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I

Basic Principles

General Aspects of Medical

1

 

 

Microbiology

 

 

 

Basic Principles of Immunology

 

 

 

2

 

 

 

 

 

 

 

 

 

 

II

Bacteriology

General Bacteriology

3

 

 

Bacteria as Human Pathogens

 

 

 

 

 

 

4

 

 

 

 

 

 

 

 

 

 

III

Mycology

General Mycology

5

 

 

Fungi as Human Pathogens

 

 

 

 

 

 

6

 

 

 

 

 

 

 

 

IV Virology

General Virology

7

 

 

Viruses as Human Pathogens

 

 

 

 

 

 

8

 

 

 

 

 

V

Parasitology

Protozoa

 

9

 

 

Helminths

 

 

 

 

 

 

10

 

 

Arthropods

 

 

 

 

 

 

11

 

 

 

 

VI Organ System

Etiological and Laboratory

 

12

 

Infections

Diagnostic Summaries in

 

 

 

Tabular Form

 

http://www.bestmedbook.com/

II

At a Glance…

The book is divided into six main sections. The color-coded reference guide on the first page will help you find what you need.

The aspects of each pathogen are covered systematically, using the following order wherever practicable:

& Classification

& Pathogenesis and Clinical Picture

& Localization

& Diagnosis

& Morphology and Culturing

& Therapy

& Developmental Cycle

& Epidemiology and Prophylaxis

& A summary at the beginning of a chapter or section provides a quick overview of what the main text covers. Students can use the summaries to obtain a quick recapitulation of the main points. &

The Main Sections at a Glance

a The many colored illustrations serve to clarify complex topics or provide definitive impressions of pathogen morphology.

b The header caption above each illustration gives the reader the essence of what is shown.

c The detailed legends explain the illustrations independently of the main text.

Additional information

In-depth expositions and supplementary knowledge are framed in boxes interspersed throughout the main body of text. The headings outline the topic covered, enabling the reader to decide whether the specific material is needed at the present time.

Medical Microbiology

Fritz H. Kayser, M.D.

Emeritus Professor of Medical Microbiology

Institute of Medical Microbiology

University of Zurich

Zurich, Switzerland

Kurt A. Bienz, Ph.D.

Emeritus Professor of Virology

Institute of Medical Microbiology

University of Basle

Basle, Switzerland

Johannes Eckert, D.V.M.

Emeritus Professor of Parasitology

Institute of Parasitology

University of Zurich

Zurich, Switzerland

Rolf M. Zinkernagel, M.D.

Professor

Institute of Experimental Immunology

Department of Pathology

Zurich, Switzerland

177 illustrations

97 tables

Thieme

Stuttgart ! New York

Library of Congress Cataloging-in- Publication Data

Medizinische Mikrobiologie. English. Medical microbiology / Fritz H. Kayser ...

[et al.]. p. ; cm.

ISBN 3-13-131991-7 (GTV : alk. paper) – ISBN 1-58890-245-5 (TNY; alk. paper) 1. Medical microbiology.

[DNLM: 1. Microbiology. QW 4 M491 2005a] I. Kayser, F. H. (Fritz H.) II. Title. QR46.M48813 2005

616.9’041–dc22 2004021965

1st German edition 1969 2nd German edition 1971 3rd German edition 1974 4th German edition 1978 5th German edition 1982 6th German edition 1986 7th German edition 1989 8th German edition 1993 9th German edition 1998

1st Greek edition 1995 1st Italian edition 1996 1st Japanese edition 1980

1st Spanish edition 1974 2nd Spanish edition 1982

1st Turkish edition 2001

This book is an authorized and updated translation of the 10th German edition published and copyrighted 2001

by Georg Thieme Verlag, Stuttgart, Germany. Title of the German edition: Medizinische Mikrobiologie

ª 2005 Georg Thieme Verlag,

Ru¨ digerstraße 14, 70469 Stuttgart, Germany

http://www. thieme.de

Thieme New York, 333 Seventh Avenue, New York, NY 10001 USA http://www.thieme.com

Cover design: Cyclus, Stuttgart Typesetting by Mitterweger & Partner GmbH, 68723 Plankstadt

Printed in Germany by Appl, Wemding

ISBN 3-13-131991-7 (GTV)

 

ISBN 1-58890-245-5 (TNY)

1 2 3 4 5

Important note: Medicine is an ever-chan- ging science undergoing continual development. Research and clinical experience are continually expanding our knowledge, in particular our knowledge of proper treatment and drug therapy. Insofar as this book mentions any dosage or application, readers may rest assured that the authors, editors, and publishers have made every effort to ensure that such references are in accordance with the state of knowledge at the time of production of the book.

Nevertheless, this does not involve, imply, or express any guarantee or responsibility on the part of the publishers in respect to any dosage instructions and forms of applications stated in the book. Every user is requested to examine carefully the manufacturers’ leaflets accompanying each drug and to check, if necessary in consultation with a physician or specialist, whether the dosage schedules mentioned therein or the contraindications stated by the manufacturers differ from the statements made in the present book. Such examination is particularly important with drugs that are either rarely used or have been newly released on the market. Every dosage schedule or every form of application used is entirely at the user’s own risk and responsibility. The authors and publishers request every user to report to the publishers any discrepancies or inaccuracies noticed.

Some of the product names, patents, and registered designs referred to in this book are in fact registered trademarks or proprietary names even though specific reference to this fact is not always made in the text. Therefore, the appearance of a name without designation as proprietary is not to be construed as a representation by the publisher that it is in the public domain.

This book, including all parts thereof, is legally protected by copyright. Any use, exploitation, or commercialization outside the narrow limits set by copyright legislation, without the publisher’s consent, is illegal and liable to prosecution. This applies in particular to photostat reproduction, copying, mimeographing, preparation of microfilms, and electronic data processing and storage.

V

Preface

Medical Microbiology comprises and integrates the fields of immunology, bacteriology, virology, mycology, and parasitology, each of which has seen considerable independent development in the past few decades. The common bond between them is the focus on the causes of infectious diseases and on the reactions of the host to the pathogens. Although the advent of antibiotics and vaccines has certainly taken the dread out of many infectious diseases, the threat of infection is still a fact of life: New pathogens are constantly being discovered; strains of „old“ ones have developed resistance to antibiotics, making therapy more and more difficult; incurable infectious diseases (AIDS, rabies) are still with us.

The objective of this textbook of medical microbiology is to instill a broadbased knowledge of the etiologic organisms causing disease and the pathogenetic mechanisms leading to clinically manifest infections into its users. This knowledge is a necessary prerequisite for the diagnosis, therapy, and prevention of infectious diseases. This book addresses primarily students of medicine, dentistry, and pharmacy. Beyond this academic purpose, its usefulness extends to all medical professions and most particularly to physicians working in both clinical and private practice settings.

This book makes the vast and complex field of medical microbiology more accessible by the use of four-color graphics and numerous illustrations with detailed explanatory legends. The many tables present knowledge in a cogent and useful form. Most chapters begin with a concise summary, and in-depth and supplementary knowledge are provided in boxes separating them from the main body of text.

This textbook has doubtless benefited from the extensive academic teaching and the profound research experience of its authors, all of whom are recognized authorities in their fields.

The authors would like to thank all colleagues whose contributions and advice have been a great help and who were so generous with illustration material. The authors are also grateful to the specialists at Thieme Verlag and to the graphic design staff for their cooperation.

Zurich, fall of 2004

On behalf of the authors

 

Fritz H. Kayser

VII

Abbreviations

&ABC:

antigen-binding cell

CCC:

covalently closed circular

ABS:

antigen-binding site

 

(DNA)

ADA:

adenosine deaminase

CD:

cluster of differentiation/

ADCC:

antibody-dependent

 

cluster determinant

 

cellular cytotoxicity

CDR:

complementarity-deter-

ADE:

antibody-dependent

 

mining regions

 

enhancement (of viral

CE:

cystic echinococcosis

 

infection)

CEA:

carcinoembryonic antigen

AE:

alveolar echinococcosis

CFA:

colonizing factor antigen

AFC:

antibody-forming cell

CFT:

complement fixation test

AFP:

alpha-fetoprotein

CFU:

colony forming units

AIDS:

acquired immune

CJD:

Creutzfeldt-Jakob disease

 

deficiency syndrome

CLIP:

class II-inhibiting protein

ANA:

antinuclear antibodies

CMI:

cell-mediated immunity

APC:

antigen-presenting cell

CMV:

cytomegaly virus

APO:

apoptosis antigen

 

(cytomegalovirus)

aPV:

acellular pertussis vaccine

CNS:

central nervous system/

ASL titer: antistreptolysin titer

 

coagulase-negative

AZT:

azidothymidine

 

staphylococci

 

 

Con A:

concanavalin A

&BAL:

bronchoalveolar lavage

CPE:

cytopathic effect

BALT:

bronchus-associated

CPH:

chronic persistent

 

lymphoid tissue

 

hepatitis

BCG:

bacillus Calmette-Guerin

CR:

cistron region

BCGF:

B-cell growth factor

CSF:

colony-stimulating factor

Bcl2:

B-cell leukemia 2 antigen

CTA:

cholera toxin A

BSE:

bovine spongiform ence-

CTB:

cholera toxin B

 

phalopathy

CTL:

cytotoxic CD8+ T cell

 

 

CTX:

cholera toxin (element)

&C:

complement

 

 

CAH:

chronic aggressive

&DAF:

decay accelerating factor

 

hepatitis

DAG:

diacyl glycerol

CAM:

cell adhesion molecules

DARC:

Duffy antigen receptor

CAPD:

continuous ambulant

 

for chemokines

 

peritoneal dialysis

DC:

dendritic cells

VIII Abbreviations

 

 

 

 

 

 

 

 

 

 

virus

DHF:

dengue hemorrhagic

 

 

fever

EPEC:

enteropathogenic

DHPG:

dihydroxy propoxy-

 

E. coli

 

methyl guanine

EPS:

extracellular polymer

D vaccine:

 

substance

diphtheria toxoid vaccine

ETEC:

enterotoxic E. coli

DNA:

deoxyribonucleic acid

EU:

European Union

DNP:

dinitrophenol

 

 

 

DR:

direct repeats

&F factor:

fertility factor

ds:

double-stranded nucleic

FA:

Freund’s adjuvant

 

acid

FACS:

fluorescence-activated

DSS:

dengue shock syndrome

 

cell sorter

DTH:

delayed type hypersensi-

Fas:

F antigen

 

tivity

FcR:

Fc receptor

DtxR:

diphtheria toxin repressor

FDC:

follicular dendritic cell

&EA:

early antigen

FHA:

filamentous hemagglutin

FITC:

fluorescein isothiocyanate

EAE:

experimental allergic

FTA-ABS:

fluorescent treponemal

 

encephalitis

 

antibody absorption test

EAF:

EPEC adhesion factor

 

 

 

EaggEC:

enteroaggregative

&G6PDD:

glucose-6-phosphate

 

Escherichia coli

 

dehydrogenase deficiency

EB:

elementary body

GAE:

granulomatous amebic

EBNA:

Epstein-Barr nuclear

 

encephalitis

 

antigen

gag:

group-specific antigen

EBV:

Epstein-Barr virus

GALT:

gut-associated lymphoid

EDTA:

ethylene diamine tetra-

 

tissue

 

acetic acid

GC:

guanine-cytosine/gas

eEF2:

eucaryotic elongation

 

chromatography

 

factor 2

GM-CSF:

granulocyte-macrophage

EF:

edema factor in spotted

 

colony-stimulating factor

 

fevers

GP:

glycoprotein

EHEC:

enterohemorrhagic

GSS:

Gerstmann-Stra¨ussler-

 

E. coli

 

Scheinker (syndrome)

EIA:

enzyme immunoassay

GVH:

graft-versus-host (reaction)

EIEC:

enteroinvasive E. coli

 

 

 

EITB:

enzyme-linked immuno-

&H:

heavy chain

 

electrotransfer blot

HACEK:

Haemophilus, Actinoba-

ELISA:

enzyme-linked immuno-

 

cillus, Cardiobacterium,

 

sorbent assay

 

Eikenella, Kingella

EM:

electron microscopy

HAT:

hypoxanthine,

EMB:

ethambutol

 

aminopterin, thymidine

EMCV:

encephalomyocarditis

Hb:

hemoglobin

 

 

 

 

Abbreviations IX

 

 

 

 

 

 

 

 

HBs:

hepatitis B surface antigen

&IB:

initial body

HBV:

hepatitis B virus

IEP:

immunoelectrophoresis

HB vaccine: hepatitis B vaccine

IFAT:

indirect immunofluores-

HCC:

hepatocellular carcinoma

 

cent antibody test

HCV:

hepatitis C virus/

IFN:

interferon

 

(human corona virus)

Ig:

immunoglobulin

HDCV:

human diploid cell

IHA:

indirect hemagglutina-

 

vaccine

 

tion

HDV:

hepatitis D virus

(I)IF:

(indirect) immunofluor-

HEV:

hepatitis E virus/high

 

escence

 

endothelial venules

IL:

interleukin

Hfr:

high frequency of recom-

In:

integron

 

bination

INH:

isoniazid (isonicotinic

HGE:

human granulocytic

 

acid hydrazide)

 

ehrlichiosis

IP3:

inositol trisphosphate

HGV:

hepatitis G virus

IPV:

inactivated polio vaccine

HHV:

human herpes virus

IR:

inverted repeats

HI:

hemagglutination

Ir genes:

immune response genes

 

inhibition

IS:

insertion sequence/inter-

Hib:

Haemophilus influenzae,

 

cistron space

 

type b serovar

 

 

 

HIV:

human immunodefi-

&K cells:

killer cells

 

ciency virus

&L:

light chain

HME:

human monocytic

LA:

latex agglutination

 

ehrlichiosis

 

lac operon: lactose operon

HPLC:

high-pressure liquid

LAK:

lymphokine-activated

 

chromatography

 

 

killer cells

HPS:

hantavirus pulmonary

 

LB:

leprosy bacterium

 

syndrome

 

LCA:

leukocyte common

HRF:

homologous restriction

 

antigen

 

factor (also histamine

 

 

LCM(V):

lymphocytic chorio-

 

releasing factor)

 

 

meningitis (virus)

HFRS:

hemorrhagic fever with

 

LE:

lupus erythematosus

 

renal syndrome

 

LFA:

lymphocyte function

hsp70:

heat shock protein 70

 

antigen

HSV:

herpes simplex virus

 

LGL:

large granular

HTLV:

human T cell leukemia

 

lymphocyte

 

virus

 

 

LIF:

leukemia inhibitory

HuCV:

human calicivirus

 

factor

HUS:

hemolytic-uremic

 

LL:

lepromatous leprosy

 

syndrome

 

LM:

light microscopy

HVG:

host-versus-graft

LMC:

larva migrans cutanea

 

(reaction)

 

 

 

 

X Abbreviations

LMV: larva migrans visceralis LOS: lipo-oligosaccharide LPS: lipopolysaccharide

LT: heat-labile E. coli enterotoxin

LTR: long terminal repeats

&MAC: membrane attack complex

MAF: macrophage activating factor

MALT: mucosa-associated lymphoid tissue

MBC: minimal bactericidal concentration

MBP: major basic protein/ myelin basic protein MCP: membrane cofactor

protein

M-CSF: macrophage colonystimulating factor

MF: merthiolate-formalin Mf: microfilaria

MHC: major histocompatibility complex

MIC: minimal inhibitory concentration

MIF: migration inhibitory factor/microimmunefluorescence

MLC: mixed lymphocyte culture

MLR: mixed lymphocyte reaction

MMR: live, attenuated, trivalent measles, mumps, and rubella vaccine

MMTV: murine mammary tumor virus

MOMP: major outer membrane protein

MOTT: mycobacteria other than TB (see NTM)

MZM: marginal zone macrophages

&NANB: nonA, nonB hepatitis NCVP: noncapsidic viral protein

NE: Nephropathica epidemica

Nfa: nonfimbrial adhesin NGU: nongonococcal urethritis NIDEP: German study on assess-

ment and prevention of nosocomial infections

NK cells: natural killer cells NTM: nontuberculous

(atypical) mycobateria (see MOTT)

NTR: nontranslated region

&OC: open circular (DNA)

OM: opportunistic mycosis OMP, Omp: outer membrane

protein

OPV: oral polio vaccine OSP, Osp:outer surface protein

&P:

promoter

 

PAE:

postantibiotic effect

PAIR:

puncture, aspiration, in-

 

jection, respiration

PAS:

para-aminosalicylic acid/

 

periodic acid-Schiff stain

PAM:

primary amebic

 

meningoencephalitis

PAP:

pyelonephritis-associated

 

pili

 

PBL:

peripheral

blood lym-

 

phocytes

 

PC:

phosphoryl

choline/pri-

 

mary (tuberculous)

 

complex, Ghon’s complex

PCA:

passive cutaneous

 

anaphylaxis

 

PCR:

polymerase chain reaction