image

CONTENTS

Tables and Figures

Preface

The Author

Acknowledgments

Part 1 : Introduction to Emerging Infectious Diseases

Chapter 1 : Infectious Diseases Past and Present

Major Concepts

History of Infectious Diseases

The Role of Infectious Diseases in the World Today

The Links Between Infectious Diseases, Poverty, and Civil Unrest

Emerging and Reemerging Infectious Diseases

Factors Contributing to the Emergence of New Infectious Diseases and the Spread and Evolution of Older Diseases

Timeline

Summary

Key Terms

Review Questions

Topics for Further Discussion

Resources

Chapter 2 : Of Microbes and Men

Major Concepts

Introduction

Infectious Agents: The Enemy Combatants

Genetic Information and the Making of Proteins: Preparing the Armament

The Immune Response: Humans Fight Back, Part One

Antimicrobial Agents: Humans Fight Back, Part Two

Summary

Key Terms

Review Questions

Topics for Further Discussion

Resources

Part 2 : Bacterial Infections

Chapter 3 : Lyme Disease

Major Concepts

Introduction

History

The Disease

The Causative Agent

The Immune Response

Diagnosis

Treatment

Prevention

Surveillance

Summary

Key Terms

Review Questions

Topics for Further Discussion

Resources

Chapter 4 : Human Ehrlichiosis

Major Concepts

Introduction

History

The Diseases

The Causative Agents

The Immune Response

Diagnosis

Treatment

Prevention

Surveillance

Summary

Key Terms

Review Questions

Topics for Further Discussion

Resources

Chapter 5 : Bartonella Infections

Major Concepts

Introduction

History

The Diseases

The Causative Agents

The Immune Response

Diagnosis

Treatment

Prevention

Surveillance

Summary

Key Terms

Review Questions

Topics for Further Discussion

Resources

Chapter 6 : Group A Streptococci

Major Concepts

Introduction

History

The Diseases

The Causative Agents

The Immune Response

Diagnosis

Treatment

Prevention

Surveillance

Summary

Key Terms

Review Questions

Topics for Further Discussion

Resources

Chapter 7 : Escherichia Coli O157:H7

Major Concepts

Introduction

History

The Diseases

The Causative Agents

The Immune Response

Diagnosis

Treatment

Prevention

Surveillance

Summary

Key Terms

Review Questions

Topics for Further Discussion

Resources

Chapter 8 : Helicobacter Pylori, Ulcers, and Cancer

Major Concepts

Introduction

History

The Diseases

The Causative Agent

The Immune Response

Diagnosis

Treatment

Prevention

Surveillance

Summary

Key Terms

Review Questions

Topics for Further Discussion

Resources

Chapter 9 : Legionnaires’ Disease and Pontiac Fever

Major Concepts

Introduction

History

The Diseases

The Causative Agent

The Immune Response

Diagnosis

Treatment

Prevention

Surveillance

Summary

Key Terms

Review Questions

Topics for Further Discussion

Resources

Chapter 10 : Pulmonary Tuberculosis and Multidrug Resistance

Major Concepts

Introduction

History

The Disease

The Causative Agents

The Immune Response

Detection and Diagnosis

Treatment and Drug Resistance

Prevention

Surveillance

Summary

Key Terms

Review Questions

Topics for Further Discussion

Resources

Chapter 11 : Emerging Bacterial Drug Resistance

Major Concepts

Introduction

History

The Diseases, Causative Agents, and Treatment Options

Mechanisms of Resistance

Diagnosis

Prevention

Surveillance

Summary

Key Terms

Review Questions

Topics for Further Discussion

Resources

Part 3 : Viral Infections

Chapter 12 : Marburg and Ebola Hemorrhagic Fevers

Major Concepts

Introduction

History

The Diseases

The Causative Agents

The Immune Response

Diagnosis

Treatment

Prevention

Surveillance

Summary

Key Terms

Review Questions

Topics for Further Discussion

Resources

Chapter 13 : American Hemorrhagic Fevers

Major Concepts

Introduction

History

The Diseases

The Causative Agents

The Immune Response

Diagnosis

Treatment

Prevention

Surveillance

Summary

Key Terms

Review Questions

Topics for Further Discussion

Resources

Chapter 14 : Lassa Hemorrhagic Fever

Major Concepts

Introduction

History

The Disease

The Causative Agent

The Immune Response

Diagnosis

Treatment

Prevention

Surveillance

Summary

Key Terms

Review Questions

Topics for Further Discussion

Resources

Chapter 15 : Dengue Fever and Dengue Hemorrhagic Fever

Major Concepts

Introduction

History

The Diseases

The Causative Agent

The Immune Response

Diagnosis

Treatment

Prevention

Surveillance

Summary

Key Terms

Review Questions

Topics for Further Discussion

Resources

Chapter 16 : The Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome

Major Concepts

Introduction

History

The Diseases

The Causative Agent

The Immune Response

Diagnosis and Detection

Treatment

Prevention

Surveillance

Summary

Key Terms

Review Questions

Topics for Further Discussion

Resources

Chapter 17 : Human Herpesvirus 8 and Kaposi’s Sarcoma

Major Concepts

Introduction

History

The Diseases

The Causative Agent

The Immune Response

Diagnosis

Treatment

Prevention

Surveillance

Summary

Key Terms

Review Questions

Topics for Further Discussion

Resources

Chapter 18 : Hepatitis C

Major Concepts

Introduction

History

The Diseases

The Causative Agent

The Immune Response

Diagnosis

Treatment

Prevention

Surveillance

Summary

Key Terms

Review Questions

Topics for Further Discussion

Resources

Chapter 19 : Epidemic and Pandemic Influenza

Major Concepts

Introduction

History

The Disease

The Causative Agent

The Immune Response

Diagnosis

Treatment

Prevention

Surveillance

Summary

Key Terms

Review Questions

Topics for Further Discussion

Resources

Chapter 20 : Hantavirus Pulmonary Syndrome

Major Concepts

Introduction

History

The Diseases

The Causative Agents

The Immune Response

Diagnosis

Treatment

Prevention

Surveillance

Summary

Key Terms

Review Questions

Topics for Further Discussion

Resources

Chapter 21 : Severe Acute Respiratory Syndrome

Major Concepts

Introduction

History

The Disease

The Causative Agent

The Immune Response

Diagnosis

Treatment

Prevention

Surveillance

Summary

Key Terms

Review Questions

Topics for Further Discussion

Resources

Chapter 22 : West Nile Disease in the United States

Major Concepts

Introduction

History

The Diseases

The Causative Agent

The Immune Response

Diagnosis

Treatment

Prevention

Surveillance

Summary

Key Terms

Review Questions

Topics for Further Discussion

Resources

Chapter 23 : Monkeypox

Major Concepts

Introduction

History

The Disease

The Causative Agent

The Immune Response

Diagnosis

Treatment

Prevention

Surveillance

Summary

Key Terms

Review Questions

Topics for Further Discussion

Resources

Part 4 : Parasitic Infections

Chapter 24 : Malaria: Reemergence and Recent Successes

Major Concepts

Introduction

History

The Disease

The Causative Agents

The Immune Response

Diagnosis

Treatment and Drug Resistance

Prevention: Failures and Successes

Surveillance

Summary

Key Terms

Review Questions

Topics for Further Discussion

Resources

Chapter 25 : Babesiosis

Major Concepts

Introduction

History

The Disease

The Causative Agent

The Immune Response

Diagnosis

Treatment

Prevention

Surveillance

Summary

Key Terms

Review Questions

Topics for Further Discussion

Resources

Chapter 26 : Cryptosporidiosis

Major Concepts

Introduction

History

The Disease

The Causative Agents

The Immune Response

Diagnosis

Treatment

Prevention

Surveillance

Summary

Key Terms

Review Questions

Topics for Further Discussion

Resources

Chapter 27 : Chagas’ Disease and Its Emergence in the United States

Major Concepts

Introduction

History

The Disease

The Causative Agent

The Immune Response

Diagnosis

Treatment

Prevention

Surveillance

Summary

Key Terms

Review Questions

Topics for Further Discussion

Resources

Part 5 : Infectious Proteins

Chapter 28 : Creutzfeldt-Jakob Disease and Other Transmissible Spongiform Encephalopathies

Major Concepts

Introduction

History

The Diseases

The Causative Agents

The Immune Response

Diagnosis

Treatment

Prevention

Surveillance

Summary

Key Terms

Review Questions

Topics for Further Discussion

Resources

Part 6 : Special Issues in Infectious Diseases

Chapter 29 : The Emerging Importance of Infectious Diseases in the Immunosuppressed

Major Concepts

Introduction

Immunosuppressed Populations

Selected Causes of Immunosuppression

Infectious Diseases of the Immunosuppressed

Summary

Key Terms

Review Questions

Topics for Further Discussion

Resources

Chapter 30 : The Emerging Threat of Bioweapons

Major Concepts

Introduction

History

Bioterrorism Agents and Diseases

The Threat of Agroterrorism

Preparation for Biological Attacks

Protective Vaccines

Summary

Key Terms

Review Questions

Topics for Further Discussion

Resources

Glossary

Index

This book is dedicated to the health care professionals at the front line in the battle against infectious diseases and to the researchers who provide them with information about the enemies and weapons to defeat them.

image

TABLES AND FIGURES

Tables
Table 2.1 Immune cells and immune responses
Table 2.2 Actions of selected cytokines
Table 3.1 Incidence of Lyme disease by state
Table 5.1 Human diseases caused by Bartonella species
Table 5.2 Bartonella species that infect humans
Table 5.3 Treatment for diseases associated with Bartonella infection
Table 6.1 Diseases associated with GAS infection
Table 6.2 Actions of streptococcal virulence factors
Table 6.3 GAS and the human immune response
Table 7.1 Diseases associated with E. coli O157:H7 infection
Table 7.2 Routes of transmission of E. coli O157:H7
Table 7.3 E. coli O157:H7 virulence genes
Table 8.1 Helicobacter species associated with human disease
Table 8.2 H. pylori–induced changes in production of cytokines and chemokines
Table 8.3 Agents used in combination for the treatment of H. pylori infection
Table 9.1 Diagnostic techniques for Legionnaires’ disease
Table 9.2 Water treatment options to decrease Legionella contamination
Table 11.1 Mechanisms of antibiotic drug action
Table 13.1 Cytokines active during New World hemorrhagic fevers
Table 15.1 Factors influencing the development of DHF and DSS
Table 15.2 Roles of immune mediators in dengue infection
Table 15.3 Roles of leukocytes in dengue infection
Table 16.1 HIV transmission
Table 16.2 Total number of AIDS cases in nine U.S. states and Puerto Rico through 2007
Table 16.3 Viral and immunological characteristics during different stages of HIV infection
Table 16.4 Categories of anti-HIV agents
Table 17.1 Types of Kaposi’s sarcoma
Table 17.2 HHV-8 proteins that increase viral growth or survival
Table 19.1 Incidence and mortality: Human cases of avian influenza, 2003–January 2008
Table 20.1 Distinguishing clinical characteristics for HFRS and HPS
Table 20.2 Pathogenic members of the genus Hantavirus, family Bunyaviridae
Table 20.3 Hantavirus pulmonary syndrome in the Americas, 1993–2004
Table 21.1 Summary of probable SARS cases, November 1, 2002–July 31, 2003
Table 21.2 Graded implementation of community containment measures
Table 22.1 West Nile disease in the United States, 2008
Table 25.1 Tickborne diseases of humans
Table 25.2 Babesia species and their hosts
Table 26.1 Several Apicomplexan parasites of humans
Table 26.2 Immune system components activated by Cryptosporidium infection
Table 28.1 Infectious agents of humans
Table 28.2 Differences between sporadic and variant CJD
Table 29.1 Some factors that inhibit immune system functioning
Table 30.1 Categories of potential biological weapons agents
Table 30.2 Agents of viral hemorrhagic fever
Table 30.3 Distribution of the viruses that cause hemorrhagic fever (HF)
Table 30.4 Agents of viral encephalitis in humans
Figures
Figure 1.1 Child with smallpox
Figure 1.2 Sign announcing smallpox vaccination
Figure 1.3 Incidence of diabetes in the United States
Figure 2.1 Yellow fever virus
Figure 2.2 Transmission via respiratory secretions
Figure 3.1 Annual incidence of reported cases of Lyme disease in the United States, by age group and sex, 1992–2004
Figure 3.2 Reported cases of Lyme disease in the United States, 1994–2008
Figure 3.3 Erythema migrans
Figure 3.4 Spirochete
Figure 3.5 Nymphal Amblyomma americanum (lone star tick) and engorged tick
Figure 3.6 Approved method of tick removal
Figure 4.1 Range of one of the principal tick vectors in the United States
Figure 4.2 Lone star tick
Figure 4.3 Number of ehrlichiosis cases in the United States, 1999–2006
Figure 4.4 Ehrlichiosis by state, 2001–2002
Figure 4.5 Black-legged tick
Figure 4.6 Anaplasmosis cases in the United States, 1999–2006
Figure 4.7 Anaplasmosis by state, 2001–2002
Figure 5.1 Small, localized lesion of cat-scratch disease
Figure 5.2 Human body louse
Figure 6.1 Skin lesions due to impetigo
Figure 6.2 “Strawberry tongue”
Figure 6.3 Erysipelas
Figure 6.4 Group A streptococci growing in chains
Figure 6.5 Beta-hemolytic growth: ring of clearing around colonies grown on agar containing sheep red blood cells
Figure 7.1 Scanning electron micrograph of E. coli O157:H7
Figure 7.2 Inoculation of bacteria from a fecal sample onto an agar plate for isolation
Figure 8.1 Gastric cancer
Figure 9.1 Bilateral pulmonary infiltrates during Legionnaires’ disease
Figure 9.2 Legionella pneumophila bacilli
Figure 9.3 Scanning electron micrograph demonstrating the association of Hartmannella vermiformis amoebas with Legionella pneumophila on a potable water biofilm containing Pseudomonas aeruginosa, Klebsiella pneumoniae, and Flavobacterium
Figure 9.4 The life cycle of Legionella
Figure 9.5 Colony isolation on buffered charcoal-yeast extract (BCYE) agar
Figure 9.6 Fluorescent antibody staining to detect the presence of L. pneumophila
Figure 10.1 Advanced bilateral tuberculosis
Figure 10.2 Mycobacterium tuberculosis
Figure 10.3 M. tuberculosis with acid-fast stain
Figure 10.4 Mobile tuberculosis testing clinic, 1963
Figure 10.5 Measuring the extent of the hypersensitivity reaction during a Mantoux tuberculin skin test
Figure 11.1 MRSA
Figure 11.2 Cutaneous lesion due to MRSA infection
Figure 11.3 Electron micrograph of Pseudomonas aeruginosa
Figure 11.4 Measuring antibiotic resistance: A clearance zone appears around bacteria susceptible to antibiotics on the disks
Figure 12.1 Surveying for infection during the 1976 Ebola outbreak in Zaire
Figure 12.2 Graveyard containing some of the first victims of the Ebola outbreak in Sudan in 1976
Figure 12.3 Lung pathology due to Marburg virus infection, showing breakdown of alveolar walls, leading to pulmonary edema
Figure 12.4 Acute tubular necrosis and glomerular fibrin thrombosis in the kidney of a patient with Marburg hemorrhagic fever
Figure 12.5 Histology of liver tissue infected with Ebola virus
Figure 12.6 Electron micrographs of Ebola and Marburg viruses
Figure 12.7 Budding of Ebola virus from the plasma membrane of an infected cell
Figure 12.8 Sampling animal tissues to determine the reservoir species for Ebola virus, Kikwit, Zaire, 1995
Figure 12.9 Isolation unit harboring persons with suspected cases of Ebola hemorrhagic fever in 1976
Figure 12.10 Technician in protective field gear, Zaire, 1976
Figure 12.11 Barrier clothing donned prior to entering an Ebola isolation ward, Kikwit, Zaire, 1995
Figure 12.12 Vehicles used to cross the rugged roads of Zaire during the 1976 Ebola outbreak
Figure 13.1 Petechial lesions
Figure 13.2 Cotton rat
Figure 13.3 “Sandy” appearance of New World arenaviruses
Figure 13.4 Machupo virus
Figure 13.5 Working in a Biosafety Level 4 laboratory
Figure 13.6 Baiting a rodent trap with peanut butter
Figure 14.1 Lassa witch doctors
Figure 14.2 Serum from a nurse who contracted Lassa fever in Nigeria, 1969
Figure 14.3 Treating a child with Lassa fever in Sierra Leone
Figure 14.4 Hepatitis caused by Lassa virus
Figure 14.5 Budding of Lassa viruses from an infected host cell
Figure 14.6 Receiving plasma to maintain blood volume during Lassa fever
Figure 14.7 Barrier nursing in a men’s Lassa fever ward in Sierra Leone, 1977
Figure 14.8 Viewing tissue samples during a Lassa fever investigation
Figure 15.1 Female Aedes aegypti taking a blood meal
Figure 15.2 Cemetery in New Orleans serving as an urban breeding site for A. aegypti
Figure 15.3 Testing water from a tree hole for the presence of mosquito larvae
Figure 16.1 Chemical structure of AZT (zidovudine)
Figure 16.2 Candida infection in the mouth of an HIV-positive person
Figure 16.3 Toxoplasma infection of the heart
Figure 16.4 Two human retroviruses that infect T lymphocytes
Figure 16.5 HIV budding from a T helper lymphocyte
Figure 16.6 Multinucleated giant cell formed during HIV infection
Figure 16.7 Proper disposal of a used needle in a “sharps” container
Figure 17.1 Skin lesions of Kaposi’s sarcoma
Figure 17.2 Kaposi’s sarcoma of the hard palate of an HIV-positive person
Figure 17.3 Polymerase chain reaction (PCR)
Figure 17.4 The chemical structure of Taxol
Figure 18.1 Primary causes of chronic liver disease
Figure 18.2 Cirrhosis of the liver
Figure 18.3 Lichen planus
Figure 18.4 Electron micrograph of hepatitis viruses
Figure 18.5 The chemical structure of ribavirin
Figure 18.6 Disposing of blood-contaminated material
Figure 19.1 Annual mortality rate during recent influenza pandemics
Figure 19.2 Boxes of “swine flu” vaccine, stored in connection with the National Influenza Immunization Program
Figure 19.3 H3N2 “Hong Kong flu” virus showing spikes of hemagglutinin and neuraminidase on the surface
Figure 19.4 Inoculating a chick embryo with influenza virus during vaccine preparation
Figure 19.5 Administration of a live attenuated intranasal H1N1 vaccine
Figure 20.1 Hantavirus pulmonary syndrome (HPS) cases, by reporting states
Figure 20.2 Bilateral pulmonary effusion during HPS
Figure 20.3 Interstitial pneumonitis and intra-alveolar edema
Figure 20.4 Electron micrograph of the Sin Nombre virus
Figure 20.5 Deer mouse vector of the Sin Nombre virus
Figure 20.6 Activated immune system: lymph node from an HPS patient
Figure 20.7 Determining virus numbers in infected cells inside a BioSafety Level 4 laboratory
Figure 20.8 Examining samples suspected of involvement in a hantavirus outbreak
Figure 20.9 Donning protective wear prior to collecting deer mice during a hantavirus field study
Figure 21.1 Damage to the alveoli of the lungs caused by SARS
Figure 21.2 SARS-CoV with projecting spike proteins
Figure 21.3 Processing samples from a SARS patient
Figure 22.1 West Nile cases in the United States, 2000
Figure 22.2 West Nile cases in the United States, 2003
Figure 22.3 West Nile cases in the United States through December 15, 2008
Figure 22.4 Electron micrograph of West Nile virus
Figure 22.5 Culex tarsalis, the West Nile virus vector
Figure 22.6 Application of DEET to clothing
Figure 22.7 Breeding grounds for Culex mosquitoes: irrigation ditch and water in a tree hole
Figure 22.8 Capturing wild birds to test for West Nile virus infection
Figure 23.1 Humans and nonhuman primates share living space in many countries in Africa and Asia
Figure 23.2 Vaccination with vaccinia virus during the smallpox eradication program of the 1970s in West Africa
Figure 23.3 Monkeypox skin lesions
Figure 23.4 Chickenpox rash on the chest
Figure 23.5 Electron micrographs of two morphological forms of monkeypox virus
Figure 23.6 Electron micrographs of other orthopoxviruses that infect humans
Figure 23.7 Real-time PCR
Figure 23.8 Dryvax vaccine used to prevent smallpox and monkeypox
Figure 24.1 Construction of a drainage ditch to eliminate vector breeding sites, Virginia, 1920s
Figure 24.2 One of the fruits of malaria reduction programs in the Western Hemisphere: the Panama Canal
Figure 24.3 Malaria parasite life cycle
Figure 24.4 Microgametocyte and macrogametocyte: Plasmodium falciparum
Figure 24.5 Erythrocytes infected by multiple ring-stage Plasmodium falciparum
Figure 24.6 Plasmodium vivax schizont containing 16 trophozoites
Figure 24.7 Chemical structures of quinine and chloroquine
Figure 24.8 Skin exposure during mixing of the pesticide malathion
Figure 24.9 Female Anopheles gambiae laying eggs
Figure 25.1 Babesia protozoa in the tetrad conformation
Figure 25.2 Babesia ring-form trophozoites
Figure 25.3 The chemical structure of clindamycin
Figure 26.1 Life cycle of Cryptosporidium
Figure 26.2 Cryptosporidium in the gallbladder
Figure 26.3 Stool sample containing Cryptosporidium
Figure 27.1 Romaña’s sign: edema above the right eye
Figure 27.2 T. cruzi bloodstream trypomastigote (center)
Figure 27.3 Cluster of T. cruzi amastigotes inside heart cells (center)
Figure 27.4 Triatoma infestans, a “kissing bug” vector of Chagas’ disease
Figure 27.5 Life cycle of Trypanosoma cruzi
Figure 28.1 Unsteadiness of a BSE-affected cow
Figure 28.2 BSE cases in North America, by year and country of death, 1993 and 2003–2010
Figure 28.3 Areas reporting chronic wasting syndrome in wild deer, elk, and moose, as of March 2010
Figure 28.4 Normal cellular form of the prion protein versus the scrapie form
Figure 29.1 Pseudomonas aeruginosa
Figure 29.2 Clostridium difficile
Figure 29.3 Shingles due to varicella-zoster virus in a person with a history of leukemia
Figure 29.4 Histoplasma capsulatum
Figure 29.5 Pneumonia resulting from Candida infection
Figure 29.6 Coccidioides immitis infection of the skin
Figure 29.7 Several intracellular Toxoplasma gondii protozoa in the heart
Figure 29.8 Mild leishmanial lesion
Figure 29.9 Ascaris lumbricoides
Figure 30.1 Skin lesions due to bubonic plague
Figure 30.2 Rat flea, the vector of Yersinia pestis, causative agent of bubonic plague
Figure 30.3 Hemorrhage of the brain due to anthrax
Figure 30.4 Skin lesion due to Francisella tularensis infection
Figure 30.5 Rash typical of Rocky Mountain spotted fever
Figure 30.6 Burkholderia, obligate aerobic bacteria

PREFACE

Headlines and news reports warn of “Flesh-Eating Bacteria,” “Mad Cow Disease,” the AIDS pandemic, and flu pandemics. Drug-resistant bacteria are in our hospitals and our locker-rooms, malaria incidence is on the rise, and TB is reemerging. Every year, new infectious threats appear or old diseases spread to new areas or attack with greater viciousness. Some of the new diseases rear their heads and then suddenly vanish, like SARS, while others may be with humanity for the foreseeable future. The media warn and inform of the newly emerging diseases yet also may capitalize on public fears by overstating the real danger or describing the diseases in the most gruesome terms possible before moving on to the next “killer virus” predicted to kill tens of millions of people. Meanwhile, other, less spectacular diseases spread unnoticed through certain segments of the world’s population (as babesiosis or cryptosporidiosis in immunosuppressed persons or dengue hemorrhagic fever in many parts of the world). This book attempts to provide a balanced overview of some of the emerging and reemerging diseases of current times. No single text could cover all of these diseases, but a number of illnesses have been selected which are found in different regions of the world. Many of these strike tropical regions or developing countries with particular virulence, others are found in temperate or developed areas, and still other microbes and infections are more indiscriminate. In five or ten years, other diseases may have emerged as major killers of humanity while some of the current threats may have been neutralized by the development of new drugs, vaccines, or other preventive measures. Poverty, civil unrest and war, and lack of access to modern health care supplies and facilities have fueled epidemics of some of the diseases covered in this book. If these underlying causes could be nullified or eliminated, many diseases would be controllable and large numbers of people freed from their crippling effects upon health and prosperity.

Since many of the infectious diseases presented in this book are relatively new or little information is known about the causative agent, much of the material has been derived from recent infectious disease journals or other related articles. Other timely information is derived from the Centers for Disease Control and Prevention, the World Health Organization, or MedLine Plus. The excellent Emerging Infections series from the American Society for Microbiology have also provided much of the background material for this book.

This text has been written to accommodate several different groups of students, including but not limited to, upper-level undergraduate or graduate students in biology or medically-related professions, public health students, and persons already working in the healthcare arena. Not all of the information may be useful to every audience but the material (especially some of the immunology and microbiology) is presented for use by those who wish to have a greater understanding of how the microbes function and cause disease and how the human body attempts to remove or minimize the damage. This information may be skipped without losing understanding of the disease itself or its prevention and treatment.

The diseases are divided by type of causative agent: bacteria, viruses, protozoa, or infectious protein. Those chapters which deal with diseases induced by infection with a single organism or group of organisms are organized in a similar fashion: introduction, history, the disease(s), the causative agent(s), the immune response, diagnosis, treatment, prevention, and surveillance. The Major Concepts section presents a brief overview of the most important concepts found in the chapter. The Summary is a thumbnail sketch of the basic information about the microbe and the associated disease. Review Questions help students to test their knowledge of the material, while Topics for Further Discussion allow for a wider conversation of the implications of the disease and challenge students to “think outside of the box” to develop new solutions. There are no right answers or solutions to the material found within this section; rather, it is hoped that any students entering into the medical or research fields, as well as those destined to serve in public health, may learn to search for innovative ways of dealing with health-related problems.

The two introductory chapters provide basic information that will be useful for the other chapters, including an introduction to emerging and reemerging infectious diseases, proposed causes for disease emergence, very basic microbiology, and very basic immunology. The latter is included since a discussion of disease needs to include how the host attempts to defend itself as well as what can go wrong with this “protective” response. The last two chapters cover topics of particular interest. Chapter Twenty-Nine discusses emerging diseases in immunocompromised individuals since the numbers of people in this group are increasing rapidly, posing unique challenges to public health. Chapter Thirty describes several of the agents that may be used in acts of bioterrorism. Many of these agents have already been used for this purpose. Hopefully, the spread of knowledge about the threat of bioterrorism will discourage its usage in the future.

Lisa A. Beltz

New Philadelphia, Ohio

February 2011

THE AUTHOR

Dr. Lisa A. Beltz is an assistant professor in the Department of Biology at Kent State University at Tuscarawas, in New Philadelphia, Ohio. She has taught a number of medically-related biology courses during her 14 years of teaching at Kent State University and the University of Northern Iowa. Prior to teaching, she studied two of the diseases described in this book. While a graduate student at Michigan State University, she examined the mechanisms by which Trypanosoma cruzi inhibits human immune responses, allowing the parasite to kill large numbers of people in Central and South America. Later, at Johns Hopkins University and the University of Pittsburgh, she studied interactions between the simian and human immunodeficiency viruses and bone marrow cells as well as exploring the mechanisms by which HIV kills white blood cells. Dr. Beltz was the co-originator of the course Cancer and Emerging Infectious Diseases during her time in Iowa. The need for a college-level textbook in this field became apparent over her seven years of teaching the course. Dr. Beltz’s more recent research has involved studying the impact of nitrate and other environmental contaminants on the human immune system and studying the effects of green tea components upon normal and cancerous white blood cells.

ACKNOWLEDGMENTS

I would like to thank the following reviewers for their time and many helpful suggestions: Gokul Das, John E. Gustafson, Kathy Hanley, Carrie Horwich, Frank Jenkins, Stanley Katz, and Terri Rebmann. Mr. Andrew Pasternak and Seth Schwartz of Jossey-Bass played major roles in the writing of this text. Their ideas shaped the book and guided every step of its creation. I am also grateful for the support of the faculty and administration of Kent State University at Tuscarawas and Kent State University at Kent, particularly Dean Gregg Andrews from the Tuscarawas Campus, Dr. James Blank, Chair of the Department of Biology, Dr. Christopher Fenk, and Dr. Donald Gerbig. They provided me with the time and atmosphere in which to develop my ideas into the final product. Finally, I wish to thank my family for their patience and encouragement during the writing process.

L.A.B.

PART I

INTRODUCTION TO EMERGING INFECTIOUS DISEASES