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Approach to Travel Medicine and Contents of a Personal Travel Medicine Kit

A new medical specialty, travel medicine, emerged in the 1980s in response to the health needs of increasing numbers of international travelers—a phenomenon resulting from the rapid expansion and growing accessibility of commercial jet transportation. In 1990, the World Tourism Organization (WTO) reported approximately 457 million international arrivals per year. In 2014, the WTO reported 1138 million international arrivals per year, and just under half of…

Impact of Maternal SARS-CoV-2 Infection on the Fetus and Newborn

History of Perinatal Coronavirus Infections Before the worldwide pandemic, data on coronavirus infection in pregnancy were limited despite two previous large epidemics. A 2020 systematic review and meta-analysis found only 12 cases of Middle East respiratory syndrome coronavirus (MERS-CoV) and 33 cases of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infections in pregnancy, all of which were from case reports, case series, or small retrospective cohort studies.…

Psychiatric Manifestations of COVID-19

Introduction Neuropsychiatric sequelae of viral infections have been described in the literature and are well known from studies of influenza pandemics , , human immunodeficiency virus (HIV) infections, and viral encephalitis. Perhaps the most researched neuropsychiatric disorder after a viral infection was the development of encephalitis lethargica after the Spanish flu outbreak in the last century. Encephalitis lethargica had prominent parkinsonian symptoms, psychosis, and catatonia. Prominent…

Ophthalmic Manifestations of COVID-19

Introduction and Historical Perspectives In late December 2019, an ophthalmologist named Li Wenliang sent a message to a group of fellow physicians in Wuhan, China, warning them of an emerging respiratory illness that he thought bore resemblance to severe acute respiratory syndrome (SARS). Weeks later, after local authorities admonished him for “spreading rumors,” Dr. Li contracted the virus from one of his glaucoma patients and passed…

Kidney Manifestations of COVID-19

Acute Kidney Injury Incidence and Mortality Associated With SARS-CoV-2 Infection AKI incidence has varied based on the geographic location and clinical situation during the pandemic. A meta-analysis of over 13,000 patients reported an AKI prevalence of 17%, although the range from the individual studies that made up the meta-analysis was broad at 0.5% to 80%. Critically ill patients are more likely to have AKI in the…

Gastrointestinal Manifestations of COVID-19

OUTLINE Prevalence of Gastrointestinal Symptoms, 191 Implications of Gastrointestinal Symptoms in COVID-19, 191 Mechanism on How SARS-CoV-2 Affects Gut Health, 192 Angiotensin-Converting Enzyme-2 Receptor Mechanism, 192 Impact of SARS-CoV-2 on Gut Microbiota, 193 Impact of Gastric Acid Reduction on COVID-19 Outcomes, 193 Proton Pump Inhibitors, 193 Histamine Receptor Antagonists (H 2 -Blockers), 194 Impact of COVID-19 in Inflammatory Bowel Disease, 194 Pathogenesis of COVID-19 in Inflammatory Bowel…

Oral Cavity and COVID-19: Clinical Manifestations, Pathology, and Dental Profession

The Oral Cavity and Viral Infections The oral cavity is home to a vast microbial flora that also include a robust community of viruses. Although the viruses that infect bacteria or bacteriophages constitute the majority, viruses that infect human cells form a significant component of the oral microbiome. , Much like bacteria, viral communities are also site-specific alterations that can lead to disease. Indeed, one of…

Neurological Manifestations of COVID-19

OUTLINE Epidemiology of Neurological Manifestations of COVID-19, 159 Historical Background of Neurological Effects of the Coronavirus Family, 160 Pathophysiology, Pathogenesis, and Proposed Mechanisms of the SARS-CoV-2 Virus and the Nervous System, 161 COVID-19 and the Peripheral Nervous System, 162 Anosmia and Dysgeusia, 162 Guillain-Barré Syndrome and Associated Variants, 163 COVID-19 and the Central Nervous System, 166 Encephalopathy and Encephalitis, 166 Transverse Myelitis, 166 Seizures, 166 Cerebrovascular…

COVID-19 and the Cardiovascular System

OUTLINE Epidemiology of Cardiac Injury From COVID-19, 137 History of Cardiovascular Effects From SARS-CoV-1 and MERS-CoV, 138 Pathophysiology and Potential Mechanisms of Cardiovascular Injury From COVID-19, 138 Renin-Angiotensin System, 138 Direct Infection of the Myocardium, 139 Cytokine-Mediated Cardiac Injury, 140 COVID-19–Associated Thrombosis, 140 Clinical Manifestations and Complications, 143 Myocarditis, 143 Acute Coronary Syndrome, 143 Heart Failure, 144 Cardiac Arrhythmias, 144 Thromboembolic Events, 145 Cardiovascular Comorbidities and…

Pulmonary Manifestations of COVID-19

OUTLINE COVID-19 Manifestations in the Respiratory System, 100 Clinical Presentation, 100 Complications, 101 Acute Respiratory Distress Syndrome, 102 COVID-19 Acute Respiratory Distress Syndrome, 111 Lung Microbiome and COVID-19, 114 Specific COVID-19 Pulmonary Complications, 115 COVID-19 Long-Term Pulmonary Complications, 116 Treatment and Management of Salient Pulmonary Manifestations and Complications of COVID-19, 118 Treatment of Hypoxemia, 118 Management of Respiratory Failure, 119 Management of COVID-19 Pneumonia and Pneumonitis,…

COVID-19: Natural History and Spectrum of Disease

OUTLINE Short Comparison of SARS-CoV-2 With SARS-CoV-1 and MERS-CoV, 72 Natural History, 73 Incubation Period, 73 Spectrum of COVID-19, 74 Pathogenicity and Virulence, 74 Asymptomatic Disease and Carrier Status, 75 Asymptomatic Patient Trajectories, 75 Symptomatic Patient Trajectories, 76 Demographics, 76 Pathogenesis, 76 Clinical Characteristics, 76 Respiratory and Pulmonary Manifestations, 76 Cardiovascular Manifestations, 77 Neurological Manifestations, 77 Gastrointestinal Manifestations, 78 Renal Manifestations, 78 Cutaneous Manifestations, 82 Ocular…

Immunology of COVID-19

The extraordinary global spread of SARS-CoV-2 through naïve populations provides compelling evidence of both the strengths and limitations of the human immune response: on the one hand, recognizing and eliminating a novel viral pathogen, while on the other, causing potentially lethal immunopathological conditions ( Fig. 3.1 ). The pandemic also provided a striking opportunity to understand SARS-CoV-2 pathogenesis through a lens offered by multiple clinical trials. COVID-19…

SARS-CoV-2: Structure, Pathogenesis, and Diagnosis

SARS-CoV-2 and Coronaviruses Evolutionary Origins In the last two decades, three coronaviruses have caused outbreaks of varying scales, with the pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) representing the most recent threat to human health at a global level. Aside from severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV), which were responsible for the first two outbreaks of…

Epidemiology of SARS-CoV-2 and COVID-19

The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) causes a highly contagious disease called CO rona VI rus D isease 2019 (COVID-19). The virus was first reported in Wuhan city, Hubei Province of China in December 2019; in less than 3 months it spread globally and was declared a global pandemic by the World Health Organization (WHO) on March 11, 2020. By March 24, 2020, the novel…

Prevention of Fetal and Early Life Infections Through Maternal−Neonatal Immunization

Overall Principles Vaccination has been the most effective medical intervention in the modern era. Historically, the focus on vaccine development and implementation programs has been on preventing infectious diseases during infancy and early childhood. The current vaccine schedule for early childhood is replete with dozens of inoculations with an array of safe and effective vaccines that have dramatically reduced the incidence of many previously formidable childhood…

Clinical Pharmacology of Antiinfective Drugs

Effective antimicrobial treatment typically begins with empirical therapy at a dose that is most likely to cure the infection with the minimal risk of toxic effects. To select the correct dosage, clinicians need to understand and apply the principles of pharmacokinetics (PK) and pharmacodynamics (PD). This chapter will focus on basic pharmacology and the application of PK and PD principles to the most commonly used antiinfective…

Laboratory Aids for Diagnosis of Neonatal Sepsis

For years, investigators have sought a test or panel of tests able to diagnose neonatal sepsis accurately and more rapidly than is possible with the recovery of microorganisms from specimens of sterile body fluids or tissues. Although results of some studies have been encouraging, microbial isolation from blood, cerebrospinal fluid (CSF), urine, other body fluids (peritoneal, pleural, joint, middle ear), or tissues (bone marrow, liver, spleen)…

Health Care–Associated Infections in the Nursery

Neonates, especially premature neonates who require intensive medical care, are among the patients at highest risk for nosocomial or health care–associated infections (HAIs). Although the rate of HAIs varies with the specific patient population and institution, many institutions have achieved impressive reductions in the incidence of HAI over the past decade. For example, some reports from the early 2000s found that greater than 20% of critically…

Pneumocystis and Other Less Common Fungal Infections

Fungal infections, other than those caused by Candida spp., rarely are considered in the differential diagnosis for an acutely ill newborn infant because disorders of bacterial and viral etiology are vastly more common. Nevertheless, fungal infections do occur in neonates, especially in premature infants and those of very low birth weight (less than 1500 g), and can cause serious and frequently fatal disease. As with any…

Candidiasis

Candida species are important pathogens in the neonate. After a significant increase in the incidence of systemic candidiasis in neonatal intensive care (NICU) patients in the late 1990s, since 2000 the incidence has remained stable or even decreased slightly. However, this has clearly become a disease of the extremely-low-birth-weight (ELBW; birth weight ≤ 1000 g) or medically complex larger infant. Infections range from superficial colonization to…