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Seventh Edition
SHERRIS
MEDICAL MICROBIOLOGY
EDITOR
KENNETH J. RYAN, MD
ISBN: 978-1-25-985981-6
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NOTICE
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therapy are required. The authors and the publisher of this work have checked with sources believed to be reliable in their efforts to
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DEDICATION
Between the sixth and this seventh edition we have lost four scholars who significantly
aided founding editor John Sherris in the formation and character of this book now known
as Sherris Medical Microbiology.
George Ray was a founding author, writing on viral diseases, infectious disease syndromes,
and laboratory diagnosis. For the fourth through the sixth editions, he was also coeditor of
the book. Gorge, a national leader in rapid viral diagnosis, was also a decorated teacher
of medical students at three medical schools, the University of Washington, the University
of Arizona, and St. Louis University. At SLU, he finished his career as Chairman of
Pediatrics.
Jim Plorde, also a founding author, wrote on antibiotics, bacterial diseases, parasitic dis-
eases and infectious disease syndromes in the first through the fifth editions. Jim’s Peace
Corps and international experience was reflected in his writing, particularly on parasitic
diseases. In his faculty career at Washington he served as Chief of Infectious Diseases and
Microbiology at the Seattle Veterans Administration Medical Center.
Elizabeth Sherris not only contributed to the organization of the book, she typed the first
draft at a time before computers, copiers, and the Internet. Elizabeth had a keen sense of
language particularly concerning the clear use of medical language which earned her the
respect of the authors and the publisher. She followed later editions closely, remarking espe-
cially on the introduction of full color artwork in the fifth edition.
Fred Neidhardt was recruited as an author for the second edition during a sabbatical at
Washington and continued through the fourth edition. Fred set the standard and style for
the presentation of basic bacteriology to medical students, which continues today. A tower-
ing figure in bacterial physiology highlighted by his two-volume book on Escherichia coli,
Fred held faculty positions at Harvard, Purdue, and Michigan, where he was Chair of
Microbiology.
Preface xi 15
Viruses of Diarrhea 283
16 Arthropod-Borne and
Other Zoonotic Viruses 295
PART I
17 Rabies 319
Infection 1
L. Barth Reller, Megan E. Reller, and Kenneth J. Ryan 18
Retroviruses: Human T-Lymphotropic Virus,
Human Immunodeficiency Virus,
1 Infection—Basic Concepts 3 and Acquired Immunodeficiency
2 Immune Response to Infection 19 Syndrome 327
vii
30
Neisseria 567 46 The Opportunistic Fungi: Candida,
Aspergillus, the Zygomycetes, and
31
Haemophilus and Bordetella 583 Pneumocystis 771
32 Vibrio, Campylobacter, and Helicobacter 599 47 The Systemic Fungal Pathogens:
33 613
Enterobacteriaceae Cryptococcus, Histoplasma, Blastomyces,
787
Coccidioides, Paracoccidioides
34 645
Legionella and Coxiella
36
Plague and Other Bacterial
Pathogenic Parasites 803
Zoonotic Diseases 665 Paul Pottinger and Charles R. Sterling
AUTHORS
NAFEES AHMAD, PhD L. BARTH RELLER, MD
Professor of Immunobiology Professor of Pathology and Medicine
Director, Immunity and Infection Duke University School of Medicine
University of Arizona College of Medicine Durham, North Carolina
Tucson, Arizona
MEGAN E. RELLER, MD, PhD, MPH
J. ANDREW ALSPAUGH, MD Associate Professor of Medicine
Professor of Medicine, Molecular Genetics Duke University School of Medicine
and Microbiology Durham, North Carolina
Duke University School of Medicine
Durham, North Carolina CHARLES R. STERLING, PhD
Professor Emeritus
W. LAWRENCE DREW, MD, PhD School of Animal and Comparative
Emeritus Professor of Laboratory Biomedical Sciences
Medicine and Medicine University of Arizona
University of California, San Francisco Tucson, Arizona
School of Medicine
Mount Zion Medical Center SCOTT WEISSMAN, MD
San Francisco, California Associate Professor of Pediatrics
University of Washington School of
MICHAEL LAGUNOFF, PhD Medicine
Professor of Microbiology Seattle Children’s
University of Washington School of Seattle, Washington
Medicine
Seattle, Washington
PAUL POTTINGER, MD
Associate Professor of Medicine
Division of Allergy and Infectious Diseases
University of Washington School of
Medicine
Seattle, Washington
W
ith this seventh edition, Sherris Medical Microbiology will complete its fourth
decade. We are pleased to welcome new authors, Andy Alspaugh (mycology)
and Megan Reller (epidemiology) from Duke and Scott Weissman (bacteriology)
from the University of Washington. Sadly, George Ray a founding author and coeditor of the
last three editions is no longer with us (see Dedication). John Sherris, the founding editor,
continues to act as an inspiration to all of us.
BOOK STRUCTURE
The goal of Sherris Medical Microbiology remains unchanged from that of the first edition
(1984). This book is intended to be the primary text for students of medicine and medical
science who are encountering microbiology and infectious diseases for the first time. Part I
opens with a chapter that explains the nature of infection and the infectious agents at the
level of a general reader. The following four chapters give more detail on the immunologic,
diagnostic, and epidemiologic nature of infection with minimal detail about the agents
themselves. Parts II through V form the core of the text with chapters on the major viral,
bacterial, fungal, and parasitic diseases, and each begins with its own chapters on basic biol-
ogy, pathogenesis, and antimicrobial agents.
CHAPTER STRUCTURE
In the specific organism/disease chapters, the same presentation sequence is maintained
throughout the book. First, features of the Organism (structure, metabolism, genetics, etc.)
are described; then mechanisms of the Disease (epidemiology, pathogenesis, immunity)
the organism causes are explained; the sequence concludes with the Clinical Aspects
(manifestations, diagnosis, treatment, prevention) of these diseases. A clinical Case Study
followed by questions in USMLE format concludes each of these chapters. In Sherris Medi-
cal Microbiology, the emphasis is on the text narrative, which is designed to be read com-
prehensively, not as a reference work. Considerable effort has been made to supplement this
text with other learning aids such as the above-mentioned cases and questions as well as
tables, photographs, and illustrations.
The back of the book includes two more review tools. Infectious Diseases: Syndromes
and Etiologies is a set of tables that brings together the infectious agents (viruses, bacteria,
fungi, parasites) discussed separately in Parts II through V as probable causes of the major
infection syndromes (pneumonia, arthritis, diarrhea, etc.). It is hoped these will be of value
when the student prepares for case discussion exercises or sees patients. The 100 Practice
Questions are in USMLE format and in addition to the ones at the end of earlier chapters.
For any textbook, dealing with the onslaught of new information is a major challenge.
In this edition, much new material has been included, but to keep the student from being
overwhelmed, older or less important information has been deleted to keep the size of this
book no larger than of the sixth edition. As a rule of thumb, material on classic microbial
structures, toxins, and the like in the Organism section has been trimmed unless its role is
clearly explained in the Disease section. At the same time, we have tried not to eliminate
detail to the point of becoming synoptic and uninteresting. Genetics is one of the greatest
challenges in this regard. Without doubt this is where major progress is being made in
understanding infectious diseases, but a coherent discussion may require using the names
and abbreviations of genes, their products, and multiple regulators to tell a complete story.
Whenever possible we have tried to tell the story without all the code language. We have
also tried to fully describe the major genetic mechanisms in general chapters and then refer
to them again when that mechanism is deployed by a pathogen. For example, Neisseria
gonorrhoeae is used to explain the genetic mechanisms for antigenic variation in a general
chapter on bacterial pathogenesis (Chapter 22), but how it influences its disease, gonorrhea,
is taken up with its genus Neisseria (Chapter 30).
A saving grace is that our topic is important, dynamic, and fascinating—not just to
us but to the public at large. Newspaper headlines now carry not only the new names of
emerging threats like Zika virus but also the antigenic formulas of more familiar pathogens
like E coli and influenza virus. Resistance to antimicrobial agents and the havoc created by
antivaccine movements are regular topics on the evening news. I1t is not all bad news. We
sense a new optimism that deeper scientific understanding of worldwide scourges like HIV/
AIDS, tuberculosis, and malaria will lead to their control. We are hopeful that the basis for
understanding these changes is clearly laid out in the pages of this book.
Kenneth J. Ryan
Editor
Infection—Basic Concepts C H A P T ER 1
Immune Response to Infection C H A P T ER 2
Sterilization, Disinfection, and Infection Control C H A P T ER 3
Principles of Laboratory Diagnosis of Infectious Diseases C H A P T ER 4
Emerging and Reemerging Infectious Diseases: Emergence and Global Spread of Infection C H A P T ER 5