing Director: Andrew Allen Managing Editor: Ellen Wurm-Cutter Publishing Services Manager: Patricia Tannian Senior Project Manager: Sharon Corell Designer: Teresa McBryan Working together to grow libraries in developing countries Printed in USA www.elsevier.com | www.bookaid.org | www.sabre.org Last digit is the print number: 9 8 7 6 5 4 3 2 1 To my husband, Dan, for his love and continued support and understanding; my son, Sean, who inspires me; and my daughter, Kathleen, for showing me courage. CRM To my wife, Terri, who has given me constant support and encouragement and whose love makes anything I do possible; my parents, Gerald and Sherrie, who have always been proud of me; even though they have passed away, I know they still look over me. DCL To my daughters, Kristina and Shellie; my sisters, Libby and Helen; my brother Demetrious; and in memory of my parents, Katherine and George, for their love and encouragement. GM This page intentionally left blank Reviewers Kim Boyd, AAS, BAAS, MS, MLT(ASCP), MT(AMT) Eric Landon Parnell, M(ASCP) Assistant Professor Regional Medical Laboratories Amarillo College Battle Creek Health Systems Amarillo, Texas Adjunct Professor Kellogg Community College Russell F. Cheadle, MS, MT(ASCP) Medical Laboratory Technology Program Associate Professor Battle Creek, Michigan Program Director of Clinical Laboratory Science Western Carolina University Alisa J. Petree, MHSM, MT(ASCP) Cullowhee, North Carolina Instructor/Clinical Coordinator Medical Laboratory Technician Program Donna M. Duberg, MA, MS, MT(ASCP)SM, CLS(NCA) McLennan Community College Assistant Professor Waco, Texas Clinical Laboratory Science Department Saint Louis University Tania Puro, EdD, CA CLS, MT(ASCP) St. Louis, Missouri Instructor and Laboratory Coordinator Medical Laboratory Technician and Phlebotomy Program Rosemary Duda, MS, MT(ASCP), SM(ASCP) Hartnell College Director, Medical Technology Program Salinas, California St. Margaret Hospital Education Coordinator Hammond, Indiana Clinical Laboratory Science School Clinical Laboratory Scientist Rita M. Heuertz, PhD, MT(ASCP) Marian Medical Center Associate Professor Santa Maria, California Clinical Laboratory Science Department Consultant Internal Medicine Department Clinical Laboratory Science Program Molecular Microbiology and Immunology Department San Francisco State University Saint Louis University San Francisco, California St. Louis, Missouri Anne T. Rodgers, PhD, MT(ASCP) Paula C. Mister, MS, MT (ASCP), SM(ASCP) Professor of Medical Technology (Retired) Educational Coordinator and Clinical Microbiology Armstrong Atlantic State University Laboratory Instructor Savannah, Georgia Microbiology Department Johns Hopkins Hospital Perry M. Scanlan, PhD, MT(ASCP) Instructor, The Community College of Baltimore Country, Assistant Professor Essex Campus Department of Allied Health Sciences Baltimore, Maryland Austin Peay State University Pathogenic Microbiology Laboratory Instructor Clarksville, Tennessee Stevenson University, Stevenson, Maryland Jeremy Spinney, MT(ASCP) Hamida Nusrat, PhD Technical Manager Lecturer, Clinical Laboratory Science Internship Program Regional Medical Laboratories, Inc. College of Health and Human Services Adjunct Faculty San Francisco State University Clinical Microbiology San Francisco, California Kellogg Community College Battle Creek, Michigan vii viii RevieweRs Maria Lorraine Torres, EdD, MT(ASCP) K. Nisi Zell, EdD, MT(ASCP), SH, CLS(NCA) Clinical Laboratory Science Program Director Professor (Retired) College of Health Sciences Division of Health Sciences University of Texas at El Paso College of Coastal Georgia El Paso, Texas Brunswick, Georgia Contributors Wade K. Aldous, PhD Robert C. Fader, PhD, D(ABMM) Lieutenant Colonel, Medical Service Corps, United States Section Chief, Microbiology/Virology Laboratory Army Scott and White Memorial Hospital Chief, Microbiology Assistant Professor Department of Pathology and Area Laboratory Services Department of Pathology Brooke Army Medical Center Texas A&M University College of Medicine Fort Sam Houston, Texas Temple, Texas Leona W. Ayers, MD Maribeth Laude Flaws, PhD, SM(ASCP)SI Professor Associate Professor Department of Pathology Rush University School of Allied Medical Sciences Chicago, Illinois College of Medicine The Ohio State University Annette W. Fothergill, MA, MBA, MT(ASCP), CLS(NCA) Columbus, Ohio Assistant Professor Department of Pathology Carl Brinkley, PhD Technical Director, Fungus Testing Lab Chief, Microbiology University of Texas Health Science Center at San Antonio U.S. Army Medical Department Center and School San Antonio, Texas Fort Sam Houston, Texas Olarae Giger, PhD Maximo O. Brito, MD, FACP Lecturer, BioScience Technologies Department Assistant Professor of Medicine Jefferson College of Health Professions Director Thomas Jefferson University Infectious Diseases Fellowship Training Program Main Line Health Laboratories Section of Infectious Diseases Lankenau Hospital Immunology and International Medicine Philadelphia, Pennsylvania University of Illinois at Chicago Chicago, Illinois Gerri S. Hall, PhD, D(ABMM), F(AAM) Section Head, Clinical Microbiology Nina M. Clark, MD Medical Director, Bacteriology and Mycobacteriology Associate Professor Department of Clinical Pathology University of Illinois at Chicago Director, PBL Facilitator Recruitment and Development Director of Transplant Infectious Diseases Cleveland Clinic Lerner College of Medicine University of Illinois Medical Center Case Western Reserve University School of Medicine Chicago, Illinois The Cleveland Clinic Cleveland, Ohio James L. Cook, MD Chief, Section of Infectious Diseases Amanda T. Harrington, PhD, D(ABMM) Immunology and International Medicine Assistant Director, Microbiology and Molecular Professor of Medicine, Microbiology, and Immunology Diagnostics University of Illinois at Chicago Department of Pathology and Laboratory Medicine Chief, Infectious Diseases VA Puget Sound Health Care System University of Illinois Hospital Seattle, Washington Jesse Brown Veterans Administration Hospital Chicago, Illinois ix