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Outbreak Cases in the Real World Microbiology 1st
Edition Rodney P. Anderson Digital Instant Download
Author(s): Rodney P. Anderson
ISBN(s): 9781555813666, 1555813666
Edition: 1
File Details: PDF, 58.29 MB
Year: 2006
Language: english
Cases in Real-World Microbiology
Rodney P. Anderson
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OUTBREAK
Cases in Real-World Microbiology
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OUTBREAK
Cases in Real-World Microbiology
Rodney P. Anderson
Department of Biological and Allied Health Sciences
Ohio Northern University
Ada, Ohio
WASHINGTON, D.C.
557026_FM_Anderson 4/13/06 8:59 AM Page iv
Send orders to ASM Press, P.O. Box 605, Herndon, VA 20172, USA
Phone: (800) 546-2416 or (703) 661-1593
Fax: (703) 661-1501
E-mail: [email protected]
Online: estore.asm.org
Anderson, Rodney P.
Outbreak : cases in real-world microbiology / Rodney P. Anderson.
p. ; cm.
Includes bibliographical references and index.
ISBN-13: 978-1-55581-366-6 (pbk.)
ISBN-10: 1-55581-366-6 (pbk.)
1. Epidemics—Case studies. 2. Communicable diseases—Case studies. 3. Medical
microbiology—Case studies.
[DNLM: 1. Disease Outbreaks—Case Reports. 2. Communicable Diseases—Case
Reports. 3. Disease Reservoirs—Case Reports. 4. Disease Transmission—Case
Reports. 5. Environmental Microbiology—methods—Case Reports. WA 105 A549o
2006] I. Title.
RA651.A68 2006
614.4—dc22
2005037791
10 9 8 7 6 5 4 3 2 1
For Tami—always
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Contents
Introduction xiii
About the Author xvii
SECTION I
Outbreaks and Cases Emphasizing Concepts in Basic
Microbiology 1
OUTBREAK 1 Multidrug-Resistant Tuberculosis Outbreaks 5
OUTBREAK 2 Outbreak of a Mycoplasmal Pneumonia 7
OUTBREAK 3 Hickman Catheter-Related Infections in a Hemato-
Oncologic Department 8
OUTBREAK 4 A Gang-Related Outbreak of Drug-Resistant
Gonorrhea 10
OUTBREAK 5 Skin Rash Caused by Pseudomonas and Associated
with Pools and Hot Tubs 12
OUTBREAK 6 Human Anthrax Linked to an Outbreak in
Livestock 14
OUTBREAK 7 A Multidrug-Resistant Salmonella Outbreak in
Veterinary Clinics 15
OUTBREAK 8 A Pertussis Outbreak 17
OUTBREAK 9 Vancomycin-Resistant Staphylococcus aureus 19
O U T B R E A K 10 An Influenza Outbreak on a Cruise Ship 21
O U T B R E A K 11 An AIDS Outbreak Traced to a Single Infected
Male 22
O U T B R E A K 12 A Rubella Outbreak 24
O U T B R E A K 13 An Outbreak of Rotaviral Gastroenteritis among
Children 26
vii
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COLLEGE PERSPECTIVE
O U T B R E A K 15 An Escherichia coli O111:H8 Outbreak among
Teenage Campers 30
GLOBAL PERSPECTIVE
O U T B R E A K 16 An Outbreak of Lethal Viral Pneumonia 31
R E F E R E N C E M AT E R I A L F O R
Microbes and Diseases Demonstrating Basic Microbiological
Principles 33
SECTION II
Outbreaks of Diseases of the Respiratory Tract 51
O U T B R E A K 17 A Legionellosis Outbreak 54
O U T B R E A K 18 An Outbreak of Respiratory Syncytial Virus
Infection 55
O U T B R E A K 19 A Tuberculosis Outbreak in a Prison Housing
Inmates Infected with HIV 57
O U T B R E A K 20 An Otitis Media Outbreak in a Child Care
Center 59
O U T B R E A K 21 An Outbreak of a Rash 61
O U T B R E A K 22 An Outbreak of a Rash at a Camp for HIV-Infected
Children 63
O U T B R E A K 23 A Diphtheria Outbreak 64
O U T B R E A K 24 An Outbreak of Mononucleosis 66
O U T B R E A K 25 A Pneumonia Outbreak in a Nursing Home 67
O U T B R E A K 26 Past and Future Pandemics of Influenza A 68
COLLEGE PERSPECTIVE
O U T B R E A K 27 A Pharyngitis Outbreak in the Marine Corps 70
GLOBAL PERSPECTIVE
O U T B R E A K 28 A Measles Outbreak among Kosovar Refugee
Children 71
R E F E R E N C E M AT E R I A L F O R
Pathogens and Diseases of the Respiratory System 73
SECTION III
Outbreaks of Diseases of the Gastrointestinal Tract 83
A Salmonella enterica Serovar Enteritidis Outbreak
O U T B R E A K 29
from Eating Eggs 86
A Cryptosporidium Outbreak Associated with
O U T B R E A K 30
Swimming Pool Use 89
viii ■ CONTENTS
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COLLEGE PERSPECTIVE
O U T B R E A K 40 A Rotavirus Outbreak among College Students 107
GLOBAL PERSPECTIVE
O U T B R E A K 41 A Cholera Outbreak in a Refugee Camp 109
R E F E R E N C E M AT E R I A L F O R
Pathogens and Diseases of the Gastrointestinal Tract 111
SECTION IV
Outbreaks of Sexually Transmitted Diseases 125
An Outbreak of Sexually Transmitted Disease
O U T B R E A K 42
among Teenagers 127
O U T B R E A K 43 A Chancroid Outbreak among Hispanic Men 128
An Outbreak of Sexually Transmitted Disease in the
O U T B R E A K 44
Pornography Industry 130
O U T B R E A K 45 An Outbreak of Azithromycin-Resistant
Gonorrhea 132
O U T B R E A K 46 Invasive Cervical Cancer among Women 134
O U T B R E A K 47 An Outbreak of Lymphogranuloma Venereum in
Homosexual Men 136
COLLEGE PERSPECTIVE
A Syphilis Outbreak Connected with a Cybersex
O U T B R E A K 48
Chat Room 138
GLOBAL PERSPECTIVE
O U T B R E A K 49 The Impact of AIDS Worsens Famine 140
R E F E R E N C E M AT E R I A L F O R
Pathogens and Diseases That Are Transmitted Sexually 142
CONTENTS ■ ix
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SECTION V
Outbreaks of Diseases of the Skin, Eyes, and Deep Tissues 151
An Outbreak of Staphylococcus aureus with
O U T B R E A K 50
Increased Vancomycin Resistance 153
O U T B R E A K 51 An Outbreak of Pseudomonas Dermatitis from a
Hotel Pool and Hot Tub 155
O U T B R E A K 52 A Ringworm Outbreak in a Wrestling Team 157
O U T B R E A K 53 An Outbreak of Conjunctivitis at an Elementary
School 159
O U T B R E A K 54 A Measles Outbreak among Internationally Adopted
Children 160
O U T B R E A K 55 A Hepatitis Outbreak at a Pain Clinic 162
O U T B R E A K 56 An Outbreak of Flesh-Eating Bacteria 163
O U T B R E A K 57 An Outbreak of Invasive Group A Streptococcus at a
Child Care Center 165
COLLEGE PERSPECTIVE
O U T B R E A K 58 A Skin Infection Outbreak at a High School 167
GLOBAL PERSPECTIVE
O U T B R E A K 59 A Gas Gangrene Outbreak after a Tsunami 169
R E F E R E N C E M AT E R I A L F O R
Pathogens and Diseases of the Skin, Eyes, and Deep Tissues 171
SECTION VI
Outbreaks of Multisystem Zoonoses and Vector-Borne
Diseases 181
O U T B R E A K 60 An Outbreak of Typhus 183
O U T B R E A K 61 An Outbreak of Cyclic Fevers 185
O U T B R E A K 62 An Outbreak of Encephalitis 187
O U T B R E A K 63 Yellow Fever in a Traveler Returning from
Venezuela 189
O U T B R E A K 64 A Hantavirus Pulmonary Syndrome Outbreak 191
O U T B R E A K 65 Cases of Rash and Fever, One Fatal, in a Family
Cluster 193
O U T B R E A K 66 An Outbreak of Ebola Hemorrhagic Fever 195
O U T B R E A K 67 An Outbreak of Leptospirosis during
EcoChallenge 197
O U T B R E A K 68 A Dengue Fever Outbreak 198
COLLEGE PERSPECTIVE
O U T B R E A K 69 An Outbreak of Lyme Disease 200
GLOBAL PERSPECTIVE
OUTBREAK 70 A Plague Outbreak 202
x ■ CONTENTS
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R E F E R E N C E M AT E R I A L F O R
Multisystem Zoonoses and Vector-Borne Diseases and Pathogens 204
SECTION VII
Outbreaks of Diseases of the Central Nervous System 215
O U T B R E A K 71 An Outbreak of Acute Flaccid Paralysis 217
O U T B R E A K 72 An Outbreak of Paralysis from Eating Fermented
Beaver Tails 219
O U T B R E A K 73 Rabies Infections from Organ Donor Tissues 221
O U T B R E A K 74 A Tetanus Outbreak 223
O U T B R E A K 75 An Outbreak of Aseptic Meningitis among
Recreational Vehicle Campers 225
O U T B R E A K 76 A Mad Cow Disease Outbreak in Humans and
Cattle 226
COLLEGE PERSPECTIVE
O U T B R E A K 77 Meningitis Outbreaks Traced to Raves and
Clubs 228
GLOBAL PERSPECTIVE
O U T B R E A K 78 Meningitis among Travelers Returning from Saudi
Arabia 230
R E F E R E N C E M AT E R I A L F O R
Diseases and Pathogens of the Central Nervous System 233
SECTION VIII
Outbreaks and Cases Requiring Application of
Environmental and Industrial Microbiology Concepts 239
O U T B R E A K 79 Gastroenteritis from an Interactive Water
Fountain 242
O U T B R E A K 80 Dengue Fever Epidemics Return 244
O U T B R E A K 81 Acid Pollution in Waterways from Metal Leaching
from Mine Tailings 246
O U T B R E A K 82 A Shigellosis Outbreak from a Wading Pool 247
A Massive Outbreak of Cryptosporidium Infection
O U T B R E A K 83
Transmitted through the Public Water Supply 249
O U T B R E A K 84 Biofilm Fouling in Cooling Towers 250
An Outbreak of Legionnaires’ Disease from an Air-
O U T B R E A K 85
Conditioning Unit 251
O U T B R E A K 86 Microbiologically Influenced Corrosion of Industrial
Materials 253
COLLEGE PERSPECTIVE
O U T B R E A K 87 Increasing Production of Beer in the United
States 255
CONTENTS ■ xi
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GLOBAL PERSPECTIVE
O U T B R E A K 88 Four Successive Annual Outbreaks of Plague 256
R E F E R E N C E M AT E R I A L F O R
Microbes That Cause Environmental and Industrial Problems 258
SECTION IX
Bioterrorism Outbreaks 267
O U T B R E A K 89 An Accidental Release of Weaponized Anthrax 270
An Investigation of a Brucellosis Outbreak as
O U T B R E A K 90
Bioterrorism 272
O U T B R E A K 91 A Tularemia Outbreak 274
Bioterrorist Release of Anthrax Bacteria by a
O U T B R E A K 92
Religious Cult 276
A Death from Ebola Hemorrhagic Fever at a Former
O U T B R E A K 93
Bioweapon Laboratory 278
O U T B R E A K 94 An Inexpensive and Simple Botulism Bioweapon 280
COLLEGE PERSPECTIVE
O U T B R E A K 95 State-Sponsored Bioweapon Research 282
GLOBAL PERSPECTIVE
O U T B R E A K 96 An Outbreak of Weaponized Smallpox 284
R E F E R E N C E M AT E R I A L F O R
Pathogens and Diseases Involved in Bioterrorism 286
Index 311
xii ■ CONTENTS
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Introduction
Content
The outbreaks featured in each section are preceded by one or two
tables listing the significant pathogens that can cause outbreaks.
The cases presented in that section include only diseases caused by
pathogens listed in the table(s). The diseases and pathogens chosen
are those which are often covered in an introductory microbiology
course. Limiting the pool of possibilities helps the students learn the
basics thoroughly without having to consider the myriad of possible
causes normally associated with a differential diagnosis. Each chapter
ends with a set of descriptions of the diseases covered in the case stud-
ies. The descriptions are meant to be used by students for reference, if
necessary, to gather the information needed to develop appropriate
answers to the questions at the end of each outbreak. Each disease
description presents information on (i) the causative agent of the dis-
ease, (ii) the pathogen’s mode of transmission from its reservoir to a
new host, (iii) pathogenesis, (iv) the clinical features of the disease,
(v) clinical and laboratory diagnosis, (vi) treatment of the disease, and
xiii
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Special features
The last two outbreaks in each section are designated “College
Perspective” and “Global Perspective.” The College Perspectives
present outbreaks that directly impact the lives of students. The
pathogens are typically spread easily in the college-age population,
or the outbreaks focus on issues important to students. The Global
Perspectives present outbreaks that occur in non-Western cultures. As
a result, solutions developed by students for treatment and prevention
require them to consider cultures in which differences in customs, reli-
gion, public resources, and infrastructure impact the analysis.
xiv ■ INTRODUCTION
557026_FM_Anderson 4/13/06 8:59 AM Page xv
As with much of life, the most challenging parts are also the most
rewarding. With much of science, learning the content base, although
often challenging, is just the beginning. The real objective is to integrate
and apply scientific concepts and principles to make a difference in the
real world. The best education provides students with such opportuni-
ties both in the classroom and through practical experiences.
Acknowledgments
I thank several individuals who took time out of their busy schedules
to help with this project, especially Cara Calvo, who provided several
needed cultures and images, and Graetel Anderson, who reviewed
material for appropriate vocabulary level. I also thank the staff of and
contributors to the Centers for Disease Control and Prevention’s jour-
nals and image library. The journals and image library are a rich
resource of information for educators and the public to use.
INTRODUCTION ■ xv
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557026_FM_Anderson 4/13/06 8:59 AM Page xvii
Dr. Anderson and his wife, Tami, are parents of two adult children,
Isaac and Graetel, who are both pursuing careers in nursing. He loves
classic cars, golfing, hunting, antiquing, and spending vacations para-
chuting and rock climbing with his children.
xvii
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S E C T I O N I
W
hen one studies the fundamentals of microbial structures
and their functions, it is often difficult to link this content
to mechanisms of disease transmission and the patho-
genesis of the microbe. The outbreaks and cases in this section have
been chosen as examples of how basic microbial features enable
pathogens to cause disease. For example, the structures of some cell
walls influence a pathogen’s ability to survive treatments that would
kill other bacteria. Mycobacterium tuberculosis, the causative agent
of tuberculosis (TB), has a waxy cell wall. As a result, it resists dry-
ing, so the cell is easier to transmit. The waxy wall is also an effec-
tive barrier to the diffusion of many antibiotics and disinfectants,
making infection difficult to treat and control. In contrast, Myco-
plasma pneumoniae, one causative agent of primary atypical pneu-
monia, lacks a cell wall. This reduces its ability to survive during
transmission. As a result, long-term exposure is normally required to
transmit the pathogen. The lack of a cell wall, however, makes
Mycoplasma resistant to the antibiotics that target peptidoglycan
synthesis. In general, gram-negative cells are more resistant to anti-
septics and disinfectants than are gram-positive bacteria because
the outer membrane provides an additional barrier to diffusion. In
addition, Pseudomonas aeruginosa, a common hospital-acquired
gram-negative pathogen, has very small porins, which further restrict
diffusion, allowing it to survive some chemical treatments that effec-
tively kill other pathogens.
More recently, the ability of bacteria to form biofilms has been recog-
nized as leading to infection of indwelling catheters. The sticky coat-
ing surrounding cells contained in a biofilm allows the pathogen to
attach to plastic and also restricts the diffusion of antibiotics, result-
ing in a drug-resistant persistent infection.
2 ■ SECTION I
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