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Tropical Infectious Diseases THIRD EDITION TROPICAL INFECTIOUS DISEASES RICHARD L. GUERRANT MDThomasDAV'ID H. WALKERMD PETER F. WELLER MO FACP FIOSA çarmage and Martha Walls Distinguished H. Hunter Professor of Professor of Medicine, Harvard Medical University Chair in Tropical Diseases International Medicine School Director, Center for Biodefense and Director, Center for Global Health, Professor, Immunology and Infectious Emerging Infectious Diseases Division of Infectious Diseasesand Diseases Department, Harvard School of Professor and Chair, Department of International Health Pubüc Health University ofVirginia School of Medicine Pathology Crnef, Infectious Disease Division University ofTexas Medical Branch Charlottesville, VA, USA Vice Chair of Research, Department of Galveston, TX, USA Medicine, Beth Israel DeaconessMedica! Center Boston, MA, USA Edinburgh, London, New York, Oxford, Philadelphia, SI Louis, Sydney I Toronlo SAUNDERS ELSEVIER SAUNDERS is an imprint of EIsevier Inc. @ 20 I I, EIsevier Inc. AlI rights reserved. First edition 1999 Secondedition 2006 No pa;rt of this publication mar be reproduced or transmitted in any form or by any means,electronic or mechanical,including photocopying,recording, or any information storageand retrieval system,without permission in writing Eramthe publisher. Oetails on how to seekpermission, further information about the Publisher'spermissions policies and our arrangementswith organizationssuch asthe Copyright ClearanceCenter and the Copyright LicensingAgency, can be found at our website: www.elsevier. comi permissions. This book and the individual contributions containedin it are protected under copyright by the Publisher (other than as mar be noted herein). Chapter 41, Plague,Paul S. Mead is in the public domain apart from any borrowed figures. Chapter60, Enterovirus Infections,lncluding Poliomyelitis,MarkA. Pallanschis in the public domainapart from any borrowed figures. Chapter 62, Calicivirus Infections, GagandeepKang, Mary K. Estes,Robert L. Atmar -Mary K. Estes retains copyright of her text and images. Chapter 90, Entomophthoramycosis,Lobomycosis, Rhinosporidiosis, and Sporotrichosis, Duane R. Hospenthalis in the public domain apart Eramany borrowed figures. Chapter 99, AmericanTrypanosomiasis (Chagas Disease), Louis v: Kirchhoff is in the public domain apart from any borrowed figures. Chapter 105, Loiasisand MansonellaInfections, Amy D. Klion, ThomasB. Nutman is in the public domain apart Eramany borrowed figures. Chapter 128, Infectious Diseasesin Modern Military Forces,Alan J. Magill, BonnieL. Smoak,Truman W Sharpis in the public domain apart from any borrowed figure~. Notices Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment mar become necessary. Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safetY,and the safety of others, including parties for whom they have a professional responsibility. With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (li) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take alI appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, plfoducts, instructions, or ideas contained in the material herein. Saunders British Library Cataloguing in Publication Data your sourcefor books. joumals and multimedia in the health sciences ropical infectious diseases: principies, pathogens and practice. 3rd ed. www.elsevierhealth.com 1. Tropical medicine. I. Guerrant, Richard L. 11. Walker, Oavid H., 1943- 111.Weller, reter F. Working together to grow 616.9'883-dc22 libraries in developing countries www.elsevier.com I www.bookaid.org I www.sabre.org ISBN-13:9780702039355 A catalogue record for this book is available from the British Library Library of Congress Cataloging in Publication Data A catalog record for this book is available from the Library of Congress The publisher's policyis to use papermanufactured Printed in China from sustainableforests 987654 3 2 Last digit is the print number: 987654 3 2 I Robert B. Tesh.Pedro F.C. Vasconcelos anorexia, nausea,vomiting, and low back pain.8The face is often flushed and the conjunctivae are injected, but a true rash is absent. The disease The family Bunyav;r;daeincludes more than 300 antigenically distinct is self-limited, and the symptoms usually disappearWithin 2-3 days; members, most of which are transmitted by arthropods.! At least 4-1 of however, a general feeling of weakness and depression frequently lasts these viruses have been associatedwith human illness in the tropics. Apart for a week or more after the illness. Marked leukopenia «4000/~L), from those members that produce serious and sometimes fatal disease consisting of initial lymphopenia, followed by protracted neutropenia, (i. e., the hantaviruses, Rift Valley rever virus, and Crimean-Congo hem- algo occurs in PF.8 orrhagic rever virus), most of the remaining human pathogenic bunya- Aseptic meningitis is a relatively common manifestation of Toscana vírus infection. Originally described in central ltaly, this infection occurs viruses produce nonspecific febrile illnesses. Becauseof ,their nonspecific nature and the limited virus diagnostic capabilities in many tropical throughout much of the Mediterranean region of Europe and is a frequent countries, these infections are often unrecognized or are misdiagnosed as causeof summertime meningitis in both adults and children.9These cases begin as classic PF, with a nonspecific febrile illness for 2-+ days before other common febrile illnesses such as malaria or dengue. This chapter Robert B. Tesh .Pedro F.C. Vasconcelos describes some of the more common bunyavirus reverso the appearance of more serious symptoms, such as nuchal rigidity, posi- tive Kernig's sign, nystagmus, and reduced levels of consciousness.7In these casesthe hematologic picture is similar to that of classic PF, but the cerebrospinal fluid (CSF) mar show increased pressure, but Without pleocytosis and With normal glucose and protein levels. The neurologic Historically, phlebotomus rever (PF) has been mainly a diseaseof military abnormalities usually resolve in a few days, and most patients recover importance, since epidemics have typically occurred when large numbers spontaneously in 1-2 weeks, although headache mar persistoThe recov- of nonimmune adults enter an area of endemic virus activity. The disease ery of phlebovíruses from patients with PF is uncommon, since the occurred in troops during the Napoleonic Wars, the Austrian occupation víremia associatedWith this diseaseis quite transient (24-36 hours), and of the Adriatic, the British colonization of lndia and Pakistan, and the most patients do not seek medical care so earlY.Jge one exception is North African and Mediterranean campaigns in World War 1I.2.3The patients With neurologic diseasedue to Toscanavírus infection; vírus can largest reported outbreak of PF occurred in Serbia in 1948, when over 1 be recovered from the CSF after it has disappeared from the blood.6 million persons were affected. PF outbreaks still occur among tourists Culturein Vero cells is the isolation system of choice for most phleboví- vacationing in the Mediterranean region.+-7 ruses.2 RT-PCR can algO be dane on CSF of patients With neurologic Many of the PF group of viruses arrear to be maintained in their insect symptoms ofToscana vírus infection. vectors by vertical (transovarial) virus transmission.3 Consequently, virus A number of serologic techniques can be used for the diagnosis activity is largely correlated with adult sandf1yactivity rather than by the of PF, but each has its limitations. The IgM-capture enzyme-linked immune status of the local human or animal populations. During periods immunosorbent assar (ELISA)10 and plaque reduction neutralization of vector abundance (i.e., summer in subtropical or Mediterranean cli- test (PRNT)2.8,11are quite specific and sensitive, but one must screen mates and the rainy seasonin drier tropical climates), phlebovirus activity againsta variety of phlebovírus serotypes because of their focal and some- is continuous. In this situation one seeslittle illness in the native popula- times overlapping distribution. Seroconversion can be demonstrated in tion, most of whom are already immune, but when a group of nonim- paired samples by IgG ELISA and by fluorescent antibody (FA) or mune adults (i. e., tourists, soldiers) enters in the area, an epidemic hemagglutination-inhibition (HI) tests, but these techniques are not . k1 2 qmc y ens~es., serotype-specific. Although more than 40 PF virus serotypes have been described,2three Treatment of PF is symptomatic. Except for
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