Table Of ContentNetter’s
Infectious
Diseases
ELAINE C. JONG, MD
Clinical Professor of Medicine Emeritus
Divisions of Emergency Medicine and Allergy and Infectious Diseases
University of Washington School of Medicine
Seattle, Washington
DENNIS L. STEVENS, PhD, MD
Chief, Infectious Diseases Section
Veterans Affairs Medical Center
Boise, Idaho;
Professor of Medicine
University of Washington School of Medicine
Seattle, Washington
Illustrations by Frank H. Netter, MD
CONTRIBUTING ILLUSTRATORS:
Carlos A.G. Machado, MD
John A. Craig, MD
James A. Perkins, MS, MFA
Tiffany S. DaVanzo, MA, CMI
Anita Impagliazzo, MA, CMI
1600 John F. Kennedy Blvd.
Ste 1800
Philadelphia, PA 19103-2899
NETTER’S INFECTIOUS DISEASES ISBN: 978-1-4377-0126-5
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Library of Congress Cataloging-in-Publication Data
Netter’s infectious diseases / [edited by] Elaine C. Jong, Dennis L. Stevens ;
Illustrations by Frank H. Netter ; contributing Illustrators, Carlos A.G. Machado … [et al.].
p. ; cm.
Infectious diseases
Includes bibliographical references and index.
ISBN 978-1-4377-0126-5 (hardcover : alk. paper)
1. Communicable diseases. I. Jong, Elaine C. II. Stevens, Dennis L. III. Netter, Frank H.
(Frank Henry), 1906-1991. IV. Title: Infectious diseases.
[DNLM: 1. Communicable Diseases. WC 100]
RC111.N38 2012
362.196′9—dc23
2011020530
Acquisitions Editor: Elyse O’Grady
Developmental Editor: Andrea Vosburgh
Publishing Services Manager: Anne Altepeter
Senior Project Manager: Cheryl A. Abbott
Project Manager: Cindy Thoms Working together to grow
Design Direction: Steven Stave
libraries in developing countries
Printed in China www.elsevier.com | www.bookaid.org | www.sabre.org
Last digit is the print number: 9 8 7 6 5 4 3 2 1
About the Artists
Frank H. Netter, MD anatomy atlas of choice among medical and health profession
Frank H. Netter was born in 1906 in New York City. He studied students the world over.
art at the Art Student’s League and the National Academy of The Netter illustrations are appreciated not only for their
Design before entering medical school at New York University, esthetic qualities but, more important, for their intellectual
where he received his MD degree in 1931. During his student content. As Dr. Netter wrote in 1949, “… clarification of a
years, Dr. Netter’s notebook sketches attracted the attention of subject is the aim and goal of illustration. No matter how beauti-
the medical faculty and other physicians, allowing him to fully painted, how delicately and subtly rendered a subject may
augment his income by illustrating articles and textbooks. He be, it is of little value as a medical illustration if it does not serve
continued illustrating as a sideline after establishing a surgical to make clear some medical point.” Dr. Netter’s planning, con-
practice in 1933, but he ultimately opted to give up his practice ception, point of view, and approach are what inform his paint-
in favor of a full-time commitment to art. After service in the ings and what makes them so intellectually valuable.
U.S. Army during World War II, Dr. Netter began his long Frank H. Netter, MD, physician and artist, died in 1991.
collaboration with the CIBA Pharmaceutical Company (now Learn more about the physician-artist whose work has
Novartis Pharmaceuticals). This 45-year partnership resulted in inspired the Netter Reference Collection at www.netterimages.
the production of the extraordinary collection of medical art com/artist/netter.htm.
so familiar to physicians and other medical professionals
worldwide. Carlos Machado, MD
In 2005, Elsevier Inc. purchased the Netter Collection and Carlos Machado was chosen by Novartis to be Dr. Netter’s suc-
all publications from Icon Learning Systems. There are now cessor. He continues to be the main artist who contributes to
more than 50 publications featuring the art of Dr. Netter avail- the Netter Collection of medical illustrations.
able through Elsevier Inc. (in the United States, www. Self-taught in medical illustration, cardiologist Carlos
us.elsevierhealth.com/Netter; and outside the United States, Machado has contributed meticulous updates to some of Dr.
www.elsevierhealth.com). Netter’s original plates and has created many paintings of his
Dr. Netter’s works are among the finest examples of the use own in the style of Netter as an extension of the Netter Collec-
of illustration in the teaching of medical concepts. The 13-book tion. Dr. Machado’s photorealistic expertise and his keen insight
Netter Collection of Medical Illustrations, which includes the into the physician-patient relationship inform his vivid and
greater part of the more than 20,000 paintings created by Dr. unforgettable visual style. His dedication to researching each
Netter, became and remains one of the most famous medical topic and subject he paints places him among the premier
works ever published. The Netter Atlas of Human Anatomy, first medical illustrators at work today.
published in 1989, presents the anatomic paintings from the Learn more about his background and see more of his art at
Netter Collection. Now translated into 16 languages, it is the www.netterimages.com/artist/machado.htm.
vAi boSEuCTItON VtIIhI • ePar asEiticd Disieatseos rs
Elaine C. Jong, MD, was born in New York City, graduated Dennis L. Stevens, PhD, MD, is chief of the Infectious Diseases
from Wellesley College with a BA in biological sciences, and Section and Director of Research and Development of the Vet-
later received her medical degree from the University of Cali- erans Affairs Medical Center in Boise, Idaho, and professor of
fornia–San Diego School of Medicine in La Jolla. After com- medicine at the University of Washington’s School of Medicine
pleting her residency in internal medicine at the University of in Seattle. Dr. Stevens obtained a bachelor of arts degree in
Washington School of Medicine (UWSOM) Affiliated Hospi- microbiology from the University of Montana, a doctoral degree
tals in Seattle and a fellowship in infectious diseases at UWSOM, in microbiology from Montana State University, and a medical
she joined the faculty in the Department of Medicine in the degree from the University of Utah. He completed an internal
Division of Allergy and Infectious Diseases. She also served as medicine residency at the University of Utah and performed his
a faculty member in the Division of Emergency Medicine and fellowship in infectious diseases at Brooke Army Medical Center.
became Clinical Professor of Medicine in 1994. During her Dr. Stevens’ major research interests have been the pathogenesis
tenure at UWSOM, Dr. Jong founded and directed training of serious infections caused by toxin-producing gram-positive
clinics for the practice of refugee and international health, and pathogens including Clostridium perfringens, Clostridium sordellii,
travel and tropical medicine. She served as the director of the group A Streptococcus, and methicillin-resistant Staphylococcus
UW Hall Health Primary Care Center, incorporating the UW aureus (MRSA). Dr. Stevens recently received the Infectious Dis-
Student Health Service, and was the first medical director of the eases Society of America Citation for his work on group A strep-
UW Campus Health Services, implementing programs for tococcal infections and the William Altemeier Award from the
campus public health, occupational health, and employee health. Surgical Infections Society and was elected to membership in the
Dr. Jong has a special interest in host defense mechanisms and Association of American Physicians. He has published more than
has lectured and published widely on clinical topics in infectious 160 articles and 60 book chapters on serious invasive infections
diseases, travel and tropical medicine, and disease control and caused by gram-positive organisms and has been visiting profes-
prevention. She is co-editor of The Travel and Tropical Medicine sor at more than 70 national and 30 international institutions. He
Manual, now in its fourth edition and recently translated into a is a member of the Centers for Disease Control and Prevention
Chinese language edition, and is also co-editor of Travelers’ Vac- Working Group on Invasive Streptococcal Infections and a con-
cines, edition 2. She is a fellow of the Infectious Diseases Society sultant to the World Health Organization, and he has been an
of America, a past president of the clinical group of the Ameri- invited participant to the National Institutes of Health Work-
can Society of Tropical Medicine and Hygiene, and the chair of force on severe group A streptococcal infection. He has testified
the International Medical Advisory Board and co-director of the twice before the U.S. Congress on the importance of basic
International Travel Medicine Education Program for the Inter- science research in infectious diseases and on invasive group A
national Association for Medical Assistance to Travellers streptococcal infections. Dr. Stevens is the current chairman of
(IAMAT). the Infectious Diseases Society of America’s Guideline Commit-
tee for the Treatment of Skin and Skin Structure Infections.
Acknowledgments
Developing a new textbook of infectious diseases that would tap We are indebted to John Martines at the University of Wash-
into the rich library of medical illustrations created by the late ington, whose communications with contributors and superb
Dr. Frank Netter was a major undertaking not only for us organizational skills were invaluable.
but also for our dedicated colleagues who contributed ideas We would especially like to acknowledge our families: our
and chapters to this work. We thank everyone for devoting spouses—Dr. Britt Litchford and Dr. Amy E. Bryant—whose
precious personal time to work on their contributions, and we encouragement and understanding throughout this project were
acknowledge their expertise as well as their commitment to essential to the completion of this book; our children—Brian
excellence. and Steven Riggs, and Marisa (Stevens) Keith, and Katie Gib-
We are grateful that Elyse O’Grady, editor, Netter Products, bons—who remind us that memorable stories and images are
recognized our passion for the genius of Frank Netter and not forgotten; and finally our parents—Arthur and Peggy Jong,
invited us to serve as editors for this new Netter series volume and John and Alma Stevens—who believed that education brings
on infectious diseases. We thank Marybeth Thiel, senior devel- immeasurable benefits and is something that endures through-
opmental editor; Andrea Vosburgh, developmental editor; out one’s life.
Cheryl Abbott, senior project manager; Cindy Thoms, project It is our hope that these illustrative Netter images, combined
manager; and the superb staff in the editorial and production with evidence-based, cogent chapters, will provide valuable
offices at Elsevier for their care and commitment in developing insights into the epidemiology, pathogenesis, diagnosis, and
this new text. treatment of infections in all parts of the world.
vPiii refSEaCTIcONe VIII • Parasitic Diseases
As longtime colleagues in the Division of Allergy and Infectious readable, and clinically relevant chapters. In each chapter,
Diseases at the School of Medicine, University of Washington, Dr. Netter’s medical illustrations, in some cases revised to
Seattle, we were honored and challenged by the unique opportu- reflect new advances, are used to illustrate key points from the
nity to create a new textbook of infectious diseases, with the goal text, augmented by radiographic and photographic images,
of using the beautiful medical artwork created by the late Dr. tables, and graphs. For some topics, new artwork was created
Frank Netter to teach and clarify important concepts in by Carlos A.G. Machado, MD; John A. Craig, MD; James A.
infectious diseases. Mindful of existing textbooks, such as Perkins, MS, MFA; Tiffany S. DaVanzo, MA, CMI; and Anita
Mandell’s Infectious Diseases, that are considered authoritative Impagliazzo—talented medical artists carrying on Dr. Netter’s
as well as standards of excellence in the field, we set out to mission of using art as an educational icon.
create a new resource with a strongly clinical orientation. The Although our academic interests, clinical activities, and
purpose of this book is to provide healthcare providers, teaching commitments have kept us on different paths within
both generalists and specialists, with up-to-date clinical our large division in the past, we were drawn together to work
approaches to the broad spectrum of infectious diseases from the on this book by our mutual admiration for the work of Dr. Frank
perspective of how these various infections may affect patients Netter. His understanding of anatomy, physiology, pathogene-
as individuals, members of communities, and citizens of global sis, and clinical signs of disease are translated by his incredible
society. artistic talent into visual images that are so powerful that they
Reflecting the rapid accumulation of advances in the medical reduce complexities into simple concepts that remain embedded
sciences, the infectious diseases specialty has many branches or in our memories for decades. It is difficult to express the appre-
subspecialties, and we were fortunate in recruiting section ciation we have for how much his art contributed to our own
editors Patch Dellinger (Surgical Infections), Thomas File enjoyment of medical education. We both had a strong desire
(Respiratory Infections), Jo Hoffman (Emerging Infectious to extend this experience to our peers, trainees, and students
Diseases), Jeanne Marrazzo (Sexually Transmitted Infections), through the creation of a new up-to-date resource for learning
and ChrisAnna Mink (Vaccine-Preventable Infections of Chil- about infectious diseases. We hope that we have succeeded in
dren and Adolescents) to join us for this ambitious project. A our goal and welcome your feedback, seeking further improve-
superb roster of talented contributing authors, recruited from ments for future editions.
our extended network of colleagues and friends, contributed Elaine C. Jong, MD
their valuable time and expertise to writing concise, highly Dennis L. Stevens, PhD, MD
Editors
Elaine C. Jong, MD Jo Hofmann, MD
Clinical Professor of Medicine Emeritus Clinical Assistant Professor
Divisions of Emergency Medicine and Allergy Department of Public Health and Community Medicine
and Infectious Diseases University of Washington;
University of Washington School of Medicine Consultant
Seattle, Washington Northwest Public Health Consulting
Seattle, Washington
Dennis L. Stevens, PhD, MD
Chief, Infectious Diseases Section Jeanne M. Marrazzo, MD, MPH
Veterans Affairs Medical Center Professor
Boise, Idaho; Department of Medicine, Allergy and Infectious Diseases
Professor of Medicine University of Washington;
University of Washington School of Medicine Medical Director
Seattle, Washington Seattle STD/HIV Prevention Training Center
Seattle, Washington
Section Editors
ChrisAnna M. Mink, MD
E. Patchen Dellinger, MD
Clinical Professor of Pediatrics
Professor, Vice Chairman, and Chief
Department of Pediatrics
Division of General Surgery, Department of Surgery
David Geffen School of Medicine at UCLA
University of Washington School of Medicine;
Los Angeles, California;
Chief of General Surgery
Department of Pediatrics
Associate Medical Director
Harbor-UCLA Medical Center
Department of General Surgery
Torrance, California
University of Washington Medical Center
Seattle, Washington
Thomas M. File, Jr., MD, MSc, MACP, FIDSA, FCCP
Professor, Internal Medicine
Master Teacher
Head, Infectious Disease Section
Northeastern Ohio Universities Colleges of Medicine
and Pharmacy
Rootstown, Ohio;
Chief, Infectious Disease Service
Director, HIV Research
Summa Health System
Akron, Ohio
