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Emerging Infections: Microbial Threats to Health in the United States (1992)

Chapter:B CATALOG OF EMERGING INFECTIOUS DISEASE AGENTS

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Suggested Citation:"B CATALOG OF EMERGING INFECTIOUS DISEASE AGENTS." Institute of Medicine. 1992. Emerging Infections: Microbial Threats to Health in the United States. Washington, DC: The National Academies Press. doi: 10.17226/2008.
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B
Catalog of Emerging Infectious Disease Agents

The material in this appendix is provided for those who are interested in more detail on each of the agents considered by this committee to be emerging or reemerging and listed earlier in the report (see Table 2-1). It is a brief summary of information compiled from three sources, listed below, as well as additional data provided by committee and task force members, and other experts. The individual summaries are separated into three sections, corresponding to the categorizations of the earlier charts.

Benenson, Abram S. (ed.) 1990. Control of Communicable Diseases in Man, 15th edition. Washington, D.C.: American Public Health Association.

Mandell, Gerald L.; Douglas, R. Gordon, Jr.; and Bennett, John E. (eds.) 1990. Principles and Practice of Infectious Disease, 3rd edition. New York: Churchill Livingstone.

Wilson, Mary E. 1991. A World Guide to Infections: Diseases, Distribution, Diagnosis. New York: Oxford University Press.

EMERGENT BACTERIA, RICKETTSIAE, AND CHLAMYDIAE

Aeromonas

DISEASE(S) AND SYMPTOMS

Aeromonad gastroenteritis

  • acute diarrhea lasting several days, abdominal pain

  • vomiting, fever, and bloody stools may be present

Cellulitis, wound infection, and septicemia

  • septicemia occurs most often in predisposed patients

Suggested Citation:"B CATALOG OF EMERGING INFECTIOUS DISEASE AGENTS." Institute of Medicine. 1992. Emerging Infections: Microbial Threats to Health in the United States. Washington, DC: The National Academies Press. doi: 10.17226/2008.
×

DIAGNOSIS

  • identification of the organism in patient's feces or in wound secretions

INFECTIOUS AGENT

  • Aeromonas hydrophila, A. veronii (biovariant sobria), A. caviae

  • other species of Aeromonas (A. jandaei, A. trota, A. schubertii, and A. veronii biovariant veronii) have also been associated with human disease

  • the natural habitats of Aeromonas bacteria are water and soil

MODE OF TRANSMISSION

  • ingestion of contaminated water

  • entry of organism through a break in the skin

DISTRIBUTION

  • presence of organism in clinical specimens has been documented in the Americas, Africa, Asia, Australia, and Europe

  • distribution is worldwide

INCUBATION PERIOD

  • undefined; probably 12 hours to several days

  • organism may persist for weeks to months in gastrointestinal tract

TREATMENT

  • antibiotics: trimethoprim-sulfamethoxazole, the quinolones, aminoglycosides, and tetracyclines

  • organisms tend to be resistant to penicillins and cephalosporins

PREVENTION AND CONTROL

  • proper treatment of drinking water and monitoring of well water

  • predisposed individuals should avoid aquatic environments

FACTORS FACILITATING EMERGENCE

  • predisposition (e.g., immunosuppression)

  • improved technology for detection and differentiation

  • increased awareness

Borrelia burgdorferi

DISEASE(S) AND SYMPTOMS

Lyme disease

  • distinctive skin lesion (erythema migrans) at site of tick bite that

Suggested Citation:"B CATALOG OF EMERGING INFECTIOUS DISEASE AGENTS." Institute of Medicine. 1992. Emerging Infections: Microbial Threats to Health in the United States. Washington, DC: The National Academies Press. doi: 10.17226/2008.
×

appears as a red papule and expands in an annular fashion to at least 5 cm. in diameter

  • fatigue, headache, stiffness, myalgia, lymphadenopathy

  • neurologic (10 to 15% of patients) and cardiac (6 to 10% of patients) abnormalities may develop weeks to months after lesion

  • months to years after onset, swelling and pain in large joints may develop and persist for years ("Lyme arthritis")

DIAGNOSIS

  • currently based on clinical findings and serologic tests

  • tests are poorly standardized and are insensitive during the first several weeks of infection

INFECTIOUS AGENT

  • Borrelia burgdorferi, a spirochete bacterium

MODE OF TRANSMISSION

  • bite of an Ixodes tick; transmission does not occur until tick has fed for several hours

  • wild rodents (especially the white-footed mouse) and white-tailed deer maintain transmission cycle; tick depends on deer to reproduce and feeds on mice to become infected

  • no evidence for person-to-person transmission

  • transplacental transmission has been documented

DISTRIBUTION

  • in the United States: Atlantic coastal states from Maine to Georgia; upper midwestern states (concentrated in Minnesota and Wisconsin); California and Oregon

  • abroad: Europe, Canada, Japan, Australia, China, and the Commonwealth of Independent States

INCUBATION PERIOD

  • erythema migrans appears 3 to 32 days after tick exposure

TREATMENT

  • oral antibiotics (tetracycline, doxycycline, amoxicillin, erythromycin) for 10 to 30 days

  • high-dose intravenous penicillin or ceftriaxone is used if neurologic abnormalities develop

  • novel drug regimens are undergoing evaluation

Suggested Citation:"B CATALOG OF EMERGING INFECTIOUS DISEASE AGENTS." Institute of Medicine. 1992. Emerging Infections: Microbial Threats to Health in the United States. Washington, DC: The National Academies Press. doi: 10.17226/2008.
×

PREVENTION AND CONTROL

  • avoidance of tick-infested areas; securing of clothing at entry points (ankles, cuffs, etc.); application of tick repellent to outer clothing

  • host (mice and deer) reduction

FACTORS FACILITATING EMERGENCE

  • reforestation and consequent proliferation of deer

  • housing development in wooded areas

Campylobacter jejuni

DISEASE(S) AND SYMPTOMS

Campylobacteriosis, campylobacter enteritis

  • abdominal pain, diarrhea, fever

  • illness typically lasts two to five days

  • prolonged illness and relapses may occur

  • infection is asymptomatic in many cases

DIAGNOSIS

  • detection of organism in the stool

INFECTIOUS AGENT

  • Campylobacter jejuni, a bacterium

  • other species within the genus Campylobacter have been associated with similar disease

MODE OF TRANSMISSION

  • ingestion of contaminated food, water, or milk

  • fecal-oral spread from infected person or animal

DISTRIBUTION

  • worldwide

  • organism has a vast reservoir in animals

INCUBATION PERIOD AND COMMUNICABILITY

  • incubation period is 2 to 5 days

  • disease is communicable throughout the course of infection

TREATMENT

  • rehydration and replacement of electrolytes

  • antibiotic therapy is used in some cases, though it rarely shortens duration of symptoms

Suggested Citation:"B CATALOG OF EMERGING INFECTIOUS DISEASE AGENTS." Institute of Medicine. 1992. Emerging Infections: Microbial Threats to Health in the United States. Washington, DC: The National Academies Press. doi: 10.17226/2008.
×

PREVENTION AND CONTROL

  • chlorination of water

  • proper cooking of foods (particularly poultry) and pasteurization of milk

  • handwashing after animal contact

FACTORS FACILITATING EMERGENCE

  • improved recognition of the organism

  • an increase in poultry consumption in recent years

Chlamydia pneumoniae (TWAR Strain)

DISEASE(S) AND SYMPTOMS

TWAR infection, TWAR pneumonia

  • fever, myalgias, cough, sore throat, sinusitis

  • illness is usually mild, but recovery is slow; cough tends to last for more than two weeks

DIAGNOSIS

  • isolation of organism from throat or sputum

INFECTIOUS AGENT

  • Chlamydia pneumoniae (TWAR), a chlamydia

  • strain name is derived from designation of first two isolates, TW-183 from Taiwan and AR-39 (acute respiratory)

MODE OF TRANSMISSION

  • person to person; thought to be acquired by inhalation of infective organisms

  • possibly by direct contact with secretions of an infected person

DISTRIBUTION

  • probably worldwide

  • the majority of cases have occurred in North America, Asia, and Europe

INCUBATION PERIOD AND COMMUNICABILITY

  • 1 to 4 weeks

  • period of communicability is unknown but presumed to be long, based on duration of documented outbreaks

Suggested Citation:"B CATALOG OF EMERGING INFECTIOUS DISEASE AGENTS." Institute of Medicine. 1992. Emerging Infections: Microbial Threats to Health in the United States. Washington, DC: The National Academies Press. doi: 10.17226/2008.
×

TREATMENT

  • antibiotics: tetracycline or erythromycin

PREVENTION AND CONTROL

  • avoidance of overcrowding in living and sleeping quarters

FACTORS FACILITATING EMERGENCE

  • increased recognition

Chlamydia trachomatis

DISEASE(S) AND SYMPTOMS

Genital chlamydia

  • urethritis in males, mucopurulent cervicitis in females (opaque discharge, itching, burning upon urination)

  • asymptomatic infection can occur

  • in women, infertility and ectopic pregnancy can result from chronic infection

DIAGNOSIS

  • identification of organism on intraurethral or endocervical swab material

INFECTIOUS AGENT

  • Chlamydia trachomatis, a bacterium

MODE OF TRANSMISSION

  • sexual intercourse

DISTRIBUTION

  • worldwide; recognition has increased in the United States, Canada, Europe, and Australia over the past two decades

INCUBATION PERIOD AND COMMUNICABILITY

  • incubation period is poorly defined, probably 7 to 14 days or longer

  • period of communicability is unknown

TREATMENT

  • oral antibiotics: tetracycline, doxycycline, or quinolone

PREVENTION AND CONTROL

  • condom use during sexual intercourse

  • prophylactic treatment of sexual partners

Suggested Citation:"B CATALOG OF EMERGING INFECTIOUS DISEASE AGENTS." Institute of Medicine. 1992. Emerging Infections: Microbial Threats to Health in the United States. Washington, DC: The National Academies Press. doi: 10.17226/2008.
×

FACTORS FACILITATING EMERGENCE

  • probably increased sexual activity

Clostridium difficile

DISEASE(S) AND SYMPTOMS

Clostridium difficile colitis

  • antibiotic-associated colitis

  • pseudomembranous colitis

  • watery diarrhea, bloody diarrhea, abdominal pain

DIAGNOSIS

  • detection of C. difficile toxin in the stool

  • visualization of characteristic pseudomembranes during endoscopy of colon

INFECTIOUS AGENT

  • Clostridium difficile, a toxin-producing bacterium

MODE OF TRANSMISSION

  • fecal-oral transmission

  • acquisition of organism from the environment

DISTRIBUTION

  • worldwide

  • an estimated 3 percent of healthy adults carry the organism in the gut

INCUBATION PERIOD AND COMMUNICABILITY

  • colitis typically begins during, or shortly after, antibiotic administration (changes in gastrointestinal tract flora due to antibiotic use allow proliferation of the organism and its production of toxins)

TREATMENT

  • discontinuation of aggravating antibiotic treatment if possible

  • antibacterial agents: metronidazole, vancomycin, bacitracin

PREVENTION AND CONTROL

  • avoidance of unnecessary antibiotic administration

FACTORS FACILITATING EMERGENCE

  • immunosuppression

  • increased recognition

Suggested Citation:"B CATALOG OF EMERGING INFECTIOUS DISEASE AGENTS." Institute of Medicine. 1992. Emerging Infections: Microbial Threats to Health in the United States. Washington, DC: The National Academies Press. doi: 10.17226/2008.
×
Ehrlichia chaffeensis

DISEASE(S) AND SYMPTOMS

Ehrlichiosis

  • fever, malaise, headache, lymphadenopathy, anorexia

  • fever usually lasts 2 weeks

  • meningitis is occasionally reported

DIAGNOSIS

  • poor; few laboratories have antigen for immunoflourescence serology by surrogate E. canis antigen

INFECTIOUS AGENT

  • Ehrlichia chaffeensis, a rickettsia

  • reservoir is unknown

MODE OF TRANSMISSION

  • an undetermined tick transmits the agent (possibly the widely distributed species, Amblyomma americanum)

  • no evidence of person-to-person transmission

  • although other types of Ehrlichia are transmitted to dogs by the brown dog tick, dogs have not been found to be reservoirs of human disease

DISTRIBUTION

  • Southern and mid-Atlantic United States

INCUBATION PERIOD

  • unknown; possibly 1 to 3 weeks

TREATMENT

  • oral antibiotics: tetracycline

PREVENTION AND CONTROL

  • avoidance of tick-infested areas; securing of clothing at entry points (ankles, cuffs, etc.); application of tick repellent to outer clothing

FACTORS FACILITATING EMERGENCE

  • organism is probably newly recognized

  • possible increase in reservoir and vector populations

Suggested Citation:"B CATALOG OF EMERGING INFECTIOUS DISEASE AGENTS." Institute of Medicine. 1992. Emerging Infections: Microbial Threats to Health in the United States. Washington, DC: The National Academies Press. doi: 10.17226/2008.
×
Escherichia coli O157:H7

DISEASE(S) AND SYMPTOMS

  • Hemorrhagic colitis; hemolytic uremic syndrome

DIAGNOSIS

  • identification of antibodies to O157:H7 serotype

INFECTIOUS AGENT

  • Escherichia coli O157:H7, a bacterium

  • one of several ''EHEC" (enterohemorrhagic E. coli) strains

  • EHEC bacteria produce potent cytotoxins, called Shiga-like toxins 1 and 2

  • cattle are believed to be the reservoirs of EHECs

MODE OF TRANSMISSION

  • ingestion of contaminated food, typically poorly cooked beef and raw milk

  • transmission by direct contact may occur in high-risk populations

DISTRIBUTION

  • probably worldwide

  • most cases have occurred in North America and Europe

INCUBATION PERIOD

  • 12 to 60 hours

TREATMENT

  • oral replacement of fluids and electrolytes (intravenous if necessary)

PREVENTION AND CONTROL

  • proper cooking of meat

  • hand washing

  • proper sewage and water treatment

FACTORS FACILITATING EMERGENCE

  • probably spread of a bacterial virus carrying the gene for Shiga-like toxin production into the otherwise unremarkable host, E. coli O157:H7

Suggested Citation:"B CATALOG OF EMERGING INFECTIOUS DISEASE AGENTS." Institute of Medicine. 1992. Emerging Infections: Microbial Threats to Health in the United States. Washington, DC: The National Academies Press. doi: 10.17226/2008.
×
Haemophilus influenzae biogroup aegyptius

DISEASE(S) AND SYMPTOMS

Brazilian purpuric fever

  • irritation of the conjunctivae of the eyes, followed by edema of the eyelids, photophobia, and mucopurulent discharge

  • high fever appears 3 to 15 days after conjunctivitis, along with vomiting and purpura

  • case fatality rate is 70 percent, with death occurring shortly after onset of systemic symptoms

  • disease was first recognized in 1984

DIAGNOSIS

  • microscopic examination of bacterial culture of conjunctival discharge

  • detection of organism in the blood

INFECTIOUS AGENT

  • Haemophilus influenzae biogroup aegyptius, a bacterium

MODE OF TRANSMISSION

  • contact with the conjunctival or respiratory discharges of infected persons

  • eye flies are suspected mechanical vectors

DISTRIBUTION

  • nearly all reported cases of Brazilian purpuric fever have occurred in southern Brazil (most cases have been in young children)

  • one case was reported from Australia

INCUBATION PERIOD AND COMMUNICABILITY

  • incubation period is unknown

  • disease is communicable for the duration of active infection

TREATMENT

  • high-dose intravenous antibiotics: ampicillin, chloramphenicol

PREVENTION AND CONTROL

  • prompt treatment of patients and close contacts

  • avoidance of exposure to eye flies

  • possibly vector control

FACTORS FACILITATING EMERGENCE

  • possibly an increase in bacterial virulence due to mutation

Suggested Citation:"B CATALOG OF EMERGING INFECTIOUS DISEASE AGENTS." Institute of Medicine. 1992. Emerging Infections: Microbial Threats to Health in the United States. Washington, DC: The National Academies Press. doi: 10.17226/2008.
×
Helicobacter pylori

DISEASE(S) AND SYMPTOMS

  • dyspepsia, abdominal pain

  • chronic infection may result in peptic ulcer, gastric cancer

DIAGNOSIS

  • detection of antibodies in blood by ELISA

  • biopsy and culture

INFECTIOUS AGENT

  • Helicobacter pylori, a bacterium (formerly known as Campylobacter pylori)

MODE OF TRANSMISSION

  • unknown; some studies suggest a zoonotic origin

DISTRIBUTION

  • worldwide

INCUBATION PERIOD AND COMMUNICABILITY

  • unknown

TREATMENT

  • antibiotics: metronidazole, ampicillin, tetracycline

  • bismuth

PREVENTION AND CONTROL

  • none

FACTORS FACILITATING EMERGENCE

  • increased recognition

Legionella pneumophila

DISEASE(S) AND SYMPTOMS

Legionnaires' disease, Pontiac fever

  • initial symptoms include malaise, headache, myalgias, fever, chills, and cough

  • fever rises rapidly within 1 day, and may precede the development of pulmonary symptoms

Suggested Citation:"B CATALOG OF EMERGING INFECTIOUS DISEASE AGENTS." Institute of Medicine. 1992. Emerging Infections: Microbial Threats to Health in the United States. Washington, DC: The National Academies Press. doi: 10.17226/2008.
×
  • changes in mental status occur in 25 to 75 percent of patients

  • complications include renal failure, lung abscesses, and extrapulmonary infection

  • Pontiac fever may represent a reaction to inhaled antigen rather than bacterial invasion; patients recover in 2 to 5 days without treatment

DIAGNOSIS

  • isolation of the organism on special media

  • demonstration of organism by direct immunofluorescence stain of involved tissue or respiratory secretions

INFECTIOUS AGENT

  • Legionella pneumophila, a bacterium

MODE OF TRANSMISSION

  • aerosol transmission via aerosol-producing devices (especially air cooling systems)

  • person-to-person transmission has not been documented

DISTRIBUTION

  • documented as an important cause of pneumonia in North America, Europe, Asia, and Australia

  • also identified in South America and Africa

INCUBATION PERIOD

  • 2 to 10 days for Legionnaires' disease

  • 5 to 66 hours for Pontiac fever

TREATMENT

  • for Legionnaires' disease, antibiotics: erythromycin and rifampin

PREVENTION AND CONTROL

  • drainage of cooling towers when not in use

  • hyperchlorination and elevation of hot water temperature have been partially successful in interrupting waterborne outbreaks

FACTORS FACILITATING EMERGENCE

  • recognition in an epidemic situation

Suggested Citation:"B CATALOG OF EMERGING INFECTIOUS DISEASE AGENTS." Institute of Medicine. 1992. Emerging Infections: Microbial Threats to Health in the United States. Washington, DC: The National Academies Press. doi: 10.17226/2008.
×
Listeria monocytogenes

DISEASE(S) AND SYMPTOMS

Listeriosis

  • typically manifested as meningoencephalitis and/or septicemia (preceded by fever, headache, and vomiting)

  • delirium, shock, and coma may occur

  • disease is particularly dangerous to pregnant women, whose infants may be stillborn if infected

  • immunosuppressive conditions facilitate infection

  • fetuses and newborn infants are especially susceptible to infection

DIAGNOSIS

  • isolation of organism from the blood or cerebrospinal fluid

INFECTIOUS AGENT

  • Listeria monocytogenes, a bacterium

MODE OF TRANSMISSION

  • ingestion of contaminated foods (particularly nonreheated hotdogs, undercooked chicken, various soft cheeses, and food purchased from store delicatessen counters1)

  • direct contact with organism or with soil contaminated with infected animal feces

  • transmission can also occur by inhalation of the organism

DISTRIBUTION

  • worldwide

INCUBATION PERIOD AND COMMUNICABILITY

  • incubation period is extremely variable (from 3 to 70 days)

  • disease is communicable for duration of infection

TREATMENT

  • antibiotics: penicillin, ampicillin, contrimoxazole

1  

Centers for Disease Control, 1992h.

Suggested Citation:"B CATALOG OF EMERGING INFECTIOUS DISEASE AGENTS." Institute of Medicine. 1992. Emerging Infections: Microbial Threats to Health in the United States. Washington, DC: The National Academies Press. doi: 10.17226/2008.
×

PREVENTION AND CONTROL

  • for pregnant women, avoidance of certain foods (see above) is recommended

  • proper food-handling practices

  • pasteurization of dairy products

FACTORS FACILITATING EMERGENCE

  • increased awareness, recognition, and reporting

Mycobacterium tuberculosis

DISEASE(S) AND SYMPTOMS

Tuberculosis

  • cough, weight loss, night sweats, and low-grade fever

  • hemoptysis and chest pain are common

  • extrapulmonary tuberculosis can cause symptoms involving any organ system including kidneys, liver, and central nervous system

DIAGNOSIS

  • identification of tubercle bacteria in patient's sputum

  • characteristic changes visible in chest x-ray

INFECTIOUS AGENT

  • Mycobacterium tuberculosis, a mycobacterium

MODE OF TRANSMISSION

  • inhalation of droplet nuclei containing the bacteria (droplet nuclei can remain suspended in the air for up to 2 hours)

DISTRIBUTION

  • worldwide

  • annually, 8 million people develop clinical tuberculosis and 3 million people die of tuberculosis

  • it is estimated that up to 50 percent of the world's population (2 billion people) are infected, clinically or subclinically, with tuberculosis

INCUBATION PERIOD AND COMMUNICABILITY

  • 4 to 12 weeks

  • disease is communicable as long as viable bacteria remain in the sputum

Suggested Citation:"B CATALOG OF EMERGING INFECTIOUS DISEASE AGENTS." Institute of Medicine. 1992. Emerging Infections: Microbial Threats to Health in the United States. Washington, DC: The National Academies Press. doi: 10.17226/2008.
×

TREATMENT

  • chemotherapy involving a combination of antibiotics (esp. isoniazid and rifampin) for a period of 6 to 12 months

PREVENTION AND CONTROL

  • treatment of patients with active infection to prevent spread

  • strict respiratory isolation for patients with active pulmonary infection

  • preventive antibiotic treatment of contacts

FACTORS FACILITATING EMERGENCE

  • an increase in immunosuppressed populations

Staphylococcus aureus (and Toxic Shock Syndrome)
DISEASE(S) AND SYMPTOMS

Toxic shock syndrome

  • although symptoms of infection with S. aureaus can range from a single pustule to septicemia to death, "toxic shock syndrome," a newly emerged disease caused by S. aureus is the focus of this summary

  • symptoms of toxic shock syndrome (TSS) include sudden onset of high fever, vomiting, profuse diarrhea, myalgia, hypotension, and, in severe cases, shock

  • a sunburn-like rash is present in the acute phase of the disease, often accompanied by desquamation of the plams and soles

  • disorientation and alterations in consciousness may be present

DIAGNOSIS

  • isolation of the bacteria from the vagina or from abscess

INFECTIOUS AGENT

  • Staphylococcus aureus, a bacterium

MODE OF TRANSMISSION

  • TSS has been associated with use of super-absorbent tampons, prolonged use of diaphragms, and cesarean section deliveries

  • reported cases of TSS in males have been linked to local S. aureus infections such as abscesses and postsurgical infections

  • not directly transmitted from person to person

Suggested Citation:"B CATALOG OF EMERGING INFECTIOUS DISEASE AGENTS." Institute of Medicine. 1992. Emerging Infections: Microbial Threats to Health in the United States. Washington, DC: The National Academies Press. doi: 10.17226/2008.
×

DISTRIBUTION

  • sporadic cases throughout the world

  • TSS epidemic in the United States occurred 1980-1981

INCUBATION PERIOD

  • unknown

TREATMENT

  • initial treatment involves replacement of lost fluids/electrolytes

  • intravenous antibiotics

PREVENTION AND CONTROL

  • avoidance/minimal use of highly absorbent tampons

  • a better understanding of factors associated with nonmenstrual cases is needed

FACTORS FACILITATING EMERGENCE

  • use of super-absorbent tampons

Streptococcus pyogenes (Group A)

DISEASE(S) AND SYMPTOMS

  • the most common conditions caused by group A streptococcal bacteria are sore throat and skin infection

  • other conditions caused by the bacteria include scarlet fever, rheumatic fever, puerperal fever, septicemia, wound infections, and pneumonia

  • rarely, group A bacteria cause sepsis and streptococcal toxic shock syndrome (which can be fatal)

DIAGNOSIS

  • identification of group A streptococcal antigen in pharyngeal secretions

INFECTIOUS AGENT

  • Streptococcus pyogenes (group A), a bacterium

MODE OF TRANSMISSION

  • direct or intimate contact with infected persons/carriers of the organism

  • outbreaks of streptococcal sore throat have been linked to contaminated food

Suggested Citation:"B CATALOG OF EMERGING INFECTIOUS DISEASE AGENTS." Institute of Medicine. 1992. Emerging Infections: Microbial Threats to Health in the United States. Washington, DC: The National Academies Press. doi: 10.17226/2008.
×

DISTRIBUTION

  • worldwide

INCUBATION PERIOD AND COMMUNICABILITY

  • 1 to 3 days

  • with antibiotic therapy, period of communicability is as short as 1 to 2 days

  • untreated cases, especially those involving purulent discharges, can be communicable for weeks to months

TREATMENT

  • antibiotics: penicillin

PREVENTION AND CONTROL

  • in some cases, prophylactic treatment of close contacts with penicillin

  • people with respiratory infections or skin infections should not directly handle food

FACTORS FACILITATING EMERGENCE

  • probably a change in the virulence of some streptococci in this group has been responsible for deadly infections

Vibrio cholerae

DISEASE(S) AND SYMPTOMS

Cholera

  • sudden onset of profuse, watery diarrhea followed by profound dehydration

  • can progress to shock within 4 to 12 hours

  • in severe untreated cases, death can occur within hours

DIAGNOSIS

  • isolation of organism from stool or rectal swab

INFECTIOUS AGENT

  • Vibrio cholerae serogroup O1, biotypes cholerae and El Tor (bacteria)

MODE OF TRANSMISSION

  • ingestion of water contaminated with the feces of infected persons (organism is easily killed with chlorination but can survive in ice cubes, salt water, and mineral water)

  • ingestion of food washed with contaminated water

Suggested Citation:"B CATALOG OF EMERGING INFECTIOUS DISEASE AGENTS." Institute of Medicine. 1992. Emerging Infections: Microbial Threats to Health in the United States. Washington, DC: The National Academies Press. doi: 10.17226/2008.
×

DISTRIBUTION

  • epidemics are sporadic, the most recent being in South America in 1991

  • disease is endemic in southern Asia

INCUBATION PERIOD AND COMMUNICABILITY

  • from a few hours to 5 days; usually 2 to 3 days

  • direct, person-to-person transmission is of minor importance in areas with good sanitary facilities

TREATMENT

  • replacement of fluids and electrolytes (oral rehydration therapy [ORT])

  • antibiotics eradicate organisms and shorten duration of illness, but are secondary in importance to rehydration

PREVENTION AND CONTROL

  • currently available vaccine provides only partial protection (50%) of short duration (3 to 6 months) and thus is of no practical value in epidemic control

  • avoidance of contaminated food and water, as well as raw and undercooked crabs and shellfish harvested from potentially contaminated water

FACTORS FACILITATING EMERGENCE

  • breakdown of sanitation measures protecting water supplies

  • in Peru, miscalculation of risks involved in chlorine use (and consequent lack of chlorine use)

Vibrio vulnificus

DISEASE(S) AND SYMPTOMS

  • varies from cellulitis to fatal bacteremia associated with chronic cutaneous ulcers

  • soft tissue infection and septicemia can occur if organism enters body percutaneously

  • organism has occasionally been associated with diarrheal illness

DIAGNOSIS

  • isolation of the organism from blood or cutaneous lesions in bacteremic cases

INFECTIOUS AGENT

  • Vibrio vulnificus, a bacterium

Suggested Citation:"B CATALOG OF EMERGING INFECTIOUS DISEASE AGENTS." Institute of Medicine. 1992. Emerging Infections: Microbial Threats to Health in the United States. Washington, DC: The National Academies Press. doi: 10.17226/2008.
×

MODE OF TRANSMISSION

  • contact of superficial wounds with seawater or seafood containing the organism

  • ingestion of contaminated water or food (usually raw or undercooked seafood) by immunocompromised persons, especially those with hepatic cirrhosis

  • not transmitted person to person

DISTRIBUTION

  • organism is most commonly found in the Gulf states of the United States and is probably part of the normal marine flora in warmer climates

INCUBATION PERIOD

  • incubation period is 10 to 20 hours

TREATMENT

  • antibiotic therapy

  • surgical drainage may be necessary with soft tissue infections

  • supportive treatment for diarrheal illness (e.g., oral fluid replacement)

PREVENTION AND CONTROL

  • avoidance of exposure of open skin wounds to seawater

  • careful handling of raw or undercooked seafood by persons with superficial wounds

  • avoidance of raw or undercooked seafood, particularly by immunocompromised persons

FACTORS FACILITATING EMERGENCE

  • increased recognition

EMERGENT VIRUSESBovine Spongiform Encephalopathy Agent

DISEASE(S) AND SYMPTOMS

Bovine spongiform encephalopathy (BSE) in cattle

  • progressive neurological disease, staggering

  • BSE agent has not caused any cases of human disease

DIAGNOSIS

  • histology of brain tissue

  • epidemiological characteristics

  • no serological tests are currently available

Suggested Citation:"B CATALOG OF EMERGING INFECTIOUS DISEASE AGENTS." Institute of Medicine. 1992. Emerging Infections: Microbial Threats to Health in the United States. Washington, DC: The National Academies Press. doi: 10.17226/2008.
×

INFECTIOUS AGENT

  • BSE agent, a virus-like agent similar to scrapie prion in sheep

MODE OF TRANSMISSION

  • probably ingestion by cattle of poorly disinfected sheep offal

DISTRIBUTION

  • epidemic in England in 1990; cases in France and Switzerland

INCUBATION PERIOD AND COMMUNICABILITY

  • unknown

TREATMENT

  • none

PREVENTION AND CONTROL

  • destruction of infected animals to prevent spread

  • control measures instituted during 1990 epidemic: restrictions on use of cattle serum and cells for pharmaceutical (including vaccines) manufacturing in Europe

  • changes in the rendering process (a return to batch processing and solvent use) will probably provide effective control

FACTORS FACILITATING EMERGENCE

  • changes in the rendering process: continuous processing and elimination of solvents

California Serogroup Viruses (LaCrosse, Jamestown Canyon, California Encephalitis)

DISEASE(S) AND SYMPTOMS

  • acute, inflammatory viral diseases of short duration involving parts of the brain, spinal cord, and meninges

  • many infections are asymptomatic; severe infections involve acute onset, headache, high fever, stupor, disorientation, tremors, spasticity, and coma

  • case fatality rate is 0.5 percent

DIAGNOSIS

  • demonstration of antibodies in blood or cerebrospinal fluid

Suggested Citation:"B CATALOG OF EMERGING INFECTIOUS DISEASE AGENTS." Institute of Medicine. 1992. Emerging Infections: Microbial Threats to Health in the United States. Washington, DC: The National Academies Press. doi: 10.17226/2008.
×

INFECTIOUS AGENT

  • California serogroup viruses: LaCrosse, Jamestown Canyon, California encephalitis, and snowshoe hare virus

MODE OF TRANSMISSION

  • bite of an infective mosquito

  • not directly transmitted from person to person

DISTRIBUTION

  • United States, Canada, and Commonwealth of Independent States

  • cases typically occur in temperate latitudes in summer and early fall

INCUBATION PERIOD

  • usually 5 to 15 days

TREATMENT

  • supportive only

PREVENTION AND CONTROL

  • avoidance of exposure to mosquitoes during hours of biting (dusk to dawn)

  • mosquito control (elimination of breeding sites)

FACTORS FACILITATING EMERGENCE

  • reforestation

  • poor vector control

  • increasing interface between human activity and endemic areas

  • discarded tires as a source of mosquito breeding sites

Chikungunya Virus

DISEASE(S) AND SYMPTOMS

Chikungunya fever

  • abrupt onset of fever, headache, myalgias

  • joint pain, arthritis, hemorrhagic fever

  • disease is usually acute and self-limited

DIAGNOSIS
  • isolation of the virus from patient's blood

Suggested Citation:"B CATALOG OF EMERGING INFECTIOUS DISEASE AGENTS." Institute of Medicine. 1992. Emerging Infections: Microbial Threats to Health in the United States. Washington, DC: The National Academies Press. doi: 10.17226/2008.
×

INFECTIOUS AGENT

  • Chikungunya virus, a single-stranded RNA virus

MODE OF TRANSMISSION

  • bite of an infective Aedes mosquito

  • not directly transmitted from person to person

DISTRIBUTION

  • primarily Africa, South Asia, and the Philippines

INCUBATION PERIOD

  • 3 to 12 days

TREATMENT

  • supportive only

PREVENTION AND CONTROL

  • mosquito control in endemic areas

  • a live, attenuated vaccine is being tested

FACTORS FACILITATING EMERGENCE

  • unknown

Crimean-Congo Hemorrhagic Fever Virus

DISEASE(S) AND SYMPTOMS

Crimean-Congo hemorrhagic fever

  • abrupt onset of fever, headache, chills, photophobia, myalgia, and abdominal pain

  • nausea, vomiting, and diarrhea may be present; rash is common

  • infection to death ratio is estimated at 25:1

  • in pregnant women, infection is severe and often results in death

DIAGNOSIS

  • isolation of the virus from cerebrospinal fluid, blood, or other tissues

INFECTIOUS AGENT

  • Crimean-Congo virus, an RNA virus

Suggested Citation:"B CATALOG OF EMERGING INFECTIOUS DISEASE AGENTS." Institute of Medicine. 1992. Emerging Infections: Microbial Threats to Health in the United States. Washington, DC: The National Academies Press. doi: 10.17226/2008.
×

MODE OF TRANSMISSION

  • bite of an infective tick

  • contact with blood or secretions/excretions of an infected person or animal

  • virus has also spread by aerosolization

DISTRIBUTION

  • Eastern Europe, central and western Asia, Middle East, Sub-Saharan and southern Africa

INCUBATION PERIOD AND COMMUNICABILITY

  • 3 to 6 days

  • blood of an infected person has high concentration of virus for 8 to 10 days

TREATMENT

  • supportive

  • ribavirin may be helpful

PREVENTION AND CONTROL

  • strict isolation of infected patients

  • avoidance of contact with ticks and infected persons and animals

  • in the Commonwealth of Independent States, a killed vaccine is used in high-risk populations, with uncertain efficacy

FACTORS FACILITATING EMERGENCE

  • lack of effective tick control

  • lack of effective animal quarantine

Dengue Virus
DISEASE(S) AND SYMPTOMS

Dengue/dengue hemorrhagic fever (DHF)/dengue shock syndrome (DSS)

  • sudden onset of fever, headache, joint and muscle pain

  • nausea, vomiting, abdominal pain, and rash may be present

  • fever typically lasts 3 to 7 days; convalescence may be prolonged

  • initial phase of DHF/DSS may be similar to the above, but is followed by hemorrhagic phenomena, bleeding from multiple sites, and vascular collapse

Suggested Citation:"B CATALOG OF EMERGING INFECTIOUS DISEASE AGENTS." Institute of Medicine. 1992. Emerging Infections: Microbial Threats to Health in the United States. Washington, DC: The National Academies Press. doi: 10.17226/2008.
×

DIAGNOSIS

  • isolation of virus from blood

  • serologic studies (ELISA, etc.)

INFECTIOUS AGENT

  • dengue viruses, serotypes 1-4 (all four types can cause dengue hemorrhagic fever)

MODE OF TRANSMISSION

  • bite of an infective Aedes aegypti or Aedes albopictus mosquito

  • not directly transmitted from person to person

    Distribution

  • epidemic and endemic in tropical and subtropical areas of Africa, the Americas, Asia, Oceania, and Australia

  • widespread in the Caribbean basin

INCUBATION PERIOD AND COMMUNICABILITY

  • 3 to 14 days, average 7 to 10 days

  • while disease is not transmitted from person to person, patients can be infective for mosquitoes from the day before to the end of the febrile period (5 to 7 days)

TREATMENT

  • supportive only

PREVENTION AND CONTROL

  • control of mosquitoes

  • vaccine is not yet available

FACTORS FACILITATING EMERGENCE

  • lack of effective mosquito control

  • increased urbanization in the tropics

  • increased air travel

Filoviruses (Marburg, Ebola)

DISEASE(S) AND SYMPTOMS

  • sudden onset of fever, headache, joint and muscle pain, followed by sore throat, diarrhea, abdominal pain, vomiting, and rash

Suggested Citation:"B CATALOG OF EMERGING INFECTIOUS DISEASE AGENTS." Institute of Medicine. 1992. Emerging Infections: Microbial Threats to Health in the United States. Washington, DC: The National Academies Press. doi: 10.17226/2008.
×
  • after 3 to 5 days of fever, hemorrhagic manifestations begin

  • case fatality rate for Marburg virus infection is 25 percent

  • case fatality rates for Ebola infection have ranged from 50 to 90 percent

DIAGNOSIS

  • isolation of virus from blood, other tissues, or body fluids

  • serological detection of antibodies

INFECTIOUS AGENT

  • Ebola virus

  • Marburg virus

MODE OF TRANSMISSION

  • close contact with infected persons or infected blood, tissues, secretions, or excretions

  • transplacental and venereal transmission have occurred

  • possibly contact with infected animal vectors (primates)

DISTRIBUTION

  • Ebola: epidemics have taken place in Sudan and Zaire; virus may be endemic in other parts of Africa; monkeys infected with an Ebola-like virus were imported to the United States from the Philippines in 1989 (no human illness resulted)

  • Marburg: scattered human cases have occurred in central, eastern, and southern Africa; cases reported in Germany were a result of handling material from infected African green monkeys imported from Uganda

INCUBATION PERIOD AND COMMUNICABILITY

  • for both virus infections, 5 to 10 days

  • both viruses can persist in humans for at least 2 months

TREATMENT

  • supportive only

PREVENTION AND CONTROL

  • avoidance of contact with infected persons and their blood, other tissues, and body fluids

  • strict isolation of infected persons

FACTORS FACILITATING EMERGENCE

  • virus-infected monkeys shipped from developing countries via air

Suggested Citation:"B CATALOG OF EMERGING INFECTIOUS DISEASE AGENTS." Institute of Medicine. 1992. Emerging Infections: Microbial Threats to Health in the United States. Washington, DC: The National Academies Press. doi: 10.17226/2008.
×
Hantaviruses (Hantaan, Puumala, and Seoul)

DISEASE(S) AND SYMPTOMS

Hemorrhagic fever with renal syndrome

  • abrupt onset of fever, headache, and myalgias; abdominal pain, vomiting, and diarrhea

  • the appearance of petechiae (reddish purple, blood-filled spots) on the palate

  • in the severe form of the disease, initial febrile period may be followed by hypotension and hemorrhage from multiple sites

  • most survivors regain normal renal function

  • the most severe disease is caused by the Hantaan virus

DIAGNOSIS

  • demonstration of specific antibodies using IFA or ELISA

INFECTIOUS AGENT

  • hantaviruses, a group of RNA viruses

  • several different subtypes exist, each associated with a single rodent reservoir species (Hantaan—Apodemus field mouse; Puumala—Clethrionomys bank vole; Seoul—rats)

MODE OF TRANSMISSION

  • contact with infective material (feces, urine, saliva, tissue, etc.) of rodents

  • contact is usually by aerosol

  • transplacental transmission has been documented; other person-to-person spread has not been reported

DISTRIBUTION

  • hantaviruses are found on all continents

  • endemic and epidemic disease in China, Korea, and the Commonwealth of Independent States

  • Hantaan virus is widely distributed in eastern Asia

  • Puumala virus is common to Scandinavia and western Europe

INCUBATION PERIOD

  • 4 to 42 days; average is 12 to 16 days

TREATMENT

  • supportive only

  • recent studies show that ribavirin may shorten illness and reduce mortality

Suggested Citation:"B CATALOG OF EMERGING INFECTIOUS DISEASE AGENTS." Institute of Medicine. 1992. Emerging Infections: Microbial Threats to Health in the United States. Washington, DC: The National Academies Press. doi: 10.17226/2008.
×

PREVENTION AND CONTROL

  • rodent control

FACTORS FACILITATING EMERGENCE

  • human invasion of virus ecologic niche

Hepatitis B Virus

DISEASE(S) AND SYMPTOMS

Hepatitis B

  • insidious onset of anorexia, abdominal pain

  • sometimes arthralgias and rash, often progressing to jaundice

  • chronic infection leads to cirrhosis of the liver

DIAGNOSIS

  • elevated levels of certain liver enzymes

  • serological antibody tests (RIA, ELISA)

INFECTIOUS AGENT

  • Hepatitis B virus, a double-stranded DNA virus

MODE OF TRANSMISSION

  • virus enters body through a break in the skin or through mucous membranes

  • transmission via contaminated needles, transfusions of blood or blood products, sexual contact

  • transplacental transmission

DISTRIBUTION

  • worldwide

INCUBATION PERIOD AND COMMUNICABILITY

  • 45 to 180 days, average 60 to 90 days

  • blood containing the virus has been shown to be infective many weeks before the onset of first symptoms and to remain infective during the acute clinical course of the disease

  • chronic carriers are infectious

TREATMENT

  • supportive only

Suggested Citation:"B CATALOG OF EMERGING INFECTIOUS DISEASE AGENTS." Institute of Medicine. 1992. Emerging Infections: Microbial Threats to Health in the United States. Washington, DC: The National Academies Press. doi: 10.17226/2008.
×

PREVENTION AND CONTROL

  • immunization with Hepatitis B vaccine

  • testing of donor blood

FACTORS FACILITATING EMERGENCE

  • possibly increased sexual activity and intravenous drug abuse

Hepatitis C Virus

DISEASE(S) AND SYMPTOMS

Classic non-A, non-B hepatitis

  • onset is insidious and accompanied by anorexia, nausea, vomiting, and jaundice

  • course is similar to hepatitis B, but more prolonged

  • strong tendency to progress to chronic hepatitis and liver disease, which can be asymptomatic

  • the most common form of posttransfusion hepatitis

DIAGNOSIS

  • diagnosed by exclusion of hepatitis A, B, and delta viruses and other causes of liver injury

  • blood tests are now available for clinical use

INFECTIOUS AGENT

  • exact viral agent is unknown

  • agent appears to be a flavivirus

MODE OF TRANSMISSION

  • percutaneous exposure to contaminated blood and plasma derivatives

  • the role of sexual activity in transmission is not well defined

DISTRIBUTION

  • worldwide

  • common among dialysis patients, hemophiliacs, health care workers, and drug addicts

INCUBATION PERIOD AND COMMUNICABILITY

  • 20 to 90 days (mean: 50)

  • period of communicability extends from one week after exposure into chronic stage

Suggested Citation:"B CATALOG OF EMERGING INFECTIOUS DISEASE AGENTS." Institute of Medicine. 1992. Emerging Infections: Microbial Threats to Health in the United States. Washington, DC: The National Academies Press. doi: 10.17226/2008.
×

TREATMENT

  • existing antivirals have little effect

  • interferon may be helpful to chronic carriers

PREVENTION AND CONTROL

  • no vaccine is available

  • monitoring of blood supply for anti-HCV and elevated liver enzyme levels

  • pasteurization of clotting factor concentrates

FACTORS FACILITATING EMERGENCE

  • application of molecular virology techniques to identify etiologic agent

  • an old disease syndrome newly documented

Hepatitis E Agent

DISEASE(S) AND SYMPTOMS

Hepatitis E

  • also known as epidemic non-A, non-B hepatitis; waterborne non-A, non-B hepatitis; enterically transmitted non-A, non-B hepatitis

  • sudden onset of fever, malaise, nausea, and anorexia

  • disease varies in severity from a mild illness lasting 7 to 14 days, to a severely disabling disease lasting several months (rare)

  • jaundice can be present

  • no evidence of a chronic form

DIAGNOSIS

  • liver function tests

  • exclusion of other etiologies of hepatitis (especially hepatitis A) by serologic tests

INFECTIOUS AGENT

  • virus is not yet fully characterized

  • virus-like particles have been detected in the feces of infected patients

MODE OF TRANSMISSION

  • ingestion of contaminated water (most outbreaks have been linked to fecal contamination of water)

  • fecal-oral transmission

Suggested Citation:"B CATALOG OF EMERGING INFECTIOUS DISEASE AGENTS." Institute of Medicine. 1992. Emerging Infections: Microbial Threats to Health in the United States. Washington, DC: The National Academies Press. doi: 10.17226/2008.
×

DISTRIBUTION

  • may be widespread

  • majority of outbreaks have been reported from Asia, Africa, the Commonwealth of Independent States, and Mexico

INCUBATION PERIOD AND COMMUNICABILITY

  • 30 to 40 days

  • period of communicability is unknown; may be similar to hepatitis A

TREATMENT

  • supportive only

PREVENTION AND CONTROL

  • educational programs stressing importance of sanitary disposal of feces, careful hand washing after defecation and before handling food

FACTORS FACILITATING EMERGENCE

  • agent and disease are newly recognized

Human Herpesvirus-6

DISEASE(S) AND SYMPTOMS

  • sudden onset of fever (fever lasts 3 to 5 days)

  • maculopapular rash (exanthem subitum/roseola infantum) that appears on the trunk and spreads to rest of body

  • febrile seizures have been reported in very few cases

DIAGNOSIS

  • serology

  • ELISA is now available experimentally

INFECTIOUS AGENT

  • Human herpesvirus-6

MODE OF TRANSMISSION

  • unknown

DISTRIBUTION

  • appears ubiquitous in United States and Japan (antibody prevalence as high as 90 percent)

Suggested Citation:"B CATALOG OF EMERGING INFECTIOUS DISEASE AGENTS." Institute of Medicine. 1992. Emerging Infections: Microbial Threats to Health in the United States. Washington, DC: The National Academies Press. doi: 10.17226/2008.
×
  • disease usually occurs in children under 4 years of age

  • incidence is highest in the spring

INCUBATION PERIOD AND COMMUNICABILITY

  • incubation period is 10 days

TREATMENT

  • supportive only

PREVENTION AND CONTROL

  • none

FACTORS FACILITATING EMERGENCE

  • newly recognized

Human Immunodeficiency Virus (HIV), Types 1 and 2

DISEASE(S) AND SYMPTOMS

HIV disease; acquired immunodeficiency syndrome (AIDS); AIDS-related complex (ARC)

  • clinical features of infection are correlated with degree of immune dysfunction and range from asymptomatic to progressive and lethal

  • manifestations can involve any organ system of the body

  • initially: fever, weight loss, diarrhea, fatigue, cough, lymphadenopathy, oral thrush, and skin lesions (AIDS-related complex)

  • several opportunistic infections and cancers are very common and are considered specific indicators of HIV infection, including tuberculosis and other mycobacterial infections; Pneumocystis carinii pneumonia; chronic cryptosporidiosis; toxoplasmosis of the central nervous system (CNS); esophageal or lower respiratory tract candidiasis; disseminated cryptococcosis; pulmonary, gastrointestinal, CNS, or ocular cytomegalovirus infection; disseminated herpes simplex infection; and (cancers) Kaposi's sarcoma, primary B-cell lymphoma, and non-Hodgkin's lymphoma

  • clinical findings of common infections are often atypical (e.g., increased frequency of extrapulmonary tuberculosis)

DIAGNOSIS

  • serologic tests for HIV antibodies (ELISA, IFA, Western blot)

  • isolation of virus

Suggested Citation:"B CATALOG OF EMERGING INFECTIOUS DISEASE AGENTS." Institute of Medicine. 1992. Emerging Infections: Microbial Threats to Health in the United States. Washington, DC: The National Academies Press. doi: 10.17226/2008.
×

INFECTIOUS AGENT

  • human immunodeficiency virus, types 1 and 2 (retroviruses)

  • types 1 and 2 are serologically and geographically distinct but have similar epidemiologic and pathologic characteristics

  • humans are reservoirs

MODE OF TRANSMISSION

  • sexual exposure to an infected person

  • exposure to the blood or blood products (transfusions and needle sharing) or tissues (transplantation) of an infected person

  • transmitted from mother to fetus

  • routine social or community contact with HIV-infected persons carries no risk of transmission

DISTRIBUTION

  • worldwide

  • more than 200,000 reported cases of AIDS in the United States as of January 1992; approximately 1 million additional persons asymptomatically infected with HIV

  • worldwide, 8 to 10 million persons infected with HIV-1 by June 1990

  • HIV-2 is currently endemic only in West Africa, although cases have appeared in Europe, South America, North America, and other parts of Africa

  • cases were initially clustered among male homosexuals, intravenous drug users, prostitutes, and transfusion recipients

  • distribution patterns have changed in the past 10 years and continue to change (fewer cases of transfusion-induced HIV disease, more cases of infection acquired from heterosexual sex, more cases of transplacental transmission)

INCUBATION PERIOD AND COMMUNICABILITY

  • days to months until virus is detectable in the blood

  • months to years before appearance of clinical HIV disease (about half of HIV-infected persons will have developed AIDS 10 years after infection in the absence of specific antiviral treatment)

  • period of communicability is unknown but is presumed to begin early after onset of HIV infection and to extend through life

TREATMENT

  • early recognition and treatment of treatable infections and neoplasms (often chronic suppressive/maintenance therapy is recommended because of high infection relapse rates)

  • there are currently three Food and Drug Administration (FDA)-approved

Suggested Citation:"B CATALOG OF EMERGING INFECTIOUS DISEASE AGENTS." Institute of Medicine. 1992. Emerging Infections: Microbial Threats to Health in the United States. Washington, DC: The National Academies Press. doi: 10.17226/2008.
×

anti-HIV agents: zidovudine (AZT), dideoxyinosine (also known as VIDEX or ddI), and dideoxycytodine (also known as HIVID or ddC; approved for use only in combination with AZT); these agents do not cure HIV disease but have been shown to slow its progression

PREVENTION AND CONTROL

  • screening of blood (and other tissue) donors

  • avoidance of sexual intercourse (vaginal, anal, oral) with persons known or suspected to be infected with HIV

  • use of latex condoms and spermicide to reduce the risk of sexual transmission (there is no risk of HIV transmission in a long-term, mutually monogamous, heterosexual relationship between two partners known not to be infected with HIV)

  • caution by health care workers in handling, using, and disposing of needles and other sharp instruments, and wearing of latex gloves when coming into contact with bodily fluids of any patient

FACTORS FACILITATING EMERGENCE

  • urbanization

  • changes in lifestyles/mores

  • increased intravenous drug abuse

  • international travel

  • medical technology (transfusions)

Human Papillomavirus (HPV)

DISEASE(S) AND SYMPTOMS

  • a variety of skin and mucous membrane lesions, from the common wart to laryngeal warts (in infants infected by their mothers during birth) to venereal warts (most often seen in the moist areas in and around the genitalia and anus)

  • HPV has been strongly implicated in the etiology of cervical cancer (especially HPV types 16 and 18)

DIAGNOSIS

  • usually based on lesion appearance

  • in some cases, excision and histological examination are necessary

INFECTIOUS AGENT

  • human papillomavirus (there are at least 60 types identified)

Suggested Citation:"B CATALOG OF EMERGING INFECTIOUS DISEASE AGENTS." Institute of Medicine. 1992. Emerging Infections: Microbial Threats to Health in the United States. Washington, DC: The National Academies Press. doi: 10.17226/2008.
×

MODE OF TRANSMISSION

  • usually by direct contact

  • also by autoinoculation (e.g. by a shaving razor) and by contact with contaminated floors

  • genital warts are sexually transmitted

  • virus can be transmitted from mother to infant during birth

DISTRIBUTION

  • worldwide

INCUBATION PERIOD AND COMMUNICABILITY

  • 1 to 20 months; average is 2 to 3 months

  • period of communicability is unknown but is probably at least as long as visible lesions persist

TREATMENT

  • freezing of warts with liquid nitrogen

  • application of salicylic acid or podophyllin to remove warts

  • interferon has been shown to be effective in the treatment of genital warts

  • surgical removal or laser therapy is required for laryngeal and cervical warts

PREVENTION AND CONTROL

  • avoidance of direct contact with lesions

  • use of a condom during sexual intercourse

FACTORS FACILITATING EMERGENCE

  • possibly increases in sexual activity

Human Parvovirus B19

DISEASE(S) AND SYMPTOMS

Erythema infectiosum

  • classic infection in childhood is characterized by erythema of cheeks (slapped cheek appearance) and rash on extremities

  • adults have more severe illness, with fever and arthritis that can last for months or years

  • may cause aplastic crisis in patients with chronic hemolytic anemias

DIAGNOSIS

  • made on clinical grounds, can be confirmed by testing for antibodies

Suggested Citation:"B CATALOG OF EMERGING INFECTIOUS DISEASE AGENTS." Institute of Medicine. 1992. Emerging Infections: Microbial Threats to Health in the United States. Washington, DC: The National Academies Press. doi: 10.17226/2008.
×

INFECTIOUS AGENT

  • human parvovirus B19, a single-stranded DNA virus

MODE OF TRANSMISSION

  • most commonly, contact with infectious respiratory secretions

  • also transmitted transplacentally and via blood and blood products

DISTRIBUTION

  • worldwide; common in children

INCUBATION PERIOD AND COMMUNICABILITY

  • 4 to 20 days to development of rash

  • probably not communicable after onset of rash; immunosuppressed persons with chronic infection may be communicable up to years after onset

TREATMENT

  • supportive only

PREVENTION AND CONTROL

  • isolation not practical in community at large

  • hospitalized patients with transient aplastic crisis should be isolated

  • hand washing after patient contact

FACTORS FACILITATING EMERGENCE

  • a pervasive virus that has only recently drawn increased attention

  • as a hematogenous infection, it may increase in importance in immunosuppressed persons and as a threat to the blood supply

Human T-Cell Leukemia Virus (HTLV), Types 1 and 2

DISEASE(S) AND SYMPTOMS

Adult T-cell leukemia/lymphoma (ATLL); chronic progressive myelopathy; tropical spastic paraparesis (TSP)

  • lymphadenopathy, hepatomegaly, splenomegaly, lymphomatous meningitis

  • cutaneous lesions (generalized erythroderma, papules, nodules, plaques, and maculopapular rashes)

    fever and abdominal symptoms may occur

  • arthritis is frequently reported

  • disease ranges from subacute to rapidly lethal (median survival for ATLL is 8 months)

Suggested Citation:"B CATALOG OF EMERGING INFECTIOUS DISEASE AGENTS." Institute of Medicine. 1992. Emerging Infections: Microbial Threats to Health in the United States. Washington, DC: The National Academies Press. doi: 10.17226/2008.
×

DIAGNOSIS

  • isolation of the virus from the blood

  • detection of antibodies

INFECTIOUS AGENT

  • human T-cell leukemia virus

  • type 1 has been implicated in the causation of leukemia and lymphoma by serologic, virologic, and epidemiologic evidence

  • type 2 was initially isolated from two cases of hairy cell leukemia (causality has not yet been established)

MODE OF TRANSMISSION

  • person-to-person transmission by blood (transfusions and shared needles) and by sexual contact

  • transplacental transmission is possible

DISTRIBUTION

  • virus is present on all continents

  • cases of HTLV-1 infection have clustered in the Caribbean, south-western Japan, parts of Central and South America, Africa, Italy, and the southern United States

  • HTLV-2 is commonly found in intravenous drug abusers

INCUBATION PERIOD AND COMMUNICABILITY

  • incubation period is several years and may be as long as 20 years

  • communicability is unknown

TREATMENT

  • response of ATLL to conventional chemotherapeutic regimens has been poor

  • corticosteroids are helpful in some cases

PREVENTION AND CONTROL

  • avoidance of sexual or blood contact with an infected person

  • screening of donated blood for the virus (types 1 and 2)

FACTORS FACILITATING EMERGENCE

  • medical technology (transfusion)

  • possibly increased intravenous drug abuse

Suggested Citation:"B CATALOG OF EMERGING INFECTIOUS DISEASE AGENTS." Institute of Medicine. 1992. Emerging Infections: Microbial Threats to Health in the United States. Washington, DC: The National Academies Press. doi: 10.17226/2008.
×
Influenza A Virus

DISEASE(S) AND SYMPTOMS

Drift influenza; pandemic influenza

  • sudden onset of fever, myalgias, cough, headache, and profound fatigue

  • nasal discharge, sore throat, and hoarseness are common

  • fever lasts from 1 to 5 days; respiratory symptoms and malaise may persist another 7 to 14 days

  • severe cases involve complications such as pneumonia

  • infection can be fatal, especially in the elderly and in those debilitated by chronic cardiac, pulmonary, renal, or metabolic disease, as well as in the immunosuppressed

  • pandemic influenza is typically more severe, since populations have no immunity to pandemic strains

DIAGNOSIS

  • recognition is commonly by epidemiological characteristics

  • isolation of virus from respiratory tract

  • detection of viral antigen in respiratory secretions

INFECTIOUS AGENT

  • influenza A virus, an RNA virus that undergoes frequent mutations

  • virus isolates are described by character of hemagglutinin (H) and neuraminidase antigens; type A includes 3 subtypes (H1N1, H2N2, and H3N2)

  • emergence of completely new subtypes (antigenic shift) occurs at irregular intervals and typically results in pandemic influenza

  • minor antigenic changes (antigenic drift) are responsible for annual epidemics and regional outbreaks

MODE OF TRANSMISSION

  • airborne spread among crowded populations in enclosed spaces

  • transmission also occurs by direct contact with mucus of an infected person (influenza virus can persist for hours in dried mucus)

  • transmission from animal to human has been demonstrated rarely

DISTRIBUTION

  • worldwide

  • in temperate regions, influenza outbreaks occur during colder months

  • in tropical regions, influenza occurs year round

Suggested Citation:"B CATALOG OF EMERGING INFECTIOUS DISEASE AGENTS." Institute of Medicine. 1992. Emerging Infections: Microbial Threats to Health in the United States. Washington, DC: The National Academies Press. doi: 10.17226/2008.
×

INCUBATION PERIOD AND COMMUNICABILITY

  • 1 to 2 days

  • period of communicability is probably 3 to 5 days from clinical onset

TREATMENT

  • amantadine and rimantadine, if given early, shorten clinical illness in acute influenza A

PREVENTION AND CONTROL

  • immunization (vaccine is less effective in the elderly, in the immunosuppressed, and in people who have chronic renal failure)

  • prophylactic amantadine is recommended for selected individuals (e.g., those at high risk of complications from immunization)

FACTORS FACILITATING EMERGENCE

  • antigenic drift leads to small changes in the virus

  • significant mutations in the virus (antigenic shift) may result from animal-human virus reassortment

Japanese Encephalitis Virus

DISEASE(S) AND SYMPTOMS

Japanese encephalitis virus disease

  • clinical features range from inapparent to fatal

  • mild infections involve fever, headache, and myalgias

  • severe disease involves high fever, nausea, vomiting, and altered consciousness

  • hyperthermia, seizures, paralysis, and coma can occur

  • convalescence is prolonged; up to 80 percent of survivors experience neurologic sequelae

  • with optimal care, case fatality rate is 10 percent (as high as 40 percent in young children and in persons over 65 years of age)

DIAGNOSIS

  • isolation of the virus from cerebrospinal fluid or blood

  • isolation of viral antibodies from the blood and cerebral spinal fluid

INFECTIOUS AGENT

  • Japanese encephalitis virus

  • pigs are important amplification hosts for the virus

Suggested Citation:"B CATALOG OF EMERGING INFECTIOUS DISEASE AGENTS." Institute of Medicine. 1992. Emerging Infections: Microbial Threats to Health in the United States. Washington, DC: The National Academies Press. doi: 10.17226/2008.
×

MODE OF TRANSMISSION

  • bite of an infective mosquito

  • transplacental transmission has been documented

  • not directly transmitted from person to person

DISTRIBUTION

  • widely distributed in eastern and southern Asia, the far eastern Commonwealth of Independent States, and the Pacific islands

INCUBATION PERIOD

  • 6 to 8 days

TREATMENT

  • supportive only

PREVENTION AND CONTROL

  • mosquito control

  • an inactivated vaccine is widely used in Japan (95 percent efficacy in clinical trials)

  • a live, attenuated vaccine has been used in China

FACTORS FACILITATING EMERGENCE

  • changes in agricultural practices facilitating mosquito breeding

Lassa Virus

DISEASE(S) AND SYMPTOMS

Lassa fever

  • gradual onset of fever, malaise, headache, dizziness, and sore throat

  • nausea, vomiting, and diarrhea are common

  • in severe cases, hypotension, shock, and seizures may result

  • acute illness lasts 7 to 31 days, with an average of 12 days

DIAGNOSIS

  • isolation of virus from blood, urine, or throat washings

  • serological tests (ELISA or IFA)

INFECTIOUS AGENT

  • Lassa virus, an arenavirus named after a town in Nigeria

Suggested Citation:"B CATALOG OF EMERGING INFECTIOUS DISEASE AGENTS." Institute of Medicine. 1992. Emerging Infections: Microbial Threats to Health in the United States. Washington, DC: The National Academies Press. doi: 10.17226/2008.
×

MODE OF TRANSMISSION

  • contact with excreta of infected rodents deposited on surfaces such as beds and floors, or in food

  • transmission also occurs via contact with blood, secretions, or excretions of an infected person

  • transplacental transmission can occur

DISTRIBUTION

  • widely distributed over West Africa, especially Nigeria, Sierra Leone, and Liberia

INCUBATION PERIOD AND COMMUNICABILITY

  • 8 to 14 days

  • person-to-person transmission may occur during the acute febrile phase when virus is present in the throat

TREATMENT

  • antiviral agents: ribavirin

  • mechanical ventilation and renal dialysis may be required

PREVENTION AND CONTROL

  • avoidance of contact with rats and infected persons

  • strict isolation of infected persons

FACTORS FACILITATING EMERGENCE

  • unknown

Measles Virus

DISEASE(S) AND SYMPTOMS

Measles

  • fever, conjunctivitis, coryza, cough, and Koplic spots on the buccal mucosa

  • red blotchy rash beginning on forehead and neck, later spreading to trunk and limbs

DIAGNOSIS

  • usually made on clinical and epidemiological grounds

INFECTIOUS AGENT

  • measles virus

Suggested Citation:"B CATALOG OF EMERGING INFECTIOUS DISEASE AGENTS." Institute of Medicine. 1992. Emerging Infections: Microbial Threats to Health in the United States. Washington, DC: The National Academies Press. doi: 10.17226/2008.
×

MODE OF TRANSMISSION

  • airborne transmission by droplet spread

  • direct contact with the nasal or throat secretions of infected persons

DISTRIBUTION

  • worldwide

  • incidence in a population determined largely by levels of immunization

INCUBATION PERIOD AND COMMUNICABILITY

  • 10 to 14 days

  • infective virus is present from the 5th day of incubation through 4 days after onset of rash

  • measles is one of the most highly communicable infectious diseases (measles virus can survive in droplet nuclei for more than 2 hours)

TREATMENT

  • none

PREVENTION AND CONTROL

  • immunization with live measles vaccine

  • children should be kept out of school at least four days after the onset of rash

FACTORS FACILITATING EMERGENCE
  • deterioration of public health infrastructure supporting immunization

Norwalk and Norwalk-like Agents

DISEASE(S) AND SYMPTOMS

Gastroenteritis, epidemic diarrhea

  • vomiting, diarrhea, headache, and low-grade fever lasting 2 to 3 days

  • disease often occurs in outbreaks involving people of all age groups

DIAGNOSIS
  • identification of the agent in the stool by electron microscopy and/or immunologic assay (RIA and ELISA)

Suggested Citation:"B CATALOG OF EMERGING INFECTIOUS DISEASE AGENTS." Institute of Medicine. 1992. Emerging Infections: Microbial Threats to Health in the United States. Washington, DC: The National Academies Press. doi: 10.17226/2008.
×

INFECTIOUS AGENTS

  • Norwalk agent (virus-like), Snow Mountain agent, Hawaii agent, and other Norwalk-like agents

MODE OF TRANSMISSION

  • most likely fecal-oral transmission

  • respiratory transmission may occur via aerosolized vomitus

  • alleged vehicles of transmission include drinking water, swimming water, and uncooked foods (shellfish and salads)

DISTRIBUTION

  • worldwide

  • in developing countries, disease is more common in children; in the United States, disease typically occurs in older children and adults

INCUBATION PERIOD AND COMMUNICABILITY

  • typical incubation period is 1 to 2 days

  • disease is communicable up to 2 days after diarrhea stops

TREATMENT

  • supportive only (e.g., oral fluid replacement)

PREVENTION AND CONTROL

  • effective preventive measures are undetermined

  • possibly avoidance of alleged vehicles of transmission

FACTORS FACILITATING EMERGENCE

  • increased recognition

Rabies Virus

DISEASE(S) AND SYMPTOMS

Rabies

  • primarily a disease of animals; all warm-blooded mammals are susceptible

  • acute encephalomyelitis

  • fever, malaise, myalgia, vomiting, agitation or hydrophobia upon attempt to swallow

  • initial symptoms followed by hyperventilation, aphasia, paralysis, seizures

  • cardiac arrhythmias and coma can follow

Suggested Citation:"B CATALOG OF EMERGING INFECTIOUS DISEASE AGENTS." Institute of Medicine. 1992. Emerging Infections: Microbial Threats to Health in the United States. Washington, DC: The National Academies Press. doi: 10.17226/2008.
×

DIAGNOSIS

  • isolation and identification of rabies virus from saliva, cerebrospinal fluid, urine, brain, or other tissue

INFECTIOUS AGENT

  • rabies virus

  • dogs are most common reservoir host; in some areas, vampire bats, mongooses, wolves, foxes, raccoons, and other wild and domestic animals are important reservoir hosts; also, newly emerging in felines in the eastern United States

MODE OF TRANSMISSION

  • a bite (that breaks the skin) from an infected animal; bites around head, face, or hands carry highest risk of infection

  • mucous membrane exposure to saliva of an infected animal

DISTRIBUTION

  • worldwide; causes an estimated 30,000 human deaths per year, mostly in developing countries

INCUBATION PERIOD AND COMMUNICABILITY

  • 1 to 2 months

  • period of communicability for animals includes week before clinical signs and throughout the course of the disease

TREATMENT

  • immediate and thorough cleansing of bite wound

  • administration of rabies immune globulin (RIG) around wound and intramuscularly to prevent infection, and vaccine intramuscularly to prevent infection

  • the only treatment for disease is supportive; more than 99% of patients with symptomatic infection die

PREVENTION AND CONTROL

  • pre-exposure vaccination is recommended for persons whose occupations or travel will place them at risk for exposure to rabid animals

  • vaccination of dogs and cats

  • isolation and destruction of infected animals

FACTORS FACILITATING EMERGENCE

  • changing movements of reservoir host species

  • absence or failure of rabies control programs

Suggested Citation:"B CATALOG OF EMERGING INFECTIOUS DISEASE AGENTS." Institute of Medicine. 1992. Emerging Infections: Microbial Threats to Health in the United States. Washington, DC: The National Academies Press. doi: 10.17226/2008.
×
Rift Valley Fever Virus

DISEASE(S) AND SYMPTOMS

Rift Valley fever

  • abrupt onset of fever, severe headache, myalgias, and arthralgias

  • complications include jaundice and hemorrhagic complications

  • encephalitis and retinitis may occur

  • some survivors are left with neurologic sequelae and permanent visual damage

  • (in animals: enzootic hepatitis)

DIAGNOSIS

  • virus isolation from the blood

  • demonstration of virus antibodies in the cerebrospinal fluid or acute serum

INFECTIOUS AGENT

  • Rift Valley fever virus

MODE OF TRANSMISSION

  • bite of an infective mosquito

  • contact with infected animals or their tissues

  • possible transmission via unpasteurized milk

  • not directly transmitted from person to person

DISTRIBUTION

  • widespread in Africa; initially described in Rift Valley in Kenya

INCUBATION PERIOD

  • 3 to 5 days

TREATMENT

  • supportive only

PREVENTION AND CONTROL

  • an inactivated vaccine is available for persons at high risk of infection (veterinarians, laboratory personnel) in endemic areas

  • a candidate live, attenuated vaccine is under development

  • immunization of animals

  • mosquito control

FACTORS FACILITATING EMERGENCE

  • importation of infected mosquitoes and/or animals

  • creation of mosquito habitats through dam building and irrigation

Suggested Citation:"B CATALOG OF EMERGING INFECTIOUS DISEASE AGENTS." Institute of Medicine. 1992. Emerging Infections: Microbial Threats to Health in the United States. Washington, DC: The National Academies Press. doi: 10.17226/2008.
×
Ross River Virus

DISEASE(S) AND SYMPTOMS

Ross River fever

  • a self-limited disease characterized by arthritis (especially in the wrist, knee, ankle, and small joints of the extremities), which lasts from days to months

  • a maculopapular rash on the trunk and limbs commonly follows the onset of arthritis; rash resolves within 7 to 10 days

  • fever is frequently present, lasting 6 to 7 days

  • in 25 percent of cases, rheumatic symptoms continue one year or longer

DIAGNOSIS

  • isolation of virus from serum

  • detection of virus antibodies in serum

INFECTIOUS AGENT

  • Ross River virus

MODE OF TRANSMISSION

  • bite of an infective mosquito

  • transplacental transmission may occur

  • not directly transmitted from person to person

  • virus reservoir is probably the kangaroo

DISTRIBUTION

  • Australia, Tasmania, Papua New Guinea, Indonesia, and several South Pacific islands

INCUBATION PERIOD

  • 3 to 11 days

TREATMENT

  • supportive only

PREVENTION AND CONTROL

  • mosquito control

FACTORS FACILITATING EMERGENCE

  • importation of infected mosquitoes and/or travel by infected people

  • creation of mosquito habitats through dam building and irrigation

Suggested Citation:"B CATALOG OF EMERGING INFECTIOUS DISEASE AGENTS." Institute of Medicine. 1992. Emerging Infections: Microbial Threats to Health in the United States. Washington, DC: The National Academies Press. doi: 10.17226/2008.
×
Rotavirus

DISEASE(S) AND SYMPTOMS

Rotaviral enteritis

  • varies from asymptomatic to severe and sometimes fatal gastroenteritis; group A viruses predominate in infants and young children, group B in older children and adults

  • watery diarrhea, vomiting, low-grade fever, and dehydration

  • illness typically lasts 3 to 10 days

DIAGNOSIS

  • identification of the virus in the stool by immunologic assay (ELISA), electron microscopy, or isolation in cell culture

INFECTIOUS AGENT

  • one of three groups (A, B, or C) of rotavirus (A is the most common cause of illness in humans)

MODE OF TRANSMISSION

  • primarily fecal-oral

  • fecal-respiratory transmission may also occur

DISTRIBUTION

  • worldwide

INCUBATION PERIOD AND COMMUNICABILITY

  • incubation period is 1 to 2 days

  • virus shedding occurs throughout duration of illness and continues for several days following the disappearance of symptoms

TREATMENT

  • supportive only (e.g., oral fluid replacement)

PREVENTION AND CONTROL

  • effective preventive measures are uncertain

  • avoid exposure of infants to persons with acute gastroenteritis

  • passive immunization by oral immunoglobulin has been effective in protecting low-birth-weight newborns

  • a number of oral vaccines are in various stages of development

FACTORS FACILITATING EMERGENCE

  • increased recognition

Suggested Citation:"B CATALOG OF EMERGING INFECTIOUS DISEASE AGENTS." Institute of Medicine. 1992. Emerging Infections: Microbial Threats to Health in the United States. Washington, DC: The National Academies Press. doi: 10.17226/2008.
×
Venezuelan Equine Encephalitis (VEE) Virus

Disease(s) and Symptoms

Venezuelan equine encephalitis

  • sudden onset of fever, chills, severe headache, nausea, and vomiting

  • pharyngitis and facial erythema may be present

  • central nervous system manifestations (stupor, coma, seizures, and spastic paralysis) can accompany severe cases

  • most infections are fairly mild; symptoms last 3 to 5 days

  • in patients with encephalitis, illness typically lasts 3 to 7 days

DIAGNOSIS

  • isolation of the virus or of viral antibodies in the blood

  • sometimes based on epidemiological grounds (in areas that have experienced a recent equine epizootic)

INFECTIOUS AGENT

  • Venezuelan equine encephalomyelitis virus

  • virus is maintained in rodents

  • transmission cycle involves horses, which serve as the major source of virus to infect mosquitoes

MODE OF TRANSMISSION

  • bite of an infective mosquito

  • transmission also occurs transplacentally and in laboratories via inhalation

  • not directly transmitted from person to person

  • no evidence of aerosol transmission from horses to humans

DISTRIBUTION

  • disease is enzootic and epizootic in tropical South America, Central America, the Caribbean, southern North America, and Mexico

INCUBATION PERIOD

  • 2 to 5 days

TREATMENT

  • supportive only

PREVENTION AND CONTROL

  • mosquito control

  • a live, attenuated vaccine is available for laboratory workers and other adults at high risk of infection

Suggested Citation:"B CATALOG OF EMERGING INFECTIOUS DISEASE AGENTS." Institute of Medicine. 1992. Emerging Infections: Microbial Threats to Health in the United States. Washington, DC: The National Academies Press. doi: 10.17226/2008.
×
  • a killed, attenuated vaccine exists for cases in which the live vaccine is ineffective

  • control of infection in horses by vaccination

FACTORS FACILITATING EMERGENCE

  • introduction into new regions via infected mosquitoes and horses

Yellow Fever Virus

DISEASE(S) AND SYMPTOMS

Yellow fever

  • clinical features range from inapparent to fatal

  • typical attacks are characterized by abrupt onset, fever, chills, headache, muscle pain, nausea, and vomiting

  • as disease progresses, jaundice, hemorrhagic complications, and renal failure may occur

  • pulse may be slow despite high fever

  • the case fatality rate among indigenous populations of endemic regions is less than 5 percent; this rate may exceed 50 percent among nonindigenous groups and in epidemics

  • recovery is slow but complete in survivors

DIAGNOSIS

  • isolation of virus from the blood

  • demonstration of viral antigen in the blood or liver tissue by ELISA

INFECTIOUS AGENT

  • Yellow fever virus

MODE OF TRANSMISSION

  • bite of an infective mosquito

  • not directly transmitted from person to person

DISTRIBUTION

  • disease is endemic in tropical South and Central America and in Africa

  • potential for outbreaks exists in other areas where vector mosquito is found (including the United States)

INCUBATION PERIOD

  • range is 3 to 14 days; usually 1 to 6 days

Suggested Citation:"B CATALOG OF EMERGING INFECTIOUS DISEASE AGENTS." Institute of Medicine. 1992. Emerging Infections: Microbial Threats to Health in the United States. Washington, DC: The National Academies Press. doi: 10.17226/2008.
×
  • blood of patients is infective for mosquitoes 3 to 5 days after onset of illness

TREATMENT

  • supportive only

PREVENTION AND CONTROL

  • a live viral vaccine prepared from chick embryos is safe and highly effective (more than 95 percent of those vaccinated will have immune response within 7 to 10 days; immunity lasts at least 10 years)

  • mosquito control

FACTORS FACILITATING EMERGENCE

  • lack of effective mosquito control

  • lack of widespread vaccination

  • urbanization in the tropics

  • increased air travel

EMERGENT PROTOZOANS, HELMINTHS, AND FUNGI

Anisakis

DISEASE(S) AND SYMPTOMS

Anisakiasis, herring worm disease, cod worm disease

  • severe epigastric pain, nausea, vomiting, fever

  • obstruction, ulceration, and bleeding in the gastrointestinal tract are possible

DIAGNOSIS

  • recognition of the 2 to 3 cm. larva invading the oropharynx

  • visualization of larvae through gastroscopic examination

INFECTIOUS AGENT

  • larval nematodes of the Anisakidae family, common parasites of marine mammals and fish

MODE OF TRANSMISSION

  • ingestion of larvae in raw or undercooked fish, squid, or octopus (larvae are colorless, tightly coiled, and not easily seen in fish flesh)

  • not transmitted directly from person to person

Suggested Citation:"B CATALOG OF EMERGING INFECTIOUS DISEASE AGENTS." Institute of Medicine. 1992. Emerging Infections: Microbial Threats to Health in the United States. Washington, DC: The National Academies Press. doi: 10.17226/2008.
×

DISTRIBUTION

  • most cases are reported from Japan

  • cases are also sporadically reported from North and South America, Europe, Asia, and the South Pacific

  • infected fish can potentially be shipped to any region of the world

INCUBATION PERIOD

  • 1 to 12 hours for gastric attachment; 7 to 14 days for intestinal attachment

TREATMENT

  • endoscopic removal of larva

  • surgery may be necessary to remove obstruction

PREVENTION AND CONTROL

  • heating marine fish to 140°F for 10 minutes or freezing at -4°F for at least five days kills the larvae

FACTORS FACILITATING EMERGENCE

  • increasing popularity of raw fish dishes in the United States and elsewhere

Babesia

DISEASE(S) AND SYMPTOMS

Babesiosis

  • fever, fatigue, chills, and hemolytic anemia lasting from several days to a few months

DIAGNOSIS

  • blood smear contains red blood cells with visible parasites

INFECTIOUS AGENT

  • Babesia microti and other Babesia species (protozoan parasites)

  • nymphal Ixodes ticks (carried by deer mice) are vectors; adult ticks live on deer

MODE OF TRANSMISSION

  • bite of a nymphal Ixodes tick

  • not directly transmitted from person to person

  • occasional transmission by blood transfusion has been reported

Suggested Citation:"B CATALOG OF EMERGING INFECTIOUS DISEASE AGENTS." Institute of Medicine. 1992. Emerging Infections: Microbial Threats to Health in the United States. Washington, DC: The National Academies Press. doi: 10.17226/2008.
×

DISTRIBUTION

  • widespread in areas where ticks are present

  • majority of cases are from northeastern United States

  • also reported from France and other European countries

INCUBATION PERIOD

  • variable; 1 week to 12 months reported

TREATMENT

  • a combination of antiparasitic agents (clindamycin and quinine) has been effective in most patients

  • exchange blood transfusion may be required in patients with very high-grade parasitemia

PREVENTION AND CONTROL

  • avoidance of tick exposure in endemic areas (protective clothing, tick repellant)

  • control of rodents around human habitations

FACTORS FACILITATING EMERGENCE

  • reforestation and subsequent increase in deer population

  • housing development in wooded areas

Candida

DISEASE(S) AND SYMPTOMS

Candidiasis

  • fungal infections usually confined to the superficial layers of skin or mucous membranes: oral thrush, intertrigo, vulvovaginitis, paronychia, or onychomycosis

  • ulcers may be formed in the esophagus, gastrointestinal tract, or bladder

  • dissemination in the blood may produce lesions in other organs (kidney, spleen, liver, lung, endocardium, eye, or brain)

DIAGNOSIS

  • microscopic demonstration of yeast cells in infected tissue or body fluid

  • fungal culture

Suggested Citation:"B CATALOG OF EMERGING INFECTIOUS DISEASE AGENTS." Institute of Medicine. 1992. Emerging Infections: Microbial Threats to Health in the United States. Washington, DC: The National Academies Press. doi: 10.17226/2008.
×

INFECTIOUS AGENT

  • species of the fungus, Candida

MODE OF TRANSMISSION

  • contact with secretions or excretions of mouth, skin, or vagina of infected persons, or with the feces of infected persons

  • passage from mother to infant during childbirth

  • endogenous spread

  • disseminated candidiasis can originate from indwelling urinary catheters and percutaneous intravenous catheters

DISTRIBUTION

  • worldwide

  • the fungus (C. albicans) is often part of the normal human flora

INCUBATION PERIOD AND COMMUNICABILITY

  • incubation period is variable

  • infection is presumably communicable while lesions are present

TREATMENT

  • topical antifungal agents: imidazole, nystatin

  • oral clotrimazole troches or nystatin suspension is effective for treatment of oral thrush

  • oral ketoconazole is effective for treatment of infected skin and mucous membranes of the mouth, esophagus, and vagina

PREVENTION AND CONTROL

  • detection and treatment of infection early to prevent systemic spread

  • detection and treatment of vaginal candidiasis during third trimester of pregnancy to prevent neonatal thrush

  • amelioration of underlying causes of infection (e.g., removal of indwelling venous catheters)

FACTORS FACILITATING EMERGENCE

  • immunosuppression

  • medical management (catheters)

  • antibiotic use

Suggested Citation:"B CATALOG OF EMERGING INFECTIOUS DISEASE AGENTS." Institute of Medicine. 1992. Emerging Infections: Microbial Threats to Health in the United States. Washington, DC: The National Academies Press. doi: 10.17226/2008.
×
Crytococcus

DISEASE(S) AND SYMPTOMS

Cryptococcosis

  • a fungal infection, usually presenting as a subacute or chronic meningitis

  • skin may show acneiform lesions, ulcers, or subcutaneous tumor-like masses

  • infection of lungs, kidneys, prostate, bone, and liver may occur

  • untreated cryptococcal meningitis terminates fatally within several months

DIAGNOSIS

  • visualization of fungus on microscopic examination of cerebrospinal fluid

  • tests for antigen in serum and cerebrospinal fluid

INFECTIOUS AGENT

  • Crytococcus species, typically C. neoformans, a fungus

  • fungus grows saprophytically in external environment (can be isolated from the soil in many parts of the world)

  • fungus can consistently be isolated from old pigeon nests and pigeon droppings

MODE OF TRANSMISSION

  • presumably by inhalation

  • waterborne transmission can also occur

  • not transmitted directly from person to person or between animals and people

DISTRIBUTION

  • worldwide

  • infection occurs mainly in adults

  • disseminated or central nervous system cryptococcosis is often a sentinel infection for HIV-infected persons

  • infection also occurs in dogs, cats, horses, cows, monkeys, and other animals

INCUBATION PERIOD

  • unknown

Suggested Citation:"B CATALOG OF EMERGING INFECTIOUS DISEASE AGENTS." Institute of Medicine. 1992. Emerging Infections: Microbial Threats to Health in the United States. Washington, DC: The National Academies Press. doi: 10.17226/2008.
×

TREATMENT

  • antifungal agents: amphotericin B is effective in many cases

  • very difficult to cure in persons with HIV disease

PREVENTION AND CONTROL

  • careful removal (preceded by chemical decontamination and wetting with water or oil to prevent aerosolization) of large accumulations of pigeon droppings

FACTORS FACILITATING EMERGENCE

  • immunosuppression

Cryptosporidium

DISEASE(S) AND SYMPTOMS

Cryptosporidiosis

  • a parasitic infection of the epithelial cells of the gastrointestinal, biliary, and respiratory tracts of man, as well as other vertebrates (birds, fish, reptiles, rodents, cats, dogs, cattle, and sheep)

  • symptoms of infection include watery diarrhea, nausea, vomiting, malaise, myalgias, and, in about half of cases, fever

  • symptoms usually come and go, but subside in fewer than 30 days in most healthy, immunocompetent persons

  • immunocompromised persons may not be able to clear the parasite, with disease becoming prolonged and fulminant and contributing to death

DIAGNOSIS

  • identification of oocysts in fecal smears

  • identification of parasites in intestinal biopsies

INFECTIOUS AGENT

  • Cryptosporidium, a protozoan parasite

MODE OF TRANSMISSION

  • fecal-oral spread from contaminated fingers, food, and water

  • occasional transmission by aerosolized organisms has been reported

DISTRIBUTION

  • worldwide; organism has been found wherever sought

Suggested Citation:"B CATALOG OF EMERGING INFECTIOUS DISEASE AGENTS." Institute of Medicine. 1992. Emerging Infections: Microbial Threats to Health in the United States. Washington, DC: The National Academies Press. doi: 10.17226/2008.
×

INCUBATION PERIOD AND COMMUNICABILITY

  • probably 1 to 12 days

  • oocysts, the infectious stage of the parasite, appear in the stool from the onset of symptoms to several weeks after symptoms resolve

  • outside the body, oocysts can remain infective for 2 to 6 months in a moist environment

TREATMENT

  • fluid and electrolyte replacement; nutritional support

  • effective, specific therapy has not yet been identified

PREVENTION AND CONTROL

  • careful handling of animal excreta

  • hand washing by those in contact with calves and other animals with diarrhea

  • effective water treatment

FACTORS FACILITATING EMERGENCE

  • development near watershed areas

  • immunosuppression

Giardia lamblia

DISEASE(S) AND SYMPTOMS

Giardiasis

  • infection of the upper small intestine

  • frequent diarrhea, bloating, abdominal cramps, fatigue, low-grade fever, malaise, and weight loss

  • symptoms typically subside after 2 to 3 weeks, but chronic or relapsing diarrhea may occur

DIAGNOSIS

  • identification of cysts or trophozoites in feces or of trophozoites in biopsy material from the small intestine

INFECTIOUS AGENT

  • Giardia lamblia, a protozoan parasite

MODE OF TRANSMISSION

  • ingestion of cysts in fecally contaminated food or water

Suggested Citation:"B CATALOG OF EMERGING INFECTIOUS DISEASE AGENTS." Institute of Medicine. 1992. Emerging Infections: Microbial Threats to Health in the United States. Washington, DC: The National Academies Press. doi: 10.17226/2008.
×
  • direct person-to-person spread via hand-to-mouth transfer of cysts from an infected individual (especially in day care centers and chronic care institutions)

DISTRIBUTION

  • worldwide; causes both sporadic outbreaks and epidemics

INCUBATION PERIOD AND COMMUNICABILITY

  • incubation period ranges from 3 days to 6 weeks; usually 1 to 3 weeks

  • infected persons can be a source of infection for as long as they carry the organism

TREATMENT

  • antiparasitic agents: quinacrine, metronidazole, furazolidine

PREVENTION AND CONTROL

  • avoidance of drinking untreated surface water

  • disposal of feces in a sanitary manner

FACTORS FACILITATING EMERGENCE

  • infection in the animal population (beavers and dogs)

  • capability of the organism to survive in water supply systems that use superficial water

  • immunosuppression

  • international travel

Microsporidia

DISEASE(S) AND SYMPTOMS

Microsporidiosis

  • chronic gastroenteritis, diarrhea, and wasting in patients with HIV disease

  • conjunctivitis, scleritis, diffuse punctate keratopathy, and corneal ulceration have also been reported, primarily in patients with HIV disease

  • other findings include fever, hepatitis, muscle weakness, and neurologic changes

DIAGNOSIS

  • requires electron microscopy of biopsy specimen

Suggested Citation:"B CATALOG OF EMERGING INFECTIOUS DISEASE AGENTS." Institute of Medicine. 1992. Emerging Infections: Microbial Threats to Health in the United States. Washington, DC: The National Academies Press. doi: 10.17226/2008.
×

INFECTIOUS AGENT

  • protozoan parasites from the phylum Microspora (phylum consists of about 80 genera, of which at least four cause human disease: Encephalitozoon, Enterocytozoon, Nosema, and Pleistophora)

  • microsporidia typically infect animals and have only recently been recognized as human pathogens

MODE OF TRANSMISSION

  • unknown; probably by ingestion of contaminated food or water

  • spores of some species survive up to 4 months in the environment

DISTRIBUTION

  • worldwide

  • human infections have been reported from Africa, North and South America, Asia, and Europe

  • the majority of reported patients have been immunosuppressed

INCUBATION PERIOD AND COMMUNICABILITY

  • unknown

TREATMENT

  • no clearly effective therapy is available

  • some patients have improved with antiparasitic drugs pyrimethamine and metronidazole

PREVENTION AND CONTROL

  • unknown at this time

FACTORS FACILITATING EMERGENCE

  • immunosuppression

  • parasite is newly recognized

Plasmodium

DISEASE(S) AND SYMPTOMS

Malaria

  • fever, headache, nausea, vomiting, diarrhea, myalgias, and malaise

  • in 30 to 40 percent of acute cases, the spleen is enlarged and liver may be tender

  • respiratory and renal failure, shock, acute encephalopathy, pulmonary

Suggested Citation:"B CATALOG OF EMERGING INFECTIOUS DISEASE AGENTS." Institute of Medicine. 1992. Emerging Infections: Microbial Threats to Health in the United States. Washington, DC: The National Academies Press. doi: 10.17226/2008.
×

and cerebral edema, coma, and death may result from severe cases (especially P. falciparum infections)

  • duration of an untreated primary attack ranges from 1 week to 1 month or longer; relapses of febrile illness can occur at irregular intervals for up to 2 to 5 years

  • chronically infected persons develop hyperreactive malarial splenomegaly or nephrotic syndrome

  • case fatality rates among untreated children and nonimmune adults exceed 10 percent

DIAGNOSIS

  • identification of characteristic intraerythrocytic parasites on a blood smear

INFECTIOUS AGENT

  • Plasmodium falciparum, P. vivax, P. ovale, and P. malariae

  • protozoan parasites with an asexual cycle in humans and sexual cycle in mosquitoes

MODE OF TRANSMISSION

  • bite of an infective mosquito

  • not directly transmitted from person to person

  • transmission by transfusion and transplacental transmission account for a small percentage of infections

DISTRIBUTION

  • indigenous malaria persists in about 100 tropical and subtropical countries

  • disease occurs in Africa, Asia, Mexico, Central and South America, the Caribbean, the South Pacific Islands, and in parts of the Commonwealth of Independent States

  • worldwide, an estimated 200 to 300 million infections occur annually, with 2 to 3 million deaths (most are from P. falciparum)

  • chloroquine-resistant P. falciparum strains have been reported from endemic areas in Africa, Asia, and the Americas; continued spread of resistance is expected

INCUBATION PERIOD

  • 10 to 30 days, depending on virus strain

  • transmission by transfusion can occur as long as asexual forms of the parasite remain in the circulating blood (for P. malariae, this can be more than 40 years)

Suggested Citation:"B CATALOG OF EMERGING INFECTIOUS DISEASE AGENTS." Institute of Medicine. 1992. Emerging Infections: Microbial Threats to Health in the United States. Washington, DC: The National Academies Press. doi: 10.17226/2008.
×

TREATMENT

  • chloroquine is drug of choice unless resistant P. falciparum is suspected

  • quinine plus tetracycline, pyrimethamine and sulfadiazine/clindamycin, or mefloquine should be used for resistant P. falciparum strains

  • resistance of P. falciparum malaria to all antimalarials has been reported; in these cases, combination therapy and repeated courses of treatment may be necessary

PREVENTION AND CONTROL

  • mosquito control

  • chemoprophylactic regimens (be sure to obtain updated information)

FACTORS FACILITATING EMERGENCE

  • urbanization

  • changing parasite biology

  • environmental changes

  • drug resistance

  • air travel

Pneumocystis carinii

DISEASE(S) AND SYMPTOMS

Pneumocystis carinii pneumonia

  • progressive dyspnea, tachypnea, and cyanosis

  • pneumonia is often fatal in malnourished, chronically ill, and premature infants, as well as in adults who are immunocompromised

DIAGNOSIS

  • demonstration of the organism in material from bronchial brushings, open lung biopsy, and lung aspirates

  • no satisfactory culture method or serologic test is in routine use at present

INFECTIOUS AGENT

  • Pneumocystis carinii, a protozoan parasite (with genetic similarities to a fungus)

Suggested Citation:"B CATALOG OF EMERGING INFECTIOUS DISEASE AGENTS." Institute of Medicine. 1992. Emerging Infections: Microbial Threats to Health in the United States. Washington, DC: The National Academies Press. doi: 10.17226/2008.
×

MODE OF TRANSMISSION

  • unknown in man (airborne transmission has been reported in rats)

  • subclinical infection may be common

DISTRIBUTION

  • worldwide

  • the disease affects 60 percent of patients with human immunodeficiency virus (HIV) disease

INCUBATION PERIOD AND COMMUNICABILITY

  • unknown; symptoms typically appear 1 to 2 months after onset of immunosuppression

  • period of communicability is unknown

TREATMENT

  • cotrimoxazole is first choice drug; pentamidine is also used

PREVENTION AND CONTROL

  • prophylaxis with cotrimoxazole in immunocompromised patients

FACTORS FACILITATING EMERGENCE

  • immunosuppression

Strongyloides stercoralis

DISEASE(S) AND SYMPTOMS

Strongyloidiasis

  • transient rash at site of parasite penetration into the skin

  • coughing and wheezing may develop when parasite passes through lungs

  • abdominal symptoms occur when adult female parasite invades intestinal mucosa

  • abdominal pain, diarrhea, nausea can be chronic and relapsing

  • in the immunocompromised host, infection may become disseminated, resulting in wasting, pulmonary involvement, and death

DIAGNOSIS

  • identification of larvae in stool specimens or duodenal aspirates

Suggested Citation:"B CATALOG OF EMERGING INFECTIOUS DISEASE AGENTS." Institute of Medicine. 1992. Emerging Infections: Microbial Threats to Health in the United States. Washington, DC: The National Academies Press. doi: 10.17226/2008.
×

INFECTIOUS AGENT

  • Strongyloides stercoralis, a nematode

  • larvae penetrate skin, enter blood vessels, travel to lungs, migrate up respiratory tree to the pharynx, where they enter the gastrointestinal tract (where the female lays eggs)

MODE OF TRANSMISSION

  • penetration of skin or mucous membrane by infective larvae (usually from fecally contaminated soil)

  • free-living form of the parasite can be maintained in the environment (soil) for years

  • transmission also occurs via oral-anal sexual activities

DISTRIBUTION

  • worldwide; most common in tropical and subtropical areas

INCUBATION PERIOD AND COMMUNICABILITY

  • larvae can be found in stool 2 to 3 weeks after exposure

  • infection is potentially communicable as long as living worms remain in the intestine

TREATMENT

  • antiparasitic agents: thiabendazole, albendazole, ivermectin

PREVENTION AND CONTROL

  • disposal of feces in a sanitary manner

  • avoidance of skin-soil contact in endemic areas

FACTORS FACILITATING EMERGENCE

  • international travel

  • immunosuppression

Toxoplasma gondii

DISEASE(S) AND SYMPTOMS

Toxoplasmosis

  • a systemic protozoan disease, frequently present as an acute mononucleosis-like disease (malaise, myalgias, fever)

  • immunocompromised persons tend to have severe primary infection with pneumonitis, myocarditis, meningoencephalitis, hepatitis, chorioretinitis, or some combination of these

Suggested Citation:"B CATALOG OF EMERGING INFECTIOUS DISEASE AGENTS." Institute of Medicine. 1992. Emerging Infections: Microbial Threats to Health in the United States. Washington, DC: The National Academies Press. doi: 10.17226/2008.
×
  • congenital toxoplasmosis causes chorioretinitis, fever, jaundice, rash, and brain damage

DIAGNOSIS

  • based on clinical signs, as well as on demonstration of the organism in body tissues or fluids

INFECTIOUS AGENT

  • Toxoplasma gondii, a protozoan parasite

  • cats and other felines are reservoirs

  • intermediate hosts are sheep, goats, rodents, swine, cattle, chicken, and birds

MODE OF TRANSMISSION

  • ingestion of oocysts (on fingers or in food contaminated with cat feces) or cysts in raw or undercooked meat

  • transplacental transmission

  • transmission through blood transfusion and tissue transplantations has been reported

  • not directly transmitted from person to person (except in utero)

DISTRIBUTION

  • worldwide

  • prevalence of seropositivity is higher in warm, humid climates and is influenced by presence of cats and by eating habits

INCUBATION PERIOD

  • 1 to 3 weeks

TREATMENT

  • antiparasitic agents (pyrimethamine plus sulfadiazine) for persons with severe disease

  • no treatment is needed for most healthy, immunocompetent hosts

PREVENTION AND CONTROL

  • thorough cooking of meats

  • daily disposal of cat feces and disinfection of litter pans (pregnant women should avoid contact with litter pans)

  • thorough hand washing after handling of raw meat

  • prophylactic treatment for patients with HIV disease

FACTORS FACILITATING EMERGENCE

  • immunosuppression

  • increase in cats as pets

Suggested Citation:"B CATALOG OF EMERGING INFECTIOUS DISEASE AGENTS." Institute of Medicine. 1992. Emerging Infections: Microbial Threats to Health in the United States. Washington, DC: The National Academies Press. doi: 10.17226/2008.
×
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×
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Emerging Infections: Microbial Threats to Health in the United States Get This Book
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The emergence of HIV disease and AIDS, the reemergence of tuberculosis, and the increased opportunity for disease spread through international travel demonstrate the critical importance of global vigilance for infectious diseases.

This volume highlights risk factors for the emergence of microbial threats to health, warns against complacency in public health, and promotes early prevention as a cost-effective and crucial strategy for maintaining public health in the United States and worldwide.

The volume identifies infectious disease threats posed by bacteria and viruses, as well as protozoans, helminths, and fungi. Rich in information, it includes a historical perspective on infectious disease, with focuses on Lyme disease, peptic ulcer, malaria, dengue, and recent increases in tuberculosis.

The panel discusses how "new" diseases arise and how "old" ones resurge and considers the roles of human demographics and behavior, technology and industry, economic development and land use, international travel and commerce, microbial adaptation and change, and breakdown of public health measures in changing patterns of infectious disease.

Also included are discussions and recommendations on disease surveillance; vaccine, drug, and pesticide development; vector control; public education and behavioral change; research and training; and strengthening of the U.S. public health system.

This volume will be of immediate interest to scientists specializing in all areas of infectious diseases and microbiology, healthy policy specialists, public health officials, physicians, and medical faculty and students, as well as anyone interested in how their health can be threatened by infectious diseases.

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