Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Infections in Returning Travelers

Of the approximately 80 million people who travel from industrialized to developing countries each year, 22% to 64% of travelers report some illness. The approach to the patient requires knowledge of world geography, the epidemiology of disease patterns in 230 or so countries, and the clinical presentation of a wide spectrum of disorders. Most illnesses are mild, most are self-limited, and many are noninfectious. Up to…

Protection of Travelers

Revised March 31, 2020 Pretravel management of an international traveler should be based on risk management principles. Prevention strategies and medical interventions need to be individualized according to both the itinerary and factors that are dependent on the traveler. A structured approach to patient interaction ( Table 318.1 ) is the most efficient way to cover the necessary educational and preventive interventions. Because many of these…

Zoonoses

Zoonoses, derived from the Greek words for animal (zoo) and the suffix modification indicating a state or condition (sis), are infectious diseases of humans that originate in animals. Infectious diseases that originate in humans and move into other animals are commonly described as reverse zoonoses. The majority of emerging viral diseases, up to 70%, represent zoonoses, with such prominent examples as human immunodeficiency virus and acquired…

Immunization

Revised April 3, 2022 Revised February 24, 2020 The two most effective means of preventing disease, disability, and death from infectious diseases have been sanitation and immunization. Both approaches antedated understanding of the germ theory of disease. Artificial induction of immunity began centuries ago with variolation, the practice of inoculating fluid from smallpox lesions into skin of susceptible persons. Although this technique usually produced mild illness…

Bites

Bite wounds are common injuries caused by a wide variety of domestic and wild animals, as well as humans. Most data on the incidence of infection, bacteriology, and the value of various medical and surgical interventions in the treatment of such injuries come from small studies or anecdotal case reports. Such studies often lack randomization, concentrate on unusual organisms or complications, and are inherently biased by…

Burns

Burn Injury Injuries due to severe burns rank among the most serious forms of trauma, resulting in anatomic, physiologic, endocrine, and immunologic stresses, especially when burns involve greater than 20% of the total body surface area (TBSA). In 2015 US municipal fire departments responded to an estimated 1.4 million fires, with 3280 nonfirefighter fatalities. Approximately 75% of deaths occur at the scene, primarily because of inhalation…

Surgical Site Infections and Antimicrobial Prophylaxis

Historical Background In 1862 Louis Pasteur's ingenious experiments into the nature of putrefaction were officially endorsed by the Paris Academy of Science. The endorsement signaled an end to the long-held belief that the exposure of organic material to air brought about the spontaneous generation of microorganisms, and the concepts of sepsis and asepsis became firmly established. A mere 3 years later, Joseph Lister demonstrated the incredible…

Infections in Injection Drug Users

According to the 2017 World Drug Report, an estimated 250 million people worldwide used illicit drugs at least once in 2015. Of these, 11.8 million injected drugs. Since the early 2000s, prescription opioid injection increased dramatically in the United States, particularly in rural areas. The 2014 National Survey on Drug Use and Health Estimated that 4.3 million people were nonmedical users of prescription pain relievers. Frequently…

Infections in Asplenic Patients

After discovery of the spleen, which occurred sometime during the dawn of human dissection, its true role in health and disease remained a mystery for many generations. At the time of Galen, the spleen was thought to be important in removing “black choler” from the body; black choler (or black bile), according to Hippocrates, was one of the four humors thought to regulate bodily functions. The…

Infections in Older Adults

Predisposition of Older Adults to Infection Risk factors for infection in older adults are numerous and often coexist in complex relationships. Seemingly similar patients by conventional criteria may have very different risk due to measures not often used in young adults. These include comorbid illness, polypharmacy, functional status (physical, cognitive, sensory), place of residence, and individual variations in physiologic changes that accompany age (e.g., declining glomerular…

Infections in Patients With Spinal Cord Injury

Spinal cord injury (SCI) is a devastating condition that is unique in terms of its multisystem impact and need for multidisciplinary management. Moreover, the prevalence and occurrence of SCI have continued to escalate over the years. In 2017, approximately 285,000 Americans experienced the consequences of SCI, and at least 17,500 new cases of SCI accrue each year in the United States. Although motor vehicle crash is…

Infections in Solid-Organ Transplant Recipients

Revised November 12, 2020 Advances in surgical techniques and immunosuppressive regimens have had a pivotal role in optimizing outcomes after transplantation. The introduction of cyclosporine in the 1980s and tacrolimus a decade later heralded the era of modern immunosuppression, and transplantation advanced from being a quasiexperimental procedure to an established and accepted modality of treatment for a wide range of end-organ diseases. Table 308.1 depicts the…

Infections in Recipients of Hematopoietic Stem Cell Transplants

Revised March 29, 2021 The clinical approach to infections in patients undergoing hematopoietic stem cell transplantation (HSCT) involves an understanding of basic transplantation techniques, clinical syndromes, host defense defects at different times after transplantation, the natural history of individual infections, and the mechanisms underlying reconstitution of the immune system after transplantation. In general the dominant elements of infectious risks for bacterial, viral, fungal, and parasitic infections…

Prophylaxis and Empirical Therapy of Infection in Cancer Patients

Revised November 29, 2020 Revised November 12, 2020 Cancer patients probably represent the best example of how both a disease and its treatment can impair the complex immunologic network aimed at maintaining the integrity of our body and defending it against infections from both the external and the internal environment. For decades we have known that a granulocyte count of less than 500 cells/mm 3 (and…

Infections in the Immunocompromised Host: General Principles

Components of Host Defense Appreciation of the predisposing risk factors is an essential but perplexing exercise because it suggests that each individual component plays an independent role. Certain organisms infect patients with specific defects, and these associations should be taken into account when selecting therapy. However, this is by no means always predictable. Theoretically, a specific deficiency increases the patient's susceptibility to the very pathogens that…

Transfusion- and Transplantation-Transmitted Infections

Revised June 25, 2020 Revised March 29, 2021 Transfusion-Associated Infections Beeson reported the first cases of transfusion-associated hepatitis in 1943, describing seven patients who developed illness 1 to 4 months after having received a red blood cell (RBC) or plasma transfusion. Later identified as transfusion-transmitted hepatitis B virus (HBV), the advent of the acquired immunodeficiency syndrome (AIDS) epidemic in the 1980s followed by recognition of transfusion…

Health Care–Acquired Hepatitis

Historical Background The potential for bloodborne transmission of hepatitis B first was noted in 1885, when Lurman described jaundice in factory workers who had received smallpox vaccine prepared from “human lymph.” More reports appeared in the subsequent decades as use of vaccines derived from human serum became more common. In addition, more frequent use of phlebotomy equipment, insulin therapy, and intramuscular injection of antibiotics all led…

Health Care–Associated Urinary Tract Infections

Definitions Health care–associated urinary tract infection (UTI) refers to UTI that is acquired while a patient is receiving medical treatment in a health care setting. The majority of health care–associated UTIs occur in patients whose urinary tracts are currently or were recently catheterized. All types of urinary catheters (indwelling, suprapubic, intermittent, and external or condom catheters) increase the risk of acquisition of bacteriuria and thus UTI.…

Nosocomial Pneumonia

Nosocomial pneumonia refers to pneumonia acquired while in a hospital. It is classically divided into hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) but has also been applied to the concept of health care–associated pneumonia (HCAP). The majority of studies on nosocomial pneumonias focus on VAP; hence, this chapter also focuses primarily on VAP, but the principles developed from VAP are thought to be generally applicable. Health…

Infections Caused by Percutaneous Intravascular Devices

The relentless progress of medical science and technology has been accompanied by the development of a host of new diagnostic and therapeutic medical devices, each of which is associated with its own complications. Included in the list of devices and the complications of their use to be discussed in this chapter are peripheral and central intravenous catheters, including nontunneled central catheters and tunneled catheters, peripherally inserted…