Malassezia Species

Microbiology Malassezia (formerly called Pityrosporum ) is a genus of lipophilic, basidiomycetous yeasts lacking ballistospores and classified in the order Malasseziales . Its phylogenetic placement within the Ustilaginomycotina (Basidiomycota) is highly supported. Malassezia increasingly is recognized as an opportunist affecting both humans and animals. , Newer identification methods have made the characterization of several new species possible and also have enhanced our understanding of the ecology…

Agents of Mucormycosis

Mucormycosis (formerly zygomycosis) is an uncommon but emerging infection that occurs in immunocompromised patients, including children and neonates. Previously, the term zygomycosis was used to refer to syndromes of mucormycosis and entomophthoromycosis, but updates in taxonomy determined that the phylum name Zygomycota is invalid. Because the phylum Zygomycota no longer exists, the term zygomycosis has become obsolete. , Molds causing these infections are now in the…

Agents of Hyalohyphomycosis and Phaeohyphomycosis

Agents of hyalohyphomycosis and phaeohyphomycosis are ubiquitous filamentous molds. (Moulds is the preferred spelling by many mycologists.) These molds are soil saprobes and plant pathogens that have gained notoriety as emerging pathogens in immunocompromised hosts, including children. The pathogenesis of infections with these organisms is not clearly established because many of these organisms are minimally pathogenic in humans. However, fungal conidia can cause infection in severely…

Aspergillus Species

Although yeasts such as Candida species are the most common causes of invasive fungal infections in children, Aspergillus infections are increasing and have a dismal mortality rate. Invasive aspergillosis is a prominent infection because of more intensive chemotherapies for certain malignant diseases, immunosuppressive therapies for graft-versus-host disease (GvHD), increased use of mismatched or unrelated donor transplantations, newer preparative regimens to avoid graft rejection or disease relapse,…

Candida Species

Candida infections occur frequently in neonates, infants, and children, ranging from superficial skin infections to invasive disease. The number of children at risk for invasive candidiasis (IC) continues to increase due to new cancer therapies, increasing numbers of immunosuppressed solid organ and bone marrow transplant recipients, immune modulating agents for a wide range of autoimmune and autoinflammatory diseases, and utilization of novel medical devices. Epidemiology The…

Classification of Fungi

Fungal disease contributes significantly to patients’ morbidity and mortality in certain clinical settings. Extensive medical interventions, immunosuppression, and a heightened awareness of fungal disease, particularly opportunistic mycoses in the setting of immune compromise, have all necessitated an increased understanding of fungal etiologic agents and their classification, identification, and clinical manifestations. The Agents Definition Fungi are heterotrophic (using organic compounds as a primary source of energy and…

Hepatitis E Virus

Hepatitis E virus (HEV) is the major etiologic agent of enterically transmitted non-A viral hepatitis worldwide. It is a spherical, nonenveloped, single-stranded, positive-sense RNA virus that is approximately 32–34 nm in diameter. HEV is the sole member of the family Hepeviridae , genus Orthohepevirus . The HEV genome is approximately 7.2 kilobases and consists of 3 open reading frames (ORF 1, ORF 2, and ORF 3).…

Astroviruses

Astroviruses were first described in 1975 when they were detected by electron microscopy on stool specimens of infants with gastroenteritis. , Since 1990, with development of sensitive and specific diagnostic methods, including enzyme immunoassays (EIAs) and reverse transcriptase polymerase chain reaction (RT-PCR), astroviruses have been identified as relatively common causes of community-acquired and hospital-acquired gastroenteritis. Astroviruses are among the most common viral causes of gastroenteritis among…

Caliciviruses

Pathogens and Pathogenesis The first calicivirus was discovered in 1972 by electron microscopic examination of stool samples from children affected by an outbreak of gastroenteritis in a school in Norwalk, Ohio, several years previously. This discovery of the subsequently named Norwalk virus marked the first identification of a virus as a cause of gastroenteritis. Norwalk virus and other viruses with similar morphologic features are now classified…

Rhinoviruses

Acknowledgment Dr. Pappas retains the coauthorship of the late Dr. J. Owen Hendley as a tribute to his substantial contribution to our knowledge of respiratory viruses and to this chapter. Rhinoviruses ( rhino meaning “nose”) are the most common causes of the common cold, and they account for at least 50% of upper respiratory tract infections in children and adults. Rhinoviruses are difficult to detect, but…

Hepatitis A Virus

The Pathogen Hepatitis A virus (HAV) is a positive-sense RNA virus and a member of the Picornaviridae family. The single-stranded RNA genome is approximately 7500 nucleotides long and contains a single open reading frame. The encoded polyprotein includes structural proteins for the 27–28 nm diameter capsid, nonstructural proteins with protease or polymerase activities, and other proteins with functions that have not been fully determined. , Although…

Enteroviruses and Parechoviruses

The human enteroviruses and parechoviruses are members of the Picornaviridae family that are commonly transmitted by enteric and respiratory routes. They cause a wide spectrum of illnesses in people of all ages. The enteroviruses are divided among 4 species within the genus Enterovirus (i.e., human enterovirus A , B , C , and D ) based on RNA sequence relatedness. Enterovirus species C polioviruses and 3…

Polioviruses

Pathogen and Pathophysiology Polioviruses are positive-stranded RNA viruses belonging to the Enterovirus genus of the Picornaviridae family. They have a naked protein capsid consisting of 4 structural proteins, VP1 to VP4. The RNA-dependent RNA polymerase encoded for genome replication lacks a proofreading mechanism. Consequently, poliovirus can mutate rapidly with replication. The 3 serotypes of poliovirus are antigenically distinct, but all 3 have 70% nucleotide identity. Polioviruses…

Human Immunodeficiency Virus

The epidemiology, prevention, diagnosis, clinical manifestations, infectious complications, and management of HIV are covered in Chapter 109, Chapter 110, Chapter 111, Chapter 112, Chapter 113 . HIV types 1 and 2 (HIV-1 and HIV-2) are members of the Lentivirus genus of the Retroviridae family. HIV-1 and HIV-2 appear to have entered humans as a result of cross-species transmission of simian immunodeficiency viruses (SIVs). HIV-1 is similar…

Human T-Cell Lymphotropic Viruses

Epidemiology Human T-cell lymphotropic viruses (HTLV) include four types (HTLV-1, HTLV-2, HTLV-3, and HTLV-4). HTLV-1 and HTLV-2 were first reported in 1980 and 1982, respectively, and are the two most clinically important HTLVs. , Infections with HTLV-3 and HTLV-4 were identified in Cameroon in 2005, although the prevalence, transmissibility between humans, and clinical significance are not well defined. , There is significant geographic variation in the…

Filoviruses and Arenaviruses

Description of the Pathogens Viruses of the families Filoviridae and Arenaviridae are composed of single-stranded RNA in lipid envelopes. The Filoviridae family of viruses is further divided into three genera: Ebolavirus , Marburgvirus , and Cuevavirus . Within the genus Ebolavirus , six viruses have been identified : Ebola virus (species Zaire ebolavirus ), Sudan virus (species Sudan ebolavirus ), Taï Forest virus (species Taï Forest…

Influenza Viruses

Acknowldgment The authors acknowledge substantial contributions to this chapter from work of Joseph Bresee in previous editions. Influenza viruses cause annual winter epidemics of respiratory illness in temperate climates and have resulted in four influenza pandemics since 1900. The global burden of influenza and global variation in influenza virus circulation patterns are increasingly recognized. In the US, influenza is estimated to result in 12,000–61,000 deaths and…

Rabies Virus

The Virus Rabies virus and 17 bat lyssaviruses are members of the Rhabdoviridae family, genus Lyssavirus, which is derived from the Greek word lyssa, meaning “madness.” Rabies derives from the Sanskrit word rabhas, which means “to do violence.” Rabies virus and many lyssaviruses cause human encephalitis through zoonotic infection. The lyssaviruses differ antigenically but are morphologically similar and neurotropic. Rabies virus is an enveloped, bullet-shaped virus…