Outbreak
Description
More than 90 outbreak case studies, organized into six sections according to the human body system affected, illustrate the wide range of diseases caused by microbial pathogens. The studies are presented at differing levels of difficulty and can be taught at all undergraduate levels. Each case study includes questions for students to think about, discuss, and answer, and the book includes an appendix that directs students to the specific reference material on which each case was based, providing the opportunity to investigate further and to apply the reference content to the case being studied.
Each of the six sections of the book concludes with a College Perspective and a Global Perspective case study. The College Perspective provides a direct and practical link between the microbiology course and the daily lives of students. The Global Perspective connects students with outbreaks that have occurred in countries around the world to facilitate understanding of the social, religious, economic, and political values at play in the treatment and prevention of infectious disease. At the end of every section, detailed descriptions offer concise yet complete information on each disease involved in that section.
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Content
Introduction xiii
About the Author xvii
Section I Outbreaks of Diseases of the Respiratory Tract 1
Outbreak I-1 A Legionellosis Outbreak-Barceloneta 4
Outbreak I-2 An Outbreak of Respiratory Syncytial Virus Infection-Arviat, Canada 5
Outbreak I-3 A Tuberculosis Outbreak in a Prison Housing Inmates Infected with HIV-South Carolina 7
Outbreak I-4 An Otitis Media Outbreak in a Child Care Center-Georgia 9
Outbreak I-5 An Outbreak of a Rash-Venezuela and Colombia 11
Outbreak I-6 Hantavirus Pulmonary Syndrome Outbreak-Vermont 13
Outbreak I-7 A Diphtheria Outbreak-Newly Independent States of the Former Soviet Union 15
Outbreak I-8 An Outbreak of Mycoplasmal Pneumonia-Ohio 17
Outbreak I-9 A Pneumonia Outbreak in a Nursing Home-New Jersey 18
Outbreak I-10 Past and Future Pandemics of Influenza A-Worldwide, 1918 to Present 19
Outbreak I-11 A Pharyngitis Outbreak in the Marine Corps-San Diego 21
Outbreak I-12 A Measles Outbreak in Kosovar Refugee Children-Albania 23
Outbreak I-13 A Swimming Pool-Related Outbreak of Pharyngitis and Conjunctivitis-Spain 25
Outbreak I-14 A Cruise Ship-Associated Legionnaires' Disease Outbreak 27
Outbreak I-15 A Pertussis Epidemic-Washington State 29
College Perspective
Outbreak I-16 A Mumps Outbreak on a University Campus-California 31
Global Perspective
Outbreak I-17 A Diphtheria Outbreak-Colombia 34
Reference Material 37
Section II Outbreaks of Disease of the Gastrointestinal Tract 51
Outbreak II-1 A Salmonella enterica serovar Enteritidis Outbreak from Eating Eggs-Multistate 54
Outbreak II-2 A Diarrhea Outbreak Associated with Swimming Pool Use-Ohio 56
Outbreak II-3 Diarrhea among Attendees of the Washington County Fair-New York 58
Outbreak II-4 An Amoebiasis Outbreak-Georgia 60
Outbreak II-5 A Typhoid Fever Outbreak Linked with a Frozen Fruit Drink-Florida 62
Outbreak II-6 A Diarrhea Outbreak in a Day Care Nursery-Juneau, Alaska 64
Outbreak II-7 A Foodborne Outbreak of Bloody Diarrhea-Multistate 66
Outbreak II-8 A Multistate Outbreak of Listeriosis-Northeastern United States 68
Outbreak II-9 An Outbreak of Rotaviral Gastroenteritis among Children-Jamaica 69
Outbreak II-10 Bloody Diarrhea Associated with Eating Ground Beef-United States 71
Outbreak II-11 A Hepatitis Outbreak Associated with Restaurant Onions-Pennsylvania 73
Outbreak II-12 A Rotavirus Outbreak among College Students-District of Columbia 75
Outbreak II-13 A Cholera Outbreak in a Refugee Camp-Democratic Republic of the Congo 77
Outbreak II-14 A Diarrhea Outbreak Associated with Raw Milk and Cheese Consumption-Pennsylvania 80
Outbreak II-15 A Listeriosis Outbreak Associated with Pasteurized Milk-Massachusetts 83
Outbreak II-16 An Outbreak Associated with Seasonal Consumption of Raw Ground Beef-Wisconsin 85
College Perspective
Outbreak II-17 A Diarrhea Outbreak Associated with an Adventure Race-Nevada 87
Global Perspective
Outbreak II-18 A Case-Control Study of an Outbreak of Clostridioides difficile at a Tertiary Care Medical Center-Amsterdam, The Netherlands 89
Reference Material 93
Section III Pathogens and Diseases That Are Transmitted Sexually 105
Outbreak III-1 An STD Outbreak among Teenagers-Georgia 107
Outbreak III-2 An STD Outbreak among Hispanic Men-California 109
Outbreak III-3 An Outbreak of HIV Disease in the Adult-Film Industry-California 111
Outbreak III-4 An Outbreak of Azithromycin-Resistant Gonorrhea-Kansas City 113
Outbreak III-5 Invasive Cervical Cancer among Women-United States 115
Outbreak III-6 A Proctitis Outbreak among Men Who Have Sex with Men-Netherlands 117
Outbreak III-7 A Syphilis Outbreak Connected to a Cybersex Chat Room-San Francisco 119
Outbreak III-8 STDs in Operation Iraqi Freedom/Operation Enduring Freedom-Iraq 121
Outbreak III-9 Herpes Simplex Virus Type 2 Infection among U.S. Military Service Members 123
College Perspective
Outbreak III-10 STD Risk Increased by Using the Internet To Find Casual Sexual Partners 125
Global Perspective
Outbreak III-11 Impact of AIDS Worsens Famine-Southern Africa 127
Reference Material 129
Section IV Outbreaks of Diseases of the Skin, Soft Tissues, and Eyes 139
Outbreak IV-1 An Outbreak of Pseudomonas Dermatitis from Hotel Pool and Hot Tubs-Colorado 141
Outbreak IV-2 An Outbreak of Skin Lesions in a Wrestling Team-Alaska 143
Outbreak IV-3 An Outbreak of Conjunctivitis at an Elementary School-Maine 144
Outbreak IV-4 A Measles Outbreak among Internationally Adopted Children-United States 146
Outbreak IV-5 An Outbreak of "Flesh-Eating Bacterium" Disease-Saint John, Brunswick, Canada 148
Outbreak IV-6 An Outbreak of Invasive Group A Streptococcus at a Child Care Center-Boston 150
Outbreak IV-7 An Outbreak of a Rash at a Camp for HIV-Infected Children-Connecticut 152
Outbreak IV-8 A Rubella Outbreak-Arkansas 153
Outbreak IV-9 An Outbreak of Invasive Disease Associated with Varicella in a Child Care Center-Boston 155
Outbreak IV-10 An Outbreak of Boils Associated with Footbaths at a Nail Salon-California 157
Outbreak IV-11 An Outbreak of Boils Associated with Steam Bathing, Alaska 159
Outbreak IV-12 A Skin Infection Outbreak at a Local School-Houston, Texas 161
Outbreak IV-13 An Outbreak of MRSA at Surgical Sites-Paris 163
Outbreak IV-14 An Outbreak of Necrotizing Fasciitis and Cellulitis Associated with Vein Sclerotherapy-Australia 165
College Perspective
Outbreak IV-15 Skin Infections among Tattoo Recipients-Ohio 167
Global Perspective
Outbreak IV-16 A Gas Gangrene Outbreak after a Tsunami-Papua New Guinea 170
Reference Material 171
Section V Outbreaks of Diseases of the Cardiovascular and Lymphatic Systems 181
Outbreak V-1 An Outbreak of Typhus-Burundi 183
Outbreak V-2 An Outbreak of Cyclic Fevers-India 185
Outbreak V-3 An Outbreak of Mononucleosis-Puerto Rico 186
Outbreak V-4 Fever in a Traveler Returning from Venezuela-California 187
Outbreak V-5 Cases of Rash and Fever, One Fatal, in a Family Cluster-Kentucky 189
Outbreak V-6 An Outbreak of Ebola Hemorrhagic Fever-Uganda 191
Outbreak V-7 An Outbreak of Leptospirosis during Eco-Challenge-Malaysia 193
Outbreak V-8 A Dengue Fever Outbreak-Puerto Rico 194
Outbreak V-9 A Disease Outbreak Associated with International Travel-Chicago 196
Outbreak V-10 Pseudomonas Bloodstream Infections Associated with a Heparin-Saline Flush-Missouri 199
Outbreak V-11 A Brucellosis Outbreak Due to Unpasteurized Raw Goat Cheese-Andalusia, Spain 201
Outbreak V-12 An Acute Respiratory Illness Associated with Dried Animal Hides-New York City 203
Outbreak V-13 A Plague Outbreak-India 205
Outbreak V-14 A Hepatitis Outbreak from a Pain Clinic-Oklahoma 207
Outbreak V-15 An Outbreak of Staphylococcus aureus with Increased Vancomycin Resistance-Illinois 209
College Perspective
Outbreak V-16 An Outbreak of Lyme Disease-United States 211
Global Perspective
Outbreak V-17 The Zika Virus Spreads from Uganda to the United States 213
Reference Material 217
Section VI Outbreaks of Diseases of the Nervous System 231
Outbreak VI-1 An Outbreak of Acute Flaccid Paralysis-Cape Verde 232
Outbreak VI-2 An Outbreak of Paralysis from Eating Fermented Beaver Tails-Alaska 233
Outbreak VI-3 Rabies Infections from Organ Donor Tissues-Multistate 235
Outbreak VI-4 A Tetanus Outbreak-Puerto Rico 237
Outbreak VI-5 An Outbreak of Aseptic Meningitis among Recreational Vehicle Campers-Connecticut 239
Outbreak VI-6 A Mad Cow Disease Outbreak in Humans and Cattle-United States, Canada, Europe, and Japan 241
Outbreak VI-7 Foodborne Paralysis from Eating Home-Pickled Eggs-Illinois 243
Outbreak VI-8 An Outbreak of Encephalitis-New York 245
Outbreak VI-9 An Outbreak of Haemophilus influenzae Type b Meningitis-Alaska 247
Outbreak VI-10 An Outbreak of Foodborne Botulism from Home-Prepared Fermented Tofu-California 249
Outbreak VI-11 Meningitis among Travelers Returning from Saudi Arabia-United States 251
College Perspective
Outbreak VI-12 Meningitis Outbreaks Traced to Raves and Clubs-Michigan and Argentina 253
Global Perspective
Outbreak VI-13 An Outbreak of Pneumococcal Meningitis-Central African Republic 255
Reference Material 257
Appendix Selected Sources 265
Index 27
SECTION I
Outbreaks of Diseases of the Respiratory Tract
For full indeed is earth of woes, and full the sea; and in the day as well as night diseases unbidden haunt mankind, silently bearing ills to men.
Hesiod, Works and Days, ca. line 101(Trans., J. Banks, 1856)
Among those who require a visit to a physician, infections of the respiratory system are the most common reason for the visit. These respiratory infections account for an average of ~80 physician visits per 100 persons each year. Infections of the lower respiratory tract, such as pneumonia and influenza, are also the leading cause of death by infectious disease worldwide. Pneumonia, influenza, and tuberculosis result in about 4.3 million deaths per year.
Containment of a respiratory outbreak can be complicated by a pathogen's ability to survive outside the body. For example, some cold-causing viruses can remain infective on an environmental surface for several hours. This makes classroom desks and doorknobs potential fomites for the spread of disease. Pathogens on the hands can be inoculated into the eyes and drain into the nose. There they can attack and initiate a respiratory tract infection. Consequently, one important way to decrease spread of respiratory pathogens is to wash hands frequently and to avoid touching the eyes.
The primary method of spread for respiratory tract pathogens is via airborne particles and mucus droplets. Airborne particles can travel over 1 meter through the air and still remain infectious, while mucus droplets travel less than 1 meter through the air. As a result, respiratory pathogens are highly contagious and spread rapidly through a community. Outbreaks of respiratory pathogens are common in colleges. Students who occupy college residence halls usually share rooms with one or more students and are in contact with hundreds of students at sporting events, in recreational facilities, and in classrooms. As a result, the number of opportunities for transmission of respiratory pathogens is greatly increased relative to others who live at home. The frequency of transmission of respiratory pathogens is significantly higher during cold-weather periods, when students are restricted to indoor activities. Therefore, annual winter outbreaks of colds, influenza, strep throat, and bronchitis in this setting are common.
Although several thousand microbes are inhaled each day, the defenses of the respiratory system are very efficient and regularly prevent infection and disease. Mucus is secreted by goblet cells within the respiratory epithelium. This mucus traps most microbes before they travel deep into the respiratory tract. It helps to inhibit attachment of microbes to host cell receptors. Microbes that are trapped in the mucus are swept out of the respiratory system by cilia on the surface of the pseudostratified epithelium. The mucus is swallowed, and the microbes are destroyed in the digestive system. In addition, the mucus has a high concentration of dissolved solutes. The hypertonic environment thus created inhibits the growth of most cellular microbes-bacteria, fungi, and protozoa. In the alveoli of the lungs, macrophages are present to phagocytize microbes that escape the other defenses.
Microbial pathogens have evolved strategies to bypass these defenses. Adhesins on the surfaces of microbes allow pathogens to attach to receptors on epithelial cells so that the microbes are not swept out of the respiratory tract. These adhesins are highly specific and at times limit infections to certain parts of the respiratory tract. For example, rhinoviruses attach to receptors located in the upper respiratory tract and are thus limited to causing a common cold. Influenza A virus, however, attaches all along the respiratory mucosa and can cause a wide range of respiratory diseases, from a common cold to life-threatening pneumonia.
Microbes that can survive in the alveoli of the lungs are the most dangerous, causing a life-threatening infection that blocks gas exchange. Streptococcus pneumoniae has an antiphagocytic capsule that inhibits phagocytosis by alveolar macrophages. Strains with a capsule cause pneumonia, while those without a capsule are nonpathogenic. Mycobacterium tuberculosis, the causative agent of tuberculosis, a chronic infection of the lungs, and Legionella pneumophila, the causative agent of Legionnaires' disease, avoid being digested after being phagocytized by alveolar macrophages.
The outbreaks described in this chapter emphasize the serious nature of respiratory tract infections, the difficulty in consistently and effectively implementing basic disease control measures, and the rapid spread of microbes that travel through the air.
Table I-1 Selected outbreak-causing respiratory pathogens
Organism Key Physical Properties Disease Characteristics Bacteria Bordetella pertussis Fastidious, Gram-negative coccobacillus Whooping cough in unvaccinated individuals Chlamydophila pneumoniae Obligate intracellular bacterium; very small; Gram negative Pneumonia, bronchitis Corynebacterium diphtheriae Gram-positive, club-shaped bacillus Diphtheria in unvaccinated individuals Streptococcus pyogenes Gram-positive streptococcus; beta-hemolytic on blood agar; group A surface antigen Strep throat, scarlet fever, rheumatic fever Legionella pneumophila Fastidious, Gram-negative bacillus Pneumonia (Legionnaires' disease) Mycobacterium tuberculosis Acid-fast bacillus found in chains or cords; cell wall contains mycolic acid, which results in drug and disinfectant resistance Tuberculosis Mycoplasma pneumoniae Wall-less bacterium; variable shape Walking pneumonia Streptococcus pneumoniae Gram-positive diplococcus; alpha-hemolytic on blood agar Otitis media, sinusitis, conjunctivitis, pneumonia Viruses Adenovirus Nonenveloped polyhedral capsid with double-stranded DNA Pharyngitis, bronchiolitis, pneumonia, conjunctivitis Epstein-Barr virus Enveloped polyhedral capsid with double-stranded DNA Mononucleosis Hantavirus Enveloped helical capsid with negative-sense single-stranded RNA Hantavirus pulmonary syndrome; zoonotic disease carried by rodents Influenza viruses (A, B, and C) Enveloped pleomorphic capsid with segmented negative-sense single-stranded RNA Influenza, pneumonia; predisposes to secondary bacterial pneumonia Mumps virus Enveloped pleomorphic capsid with negative-sense single-stranded RNA Mumps Parainfluenza viruses Enveloped pleomorphic capsid with negative-sense single-stranded RNA Croup, bronchiolitis, pneumonia, laryngitis Respiratory syncytial virus Enveloped helical capsid with negative-sense single-stranded RNA Bronchiolitis and pneumonia, primarily in infants Rhinoviruses Nonenveloped polyhedral capsid with negative-sense single-stranded RNA Common cold Rubella virus Enveloped polyhedral capsid with positive-sense single-stranded RNA German measles; can cause significant birth defects when pregnant women are infected Rubeola virus Enveloped helical capsid with negative-sense single-stranded RNA Measles in unvaccinated individuals Varicella-zoster virus Enveloped polyhedral capsid with double-stranded DNA Chickenpox in unvaccinated individuals; shingles as a latent manifestationOUTBREAK I-1 A Legionellosis Outbreak-Barceloneta
In the fishing neighborhood of Barceloneta, Spain, on the Mediterranean waterfront, 33 people were hospitalized in respiratory distress. Four of the victims were in serious condition. The area is predominantly inhabited by elderly people. The youngest victim was 49, while the oldest was 92. The common signs and symptoms were fatigue, malaise, high fever, shortness of breath, and coughing. Examination revealed rales (crackling sounds heard during breathing, indicating fluid in the lungs) and bilateral shadowing in the lungs on X ray (indicating fluid accumulation in both lungs).
City health officials carried out bacterial analyses of a ventilation system in the neighborhood located in a seaside building which uses a water tower as part of the cooling system for air conditioning. They isolated Legionella pneumophila, a Gram-negative, rod-shaped bacterium (Fig....
