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Anthrax

Abstract Anthrax, caused by Bacillus anthracis, is a devastating disease for humans and animals, and one of the most important bioweapons. Though rare in the United States, natural anthrax exposure occurs sporadically worldwide. Anthrax most often manifests as cutaneous or gastrointestinal (GI) disease, with inhalation anthrax (IA) being associated with bioterrorism. Once diagnosed, anthrax must be aggressively treated with an antimicrobial regimen of fluoroquinolones, tetracycline, imipenem…

Multidrug-Resistant Tuberculosis

Abstract Tuberculosis (TB) is an important public health problem. According to the World Health Organization (WHO), approximately 10 million persons developed TB during 2018, and approximately one-fourth of the world’s population, more than 2 billion persons, are infected with Mycobacterium tuberculosis , the causative agent of TB. Worldwide, TB is the leading cause of death among persons living with human immunodeficiency virus (HIV) infection and the…

Chagas Disease

Acknowledgments The authors would like to acknowledge the work of our dear departed colleague Herbert B. Tanowitz on the previous edition chapter. Abstract Chagas disease is caused by infection with the protozoan parasite Trypanosoma cruzi. It is endemic in many areas of Latin America, where it remains an important cause of morbidity and mortality. It is a significant cause of heart disease and gastrointestinal (GI) dysfunction,…

Trichinellosis

Abstract Trichinellosis (trichinosis) is a parasitic infection caused by a roundworm of the Trichinella species. There are eight known species, and all are capable of causing human disease. The most common infections are caused by Trichinella spiralis , which can be found in pigs, rodents, horses, bears, and foxes. Another common species is Trichinella nativa , which infects humans after ingestion of infected bear or dog…

Echinococcosis: Cystic and Alveolar Disease

Abstract Within the genus Echinococcus , there are four species recognized: Echinococcus granulosus , Echinococcus multilocularis , Echinococcus vogeli , and Echinococcus oligarthrus . The larval cestodes of all four species can develop in the human host and can cause various forms of hydatid disease. A fifth species, Echinococcus shiquicus , a tapeworm of Tibetan foxes, has recently been described, but no infections have been reported…

Filarial Diseases

Abstract The filarial parasites covered in this chapter constitute a group of tissue-dwelling filarial nematodes that persist in the human host for years, causing damage to the lymphatic system that leads to elephantiasis and genital hydroceles (in the case of lymphatic filariasis) or marked inflammatory reactions in the skin and eyes leading to blindness (in the case of onchocerciasis). Both diseases are designated neglected tropical diseases…

Schistosomiasis

Abstract Schistosomiasis (bilharzia) is a disease caused by infection with parasitic flatworms known as blood flukes , belonging to the genus Schistosoma . According to the World Health Organization (WHO), schistosomiasis transmission has been reported from 78 countries, and it is estimated that more than 200 million people living in tropical endemic areas are infected. Chronic schistosomiasis causes significant morbidity and premature mortality, and negatively affects…

Food-Borne Trematodes: Liver, Lung, and Intestinal Flukes

Abstract Food-borne trematodes (FBTs) are a group of liver, lung, and intestinal flukes that typically infect humans through the ingestion of freshwater fish, crustaceans, and plants contaminated by encysted forms of the parasites. FBTs are prevalent throughout the world, with countries in Asia bearing the highest burden of infection. Transmission of FBTs is fostered by local culinary practices of consuming raw or undercooked fish and aquatic…

Cysticercosis

Abstract Cysticercosis is infection caused by the larval stage of the cestode Taenia solium , the pork tapeworm. The clinically significant helminthic invasion to central nervous system (CNS) structures and the resulting spectrum of neurologic illness define neurocysticercosis (NCC). With the more extensive use of computed tomography (CT) and magnetic resonance (MRI) neuroimaging, and the availability of accurate serologic testing, NCC has been increasingly diagnosed not…

Intestinal Cestodes (Tapeworms)

Abstract The relationship between humans and intestinal cestodes (tapeworms) goes well beyond the essential biologic interaction between host and parasite. Over time, tapeworms and tapeworm stories have contributed to human culture, literature, and dietary practices. In the late nineteenth century, part of the popular folklore was that a tapeworm infection could help make one thin, and tapeworm eggs were actually advertised commercially as a weight reduction…

Soil-Transmitted Helminths and Other Intestinal Roundworms

Abstract Infections with soil-transmitted helminths (STHs) affect the health of around 1.5 billion people around the world. Individuals of all ages may be infected with the common roundworm (Ascaris lumbricoides) , whipworm (Trichuris trichiura) , hookworm ( Ancylostoma duodenale and Necator americanus ), and Strongyloides stercoralis , although school-aged children living in resource-poor endemic areas are more likely to be infected with heavy worm burdens that…

Giardia, Cryptosporidium, Cyclospora, and Other Intestinal Protozoa

Abstract Giardia and Cryptosporidium are the two most common protozoan pathogens in the human intestine; in low-income countries, they also rank as leading causes of diarrhea in children under 5. Giardia duodenalis (previously G. lamblia or G. intestinalis ), was first discovered by Antoine van Leeuwenhoek, a 17th-century lens-grinder who invented the microscope, then found Giardia in his own stool. For the next several centuries, Giardia…

Amebiasis

Acknowledgments The authors would like to acknowledge the valuable contributions of the late Dr. Martin S. Wolfe to this chapter. Abstract Infection with Entamoeba histolytica is a leading parasitic cause of morbidity and mortality in developing nations and is an important health risk to travelers. Amebiasis is transmitted by parasite cysts via fecal-oral contamination from infected individuals or from contaminated food or water. Although most infected…

Primary Amebic Meningoencephalitis

Abstract Primary amebic meningoencephalitis (PAM) is an acute, progressive, and usually fatal condition caused by the free-living ameba Naegleria fowleri . Commonly referred to as the “brain-eating ameba,” N. fowleri is naturally found in warm freshwater (e.g., lakes, rivers, and hot springs), and soil. Infection with N. fowleri can occur when water containing the ameba enters the body through the nose. The ameba migrates to the…

Leptospirosis

Abstract Leptospirosis is the most common zoonosis worldwide and has recently emerged as an important travel-related infection, particularly in adventure travelers to the tropics and subtropics. Characteristic symptoms may include fever, headache, myalgias, jaundice, and conjunctival suffusion, but this disease often manifests as a nonspecific febrile illness. Because it has a wide range of signs and symptoms, a high index of suspicion is necessary for clinicians…

Lyme Disease

Abstract Lyme disease, caused by infection with spirochetes of the Borrelia burgdorferi complex, is the most common arthropod-borne infection in the United States. The spirochetes are transmitted to humans by bites of infected ticks of the Ixodes ricinus complex, which are also known as black-legged deer ticks. As many as 90% of patients have a characteristic rash, erythema migrans (EM); other manifestations of early disease include…

Tick-Borne Encephalitis

Acknowledgments I want to thank the companies of Baxter, Novartis, Pfizer, and GSK for providing information including data and graphics. In particular, Dr. Dieter Gniel was very helpful in sharing his vast experience on TBE. Abstract For a long time, tick-borne encephalitis (TBE) was perceived as a risk only (if ever) for the local populations living in endemic areas. There was very little specific awareness and…

West Nile Virus Disease

Abstract Before 1999, West Nile virus (WNV) received little attention outside Africa, Asia, and Europe, where it caused an endemic, mosquito-borne febrile illness and sporadic encephalitis. After the dramatic emergence of WNV in New York City in 1999, the virus spread westward across the United States, resulting in the largest outbreaks of WNV disease ever reported. From 1999 through 2018, 50,830 cases of WNV disease were…