The immune system is a complex network of cells and mediators that must balance the task of protecting the host from invasive threats. From a clinical perspective, many diseases and conditions have an obvious link to improper functioning of the immune system, and insufficient immune responses can lead to uncontrolled acute and chronic infections. The immune system may also be important in tumor surveillance and control, cardiovascular disease, health complications related to obesity, neuromuscular diseases, depression, and dementia. Thus, a working knowledge of the role of immunity in disease processes is becoming increasingly important in almost all aspects of clinical practice. This review provides an overview of the immune response and discusses immune cell populations and major branches of immunity, compartmentalization and specialized immune niches, antigen recognition in innate and adaptive immunity, immune tolerance toward self antigens, inflammation and innate immune responses, adaptive immune responses and helper T (Th) cell subsets, components of the immune response that are important targets of treatment in autoimmune diseases, mechanisms of action of biologics used to treat autoimmune diseases and their approved uses, and mechanisms of other drugs commonly used in the treatment of autoimmune diseases. Figures show the development of erythrocytes, platelets, lymphocytes, and other immune system cells originating from hematopoietic stem cells that first reside in the fetal liver and later migrate to the bone marrow, antigen–major histocompatibility complex recognition by T cell receptor control of T cell survival and activation, and Th cells as central determinants of the adaptive immune response toward different stimuli. Tables list cell populations involved in innate and adaptive immunity, pattern recognition receptors with known ligands, autoantibody-mediated human diseases: examples of pathogenic mechanisms, selected Food and Drug Administration–approved autoimmune disease indications for biologics, and mechanism of action of biologics used to treat autoimmune diseases.

This review contains 3 figures, 5 tables, and 64 references.

The advent of vaccination began a new era in the world and in medicine. From the eradication of smallpox and near-eradication of polio to the significant reduction in many childhood diseases, vaccination has saved countless lives. Progress continues today in the form of safer and more effective vaccines, along with new vaccines against old and emerging pathogens that threaten worldwide pandemics. Several vaccines have been approved recently by the Food and Drug Administration, including a more immunogenic pneumococcal vaccine, new meningococcal serotype B vaccines, a 9-valent HPV vaccine, and the first adjuvanted influenza vaccine. Additional advancement with improved vaccines against herpes zoster and novel vaccines against emerging pathogens (Ebola and Zika viruses) is on the horizon. In this review, we discuss the immune mechanisms by which vaccines induce protection, the different types of vaccines, and the most recent recommendations by the Advisory Committee on Immunization Practices for vaccination schedules in adults. Key information for the general practitioner is presented in a concise and easy-to-read format, summarized in tables whenever possible. Vaccination in special populations, such as pregnant women, immunocompromised patients, international travelers, and health care workers, is also included in this review. A list of guidelines is also included.

This review contains 7 figures, 13 tables, and 57 references.

Key words: immunocompromised host, postexposure prophylaxis, travel, vaccination, vaccine

The essential feature of effective antibiotic agents is the ability to inhibit the growth of microorganisms at concentrations tolerated by the host. Antibiotic agents generally target anatomic structures or biosynthetic pathways unique to bacteria. The appropriate choice of an antibiotic for an infection depends on the following: clinician’s level of suspicion; the infecting organism and its antibiotic susceptibilities; the type of infection; factors associated with specific antibiotic agents; host factors; and public health considerations. This review provides an overview of antibiotic therapy and covers identifying the cause of an infection, determination of bacterial susceptibility to specific drugs, site of infection and ancillary therapy, antibiotic drug targets, pharmacodynamic parameters, factors affecting dosage and route of administration, host factors, complications of antibiotic therapy, Clostridium difficile infection, and antimicrobial resistance. 

This review contains 2 figures, 7 tables, and 45 references.

Key words: Antimicrobial therapy, antibiotic, infection, microorganism, renal dosing, hepatic dosing, Clostridium difficile

The simultaneous use of multiple antibiotics in a shotgun fashion should be avoided because of the problems of drug toxicity and hypersensitivity reactions, microbial superinfections, and antagonisms between certain agents. Most bacterial infections can be treated satisfactorily with a single antibiotic agent. There are a limited number of situations, however, in which the simultaneous administration of different antibiotics is warranted. This review covers specific antimicrobial agents, including β-lactam antibiotics, aminoglycosides, polymyxins, tetracyclines, macrolides, clindamycin, nitroimidazoles, chloramphenicol, vancomycin, lipoglycopeptides, oxazolidinones, daptomycin, streptogramins, sulfonamides and trimethoprim, fluoroquinolones, nitrofurantoin, fosfomycin, rifamycins, and fidaxomicin, and provides empirical therapy recommendations. Figures show an overview of penicillin antibiotics, an overview of β-lactam/β-lactamase inhibitor combinations, and a positive D-zone test for inducible clindamycin resistance. Tables list antibacterial guidelines for initial inpatient empirical therapy and empirical sepsis guidelines.

This review contains 3 figures, 5 tables, and 51 references.

Keywords: β-Lactam Antibiotics ,penicillins,Cephalosporins, Carbapenems , monobactams, Gentamicin, Tobramycin, Polymyxins, Tetracyclines, Clarithromycin, Clindamycin

Antimicrobial resistance is a phenomenon that predates the introduction of antibiotics into clinical practice and has become an exponentially growing problem worldwide, leading to increased mortality and increased costs of health care use. Among the many organisms with ever-worsening resistance profiles, Escherichia coli and other Enterobacteriaceae species are significant pathogens, both in terms of numbers and the severity of the infections they cause. The purpose of this review is to examine the emerging concern of antimicrobial resistance and the approach to treatment in the setting of infection with resistant organisms. We will focus on the resistance mechanisms of Enterobacteriaceae to select antimicrobial classes, briefly discuss the epidemiology of resistance, and discuss current treatment strategies. The specific epidemiology, clinical manifestations, and treatment of individual members of the Enterobacteriaceae are discussed in the review “Infections Due to Escherichia coli and Other Enteric Gram-Negative Bacilli,” found elsewhere in this publication. Figures illustrate the mechanisms of antimicrobial resitance in Enterobacteriaceae. Tables list the Ambler classification of ESBL/AmpC and carbapenemase enzymes, and antibiotics with activity against carbapenem-resistant enterobacteriaceae.

This review contains 4 figures, 3 tables, and 28 references.

Abnormal elevation of body temperature, or pyrexia, can occur in one of two ways: hyperthermia or fever. In hyperthermia, thermal control mechanisms fail, so that heat production exceeds heat dissipation. In contrast, in fever, the hypothalamic thermal set point rises, and intact thermal control mechanisms are brought into play to bring body temperature up to the new set point. The distinction between fever and hyperthermia is more than academic: hyperthermia is best treated with physical cooling methods that promote heat dissipation. Fever of undetermined origin (FUO) presents one of the most challenging and perplexing problems in clinical medicine. Such fevers may persist for weeks or months in the absence of characteristic clinical findings or clues. Ultimately, most such obscure fevers prove to be caused by common diseases presenting in an atypical fashion rather than by rare and exotic illnesses. This chapter discusses fever and hyperthermia and further clarifies the distinction between fever and hyperthermia. The section on hyperthermia discusses the etiology of hyperthermia; the epidemiology, pathophysiology, diagnosis, differential diagnosis, treatment, and prevention of heatstroke; and the diagnosis and treatment of neuroleptic malignant syndrome, serotonin syndrome, and malignant hyperthermia of anesthesia. The section on fever discusses the pathogenesis, diagnosis, and treatment of fever, as well as the possible benefits and complications of elevated body temperature. The section on FUO presents the defining criteria of FUO; the etiologic classification of FUO, including the infections and neoplasms possibly responsible; and the diagnosis of FUO, including laboratory and radiologic studies, biopsies, and the role of exploratory laparotomy. Tables describe the causes of hyperthermia; the causes of FUO as reported in various studies over five decades; and a comprehensive list of causes of FUO. An algorithm depicts the progressive steps in the pathogenesis of fever and hyperthermia.

This review contains 1 highly rendered figure, 26 tables, and 107 references

Key Words: collagen, vascular disease, febrile seizures, fever, heatstroke, hyperthermia, pyrogen

Sepsis, along with the multiorgan failure that often accompanies this condition, is a leading cause of mortality in the intensive care unit. Although modest improvements in the prognosis have been made over the past two decades and promising new therapies continue to be investigated, innovations in the management of septic shock are still required. This chapter discusses the definitions, epidemiology, and pathogenesis (including microbial factors, host-derived mediators, and organ dysfunction) relating to sepsis. Management of severe sepsis and septic shock is also described. 

This review contains 5 figures, 11 tables, and 99 references

Keywords:Organ dysfunction, sepsis, septic shock, infection, bacteremia, fluid resuscitation, vasopressor

Upper respiratory tract infections are the most common maladies experienced by humankind.¹ The majority are caused by respiratory viruses. A Dutch case-controlled study of primary care patients with acute respiratory tract infections found that viruses accounted for 58% of cases; rhinovirus was the most common (24%), followed by influenza virus type A (11%) and corona­viruses (7%). Group A streptococcus (GAS) was responsible for 11%, and 3% of patients had mixed infections. Potential pathogens were detected in 30% of control patients who were free of acute respiratory symptoms; rhinovirus was the most common.² Given the increasing problem of antibiotic resistance and the increasing awareness of the importance of a healthy microbiome, antibiotic use for upper respiratory infections should be reserved for those patients with clear indications for treatment. A recent study of adult outpatient visits in the United States found that respiratory complaints accounted for 150 antibiotic prescriptions per 1,000 population annually, yet the expected “appropriate” rate would be 45.³ In other words, most antibiotic prescriptions for these complaints are unnecessary. Similarly, a study in the United Kingdom found that general practitioners prescribed antibiotics to about half of all patients presenting with an upper respiratory infection, even though most of these infections are viral.⁴

This review contains 5 figures, 16 tables, and 82 references.

Keywords: infection, airway, sinusitis, otitis media, otitis externa, pharyngitis, epiglottitis, abscess

The respiratory tract can be infected by a diverse group of viruses that produce syndromes ranging in severity from mild colds to fulminant pneumonias. Respiratory viral infections are a leading cause of morbidity, hospitalization, and mortality throughout the world; influenza and pneumonia were the most prevalent infectious causes of death during the 20th century in the United States.

This review contains 8 figures, 26 tables and 87 references.

Keywords: Virus, infection, respiratory tract, antiviral, pneumonia, croup, pharyngitis, epidemic, pandemic, outbreak

Acute bacterial meningitis is a life-threatening infection. By definition, meningitis is an infection of the meninges and the subarachnoid space. Bacterial meningitis is associated with an inflammatory response that involves the meninges, the subarachnoid space, the brain parenchyma, and the cerebral arteries and veins. As such, bacterial meningoencephalitis is the more accurate descriptive term. This chapter discusses the epidemiology, etiology, pathophysiology and pathogenesis, diagnosis, differential diagnosis, treatment, complications, and prognosis of the disease. The discussion of diagnosis covers clinical manifestations, physical examination findings, laboratory tests, and imaging studies. The discussion of treatment covers empirical therapy, specific antimicrobial therapy, and dexamethasone therapy. Graphs compare causative organisms and clinical manifestations of community-acquired meningitis. Illustrations depict proper patient positioning for detecting nuchal rigidity, Kernig sign, Brudzinski sign, and lumbar puncture, as well as a sagittal view of a lumbar puncture needle as it is advanced into the subarachnoid space. An algorithm delineates the approach to the patient with symptoms and signs of bacterial meningitis. Tables outline bacterial pathogens based on predisposing and associated conditions, cerebrospinal fluid diagnostic studies for meningitis, the appearance of the organism on a Gram stain, empirical antimicrobial therapy based on predisposing and associated conditions, recommendations for specific antibiotic therapy in bacterial meningitis, and recommended doses for antibiotics commonly used in the treatment of bacterial meningitis.

This chapter contains 8 figures, 13 tables, 78 references

Keywords: Bacterial meningitis, antibiotics, Kernig sign, Brudzinski sign, nuchal rigidity, headache

Acute viral meningitis refers to inflammation of the meninges of the brain in response to a viral pathogen. Viruses cause meningitis, encephalitis, myelitis, or a combination of these, meningoencephalitis or encephalomyelitis. Viral meningitis is typically a self-limited disorder with no permanent neurologic sequelae. This chapter reviews the epidemiology, etiology, diagnosis, differential diagnosis, treatment, complications, and prognosis. Tables describe Wallgren’s criteria for aseptic meningitis, important arboviral infections found in North America, herpes family viruses and meningitis, classic cerebrospinal fluid (CSF) abnormalities with viral meningitis, Centers for Disease Control and Prevention criteria for confirming arboviral meningitis, basic CSF studies for viral meningitis, and etiology of CSF pleocytosis. Figures depict common causes of viral meningitis, nuchal rigidity, examination for Kernig sign, and Brudzinski sign for meningeal irritation.

This chapter contains 4 figures, 12 tables, 19 references

Keywords: Meningitis, viral infection, encephalitis, enterovirus, herpesvirus, lumbar puncture, arbovirus, aseptic meningitis, Kernig sign, Brudzinski sign

Brain and spinal abscesses are focal infections of the central nervous system that are often associated with significant morbidity and mortality if not recognized early and managed in a timely manner. In patients with brain abscess, the clinical manifestations run the gamut from indolent to fulminant; most are related to the size and location of the space-occupying lesion within the brain and the virulence of the infecting organism. Untreated spinal epidural abscess usually progresses through four stages: backache and focal vertebral pain, nerve root pain, spinal cord dysfunction, and complete paralysis. Magnetic resonance imaging is the diagnostic neuroimaging procedure of choice in patients with brain and spinal abscesses; on diffusion-weighted images, restricted diffusion may be seen and may help distinguish abscesses from necrotic neoplasms. Aspiration of the abscess is important to facilitate microbiologic diagnosis; after aspiration and submission of specimens for special stains, histopathologic examination, and culture, empirical antimicrobial therapy should be initiated based on stains of the aspirated specimen and the probable pathogenesis of infection. Once the infecting pathogen is isolated, antimicrobial therapy can be modified for optimal treatment. Surgical therapy is often required for the optimal approach to patients with brain and spinal abscesses.

This review contains 6 figures, 5 tables, and 72 references.

Key words: antimicrobial therapy for central nervous system infections, brain abscess, epidural abscess, focal intracranial infections, head trauma, infections in immunocompromised hosts, spine infections, subdural empyema, toxoplasmosis 

Infections of joints and bones are important causes of morbidity due to the potential for permanent injury to structures necessary for mechanical support and useful motion. The spectrum of disease is broad, with host factors, pathogen, site of infection, and comorbidities all influencing outcome. In some cases of bone infection, cure may not be possible, and the therapeutic goal becomes control. This review details the epidemiology, pathogenesis, diagnosis, differential diagnosis, treatment, and prognosis of septic arthritis, septic bursitis, vertebral body osteomyelitis, pedal osteomyelitis in association with diabetes, and chronic posttraumatic osteomyelitis with union or malunion.

This review contains 13 highly rendered figures, 16 tables, and 192 references.

Infective endocarditis is a microbial infection of a cardiac valve or the mural endocardium caused by bacteria or fungi. Forms of this infection include subacute bacterial endocarditis (SBE) and acute bacterial endocarditis (ABE). Etiology and epidemiology are discussed. There is a section on pathogenesis followed by specific clinical presentations, including endocarditis associated with parenteral drug abuse as well as prosthetic valve endocarditis (PVE). Diagnosis and cardiac complications of endocarditis, treatment, recommendations for prophylaxis, and prognosis are addressed. There are several figures showing manifestations and anatomic relations from the infection. Tables describe microorganisms that cause native valve endocarditis, the etiology of PVE, the Duke criteria for diagnosis of infective endocarditis, antimicrobial therapy for endocarditis in adults, guidelines to prevent endocarditis, and recommendations and regimens for endocarditis prophylaxis. This chapter contains 99 references.

Sexually transmitted infections (STIs) are among the most common causes of infectious illness worldwide, and therefore, familiarity with the recognition and management of these infectious pathogens is critical for physicians. This chapter reviews the epidemiology and transmission of STIs and describes the principles of taking a sexual history, reporting STIs, and screening for them. Urethritis, vulvovaginitis, mucopurulent cervicitis, pelvic inflammatory disease (PID), and genital ulcer disease are discussed. STIs in men who have sex with men is discussed, as is anorectal STIs in women. One figure shows a Gram stain in gonorrhea; the other shows ectopic pregnancy and tubal infertility in PID. 

This review contains 2 figures, 24 tables, and 89 references.

Keywords Vulvovaginitis, sexually transmitted infection, herpes, gonorrhea, urethritis, human papilloma virus, syphilis, chlamydia, viral hepatitis, pelvic inflammatory disease

The Chlamydiaceae are obligate intracellular bacteria that produce a wide variety of infections in many mammalian and avian species. Three species belonging to two genera of Chlamydiaceae infect humans: Chlamydia trachomatis, Chlamydophila psittaci, and Chlamydophila pneumoniae. C. trachomatis is exclusively a human pathogen and is transmitted from person to person via sexual contact, perinatal transmission, or close contact in households. C. psittaci, in contrast, is more widely distributed in nature, producing genital, conjunctival, intestinal, or respiratory infections in many avian and mammalian species. C. pneumoniae is a fastidious organism that produces upper respiratory tract infection and pneumonitis in both children and adults. This chapter details the epidemiology, pathogenesis, diagnosis, and treatment of chlamydial diseases. Sexually transmitted diseases, perinatal infections, adult inclusion conjunctivitis, trachoma, and psittacosis are covered. The chapter also includes tables outlining comparative features of the three species and treatment of sexually transmitted diseases caused by C. trachomatis, as well as a figure illustrating the life cycle of Chlamydiaceae. 

This review contains 1 highly rendered figure, 2 tables, and 87 references.

Syphilis is an infectious disease with complex acute and chronic manifestations that is transmitted primarily through sexual contact. The disease has been recognized for many centuries, although its origin remains unknown. This chapter’s discussion of the epidemiology of syphilis includes figures illustrating the rate of syphilis in the United States by state and county and the rate of syphilis in the United States from 1941 to 2009. The etiology, pathogenesis and disease course, diagnosis, differential diagnosis, treatment, and complications of syphilis are discussed. Special cases of syphilis—in pregnant women, in children, in HIV-infected patients, and congenital syphilis—are also considered. Illustrations include a dark-field microphotograph of treponemes and photographs of a syphilitic chancre, the classic aculopapular rash from spirochetemia, condylomata lata, and a gumma. Tables outline the clinical manifestations of syphilis in adults and the treatment of syphilis. The nonvenereal treponematoses—yaws, endemic syphilis, and pinta—are a group of infections distributed throughout tropical and semitropical areas of the world. They are primarily noted to cause a variety of skin and skeletal lesions. There is little biologic difference between the treponemes that cause these conditions. The epidemiology, pathogenesis, diagnosis, differential diagnosis, and treatment of the nonvenereal treponematoses are discussed.

This review contains 7 highly rendered figures, 2 tables, and 60 references.

Urinary tract infection (UTI) is the most common bacterial infection, affecting women far more than men. Aerobic gram-negative bacteria are the most common uropathogens causing UTI, with Escherichia coli remaining the most predominant organism in complicated infections. UTI can result in a variety of infections and inflammations, from asymptomatic bacteriuria to typical symptomatic cystitis to acute pyelonephritis, as well as bacterial prostatitis in men. In general, antimicrobial therapy is warranted for any symptomatic infection of the urinary tract. However, new consensus treatment guidelines for uncomplicated UTI in women, set by the Infectious Diseases Society of America and the European Society for Microbiology of Infection Diseases in 2010, account for the increasing antimicrobial resistance of pathogens and focus on first-line empirical treatment regimens. To reduce the use of antibiotics, treatment and prevention of recurrent UTI may involve several strategies on varying levels of effectiveness; some of the more well-tested options include probiotics, antiseptics, and topical estrogen. Antimicrobial approaches should be reserved for women in whom these options prove to be ineffective.

This review contains 7 figures, 10 tables, and 122 references.

Gastrointestinal infections, which present with acute diarrhea, sometimes accompanied by vomiting, are an extremely common medical complaint, with an annual incidence of 0.6 illnesses per person. Transmission can occur from animals to person, from person to person, or by the ingestion of contaminated foodstuffs. In the United States, more than 90% of cases are caused by viruses, with norovirus being by far the most common. Common among bacterial causes of acute gastrointestinal infection are Salmonella, Campylobacter, Shigella, Shiga toxin–producing Escherichia coli, Vibrio, Yersinia, and Clostridium difficile. These infections are typically self-limited, but depending on the etiologic agent and characteristics of the host, antibiotic therapy may be indicated. Certain gastrointestinal infections are associated with significant complications, including reactive arthritis, Guillain-Barré syndrome, or septicemia.

This review contains 4 figures, 7 tables, and 60 references.

Key words: Campylobacter, Escherichia coli, Guillain-Barré syndrome, reactive arthritis, Shiga toxin, Shigella, Vibrio, Yersinia

Peritonitis is a diffuse or localized inflammatory process affecting the peritoneal lining. Peritonitis has acute and chronic forms and may have a variety of causes. The etiology, epidemiology, diagnosis, and treatment of acute peritonitis caused by bacteria or fungi, including primary and secondary peritonitis, are discussed in this chapter. Primary or spontaneous peritonitis has no underlying intra-abdominal disorder as a direct cause of the infection but usually involves an underlying disorder that inhibits normal host defenses in the peritoneal cavity. Secondary peritonitis has an intra-abdominal focus that initiates the infection. Tertiary peritonitis is a relatively new term that refers to the persistence of intra-abdominal infection after the initial treatment of secondary peritonitis. Peritonitis in dialysis patients is also discussed. Intra-abdominal abscesses may present as complications of abdominal surgery, intra-abdominal conditions (e.g., diverticulitis, appendicitis, biliary tract disease, pancreatitis, perforated viscus), or penetrating abdominal trauma; as fever of obscure origin; or as dysfunction of neighboring organs (e.g., so-called lower lobe pneumonia related to a subphrenic abscess). Intra-abdominal abscesses are classified according to the anatomic location in which they occur: intraperitoneal, retroperitoneal, or visceral.

This review contains 1 figure, 12 tables, and 75 references.

Keywords: Peritonitis, spontaneous bacterial peritonitis, secondary peritonitis, intra-abdominal infection, abscess

The herpes group of viruses is composed of at least eight human viruses and numerous animal viruses. The human herpesviruses include herpes simplex virus types 1 and 2 (HSV-1 and HSV-2), varicella-zoster virus (VZV), cytomegalovirus (CMV), Epstein-Barr virus (EBV), and human herpesvirus types 6 (HHV-6), 7 (HHV-7), and 8 (HHV-8, also known as Kaposi sarcoma–associated herpesvirus). Human herpesviruses share the properties of latency and reactivation. Members of the group can cause productive lytic infections, in which infectious virus is produced and cells are killed, or nonproductive lytic infections, in which viral DNA persists but complete replication does not occur and cells survive. After acute lytic infections, herpesviruses often persist in a latent form for years; periodic reactivations are followed by recurrent lytic infections. Sites of latency vary: HSV and VZV persist in neural ganglion cells, EBV persists in B cells, and CMV probably remains latent in many cell types. The sites of latency for HHV-6 and HHV-7 have not been identified, although both herpesviruses have been detected in salivary glands. All human herpesviruses have a worldwide distribution. Considerable efforts are being directed toward the development of vaccines and antiviral agents that will be active against herpesviruses. This chapter discusses the epidemiology, pathogenesis, diagnosis, prevention, and treatment of herpes simplex virus and varicella-zoster virus and their clinical syndromes. The descriptions of the clinical syndromes include complications and clinical features, as well as descriptions of symptoms. Tables provide information on chemotherapy for primary genital and mucocutaneous herpes infection, suppression of severe and recurring genital herpes infection, and varicella-zoster infection. Figures provide photographic illustrations of the various clinical syndromes. A sidebar about herpesvirus information on the Internet provides further detail.

This review contains 123 references, 4 tables, and 6 highly rendered figures.

Human infection by zoonotic viruses—pathogens that normally infect animals—may result in no obvious illness, a nonspecific viral syndrome, or more severe illness typically characterized by hemorrhagic fever, encephalitis, or rash arthralgia. Transmission usually occurs by direct contact with or a bite from an infected animal or arthropod. Viral families discussed include Flaviviridae, Bunyaviridae, Arenaviridae, Filoviridae, Togaviridae, Rhabdoviridae, Paramyxoviridae, and Reoviridae, with consideration given to the epidemiology, diagnosis, treatment, and prevention of specific viruses. Hemorrhagic fevers addressed include dengue fever, dengue hemorrhagic fever, yellow fever, Crimean-Congo hemorrhagic fever, and Rift Valley fever; hantavirus infections; and the Marburg and Ebola viruses. Encephalitic fever–causing viruses discussed include La Crosse; Japanese; Murray Valley; St. Louis; tick-borne; West Nile; Powassan; eastern, western, and Venezuelan equine; rabies; Nipah; Barmah Forest; and Colorado tick fever. Rash arthralgia may be caused by the Barmah Forest, Chikungunya, Mayaro, O’nyong-nyong, Ross River, and dengue viruses. Other viral zoonoses considered include monkey B virus, ruminant and primate poxvirus, Newcastle, and foot-and-mouth diseases, as well as vesicular stomatitis virus infection. A diagram depicts the generalized arbovirus maintenance cycle. Tables list the important viral zoonoses that cause human disease, the principal hantaviruses that cause human disease, the arenaviruses that cause significant human illness, and the viral zoonoses endemic in the United States. 

This review contains 1 figure, 32 tables, and 80 references.

Key words: dengue, diagnosis, encephalitis, epidemic, epidemiology, infection, rabies, virus, vaccine

In the quarter-century since the first report of AIDS in the United States, HIV infection has spread throughout the population, disproportionately affecting black women, Hispanic women, and men who have sex with men. The prognosis for persons infected with HIV has improved dramatically with the introduction and evolution of highly active antiretroviral therapy (HAART). The underlying principle of HAART is that a combination of potent antiretrovirals, each of which requires different mutations in the HIV genome for resistance to develop, can suppress replication sufficiently to prevent mutation and the emergence of resistance. The prospect that currently available antiretroviral therapy (ART) regimens may suppress HIV replication indefinitely provides the hope that infected patients will have life expectancies similar to those of age-matched uninfected individuals. For these patients, HIV care has shifted from an emphasis on treatment and prevention of the complications of HIV disease itself to a focus on suppression of HIV replication and management of short- and long-term complications of HIV, ART toxicities, and aging. This chapter describes the epidemiology, pathophysiology and pathogenesis, prevention, diagnosis, and management of acute and chronic HIV infection and AIDS, with figures and tables illustrating each chapter section.

This review contains 9 figures, 32 tables, and 257 references

The gram-positive cocci that produce infection include pneumococci, group A streptococci, non?group A streptococci (including groups B, C, D, G, and nongroupable streptococci), anaerobic streptococci, enterococci, and staphylococci. This chapter discusses the pathogenesis, diagnosis, and treatment of infections associated with each of these gram-positive cocci, including methicillin-resistant Staphylococcus aureus (MRSA). The clinical infections caused by each of these organisms are reviewed. Tables describe the incidence of pneumococcal disease according to age and underlying disease, factors associated with adverse outcomes in pneumococcal pneumonia; medically important streptococci and enterococci; antibiotic treatment for penicillin-resistant Streptococcus pneumoniae, enterococcal infections, and staphylococcal infections; laboratory tests for streptococcal pharyngitis; clinical manifestations and antibiotic treatment for staphylococcal toxic-shock syndrome (TSS); revised Jones criteria for the diagnosis of acute rheumatic fever, and drug treatment of acute rheumatic fever.

This review contains 105 references.

This review describes infections caused by Escherichia coli and related members of the family Enterobacteriaceae, excluding other genera that principally cause enteric infections. Infections caused by Salmonella, Shigella, and Yersinia are described in the review “Gastrointestinal Tract Infections," found elsewhere in this publication. The purpose of this review is to examine the specific epidemiology, clinical manifestations, and treatment of individual members of the Enterobacteriaceae. The emerging concern of antimicrobial resistance amongst enteric gram-negative organisms and the approach to treatment in the setting of infection with these resistant organisms are discussed in the review “Antimicrobial Resistance in Enteric Gram-Negative Organisms,” found elsewhere in this publication. Figures illustrate the mechanisms of antimicrobial resistance in Enterobacteriaceae. A table lists the clinical, epidemiologic, pathogenetic, and therapeutic aspects of infection with various pathotypes of Escherichia coli.

This review contains 6 highly rendered figures, 1 table, and 79 references.

Brucellosis, tularemia, (bubonic) plague, and bartonellosis are zoonoses (i.e., infectious diseases that can be transmitted from animals to humans) caused by gram-negative bacilli. The causative agents of these diseases are Brucella species, Francisella tularensis, Yersinia pestis, and Bartonella species, respectively. Infected arthropods, such as ticks or fleas, can serve as vectors for the transmission of tularemia, (bubonic) plague, and bartonellosis. In general, the diagnosis of these zoonoses requires the physician to consider the clinical presentation (which is not always distinctive) in light of the epidemiology of these diseases. This chapter contains discussions of epidemiology, etiology, pathogenesis, diagnosis and differential diagnosis, treatment, complications, and prognosis of brucellosis, tularemia, plague, and Bartonella infections (including trench fever, cat-scratch disease, and bacillary angiomatosis). Also included are tables outlining diagnosis and treatment and a figure showing the distribution of tularemia in the United States from 1990 to 2000. 

This review contains 1 highly rendered figure, 2 tables, and 81 references.

Anaerobes are the most predominant components of the bacterial flora of normal human skin and mucous membranes and are a frequent cause of endogenous bacterial infections. Anaerobic infections can occur in all body locations: the central nervous system, oral cavity, head and neck, chest, abdomen, pelvis, skin, and soft tissues. Treatment of anaerobic infection is complicated by the slow growth of anaerobes in culture, by their polymicrobial nature, and by their growing resistance to antimicrobials. Antimicrobial therapy is frequently the only form of therapy needed, whereas in some patients it is an important adjunct to drainage and surgery. Because anaerobes are generally isolated mixed with aerobes, the antimicrobial chosen should provide for adequate coverage of both. The most effective antimicrobials against anaerobes are metronidazole, the carbapenems (imipenem, meropenem, doripenem, ertapenem), chloramphenicol, the combination of a penicillin and a β-lactamase inhibitors (ampicillin or ticarcillin plus clavulanate, amoxicillin plus sulbactam, piperacillin plus tazobactam), tigecycline, cefoxitin, and clindamycin.

This review contains 4 figures, 9 tables, and 150 references.

Key words: anaerobic bacteria, antibiotics, antimicrobial resistance, Bacteroides fragilis, Clostridium spp, Fusobacterium spp, infection, Peptostreptococcus spp  

This review discusses the epidemiology, pathology, clinical features, laboratory findings, and treatment for Lyme disease, leptospirosis, relapsing fever, and rat-bite fever. Lyme disease is a tick-borne illness caused by the spirochete Borrelia burgdorferi. Lyme disease is a progressive infectious disease with a wide array of clinical manifestations. In most persons, the initial sign of infection is the development of erythema migrans. In general, three stages of the illness can be distinguished: early localized disease, early disseminated disease, and persisting late disease. A photograph shows an erythema migrans lesion, and an algorithm for diagnosis of Lyme disease is provided. A table lists the antibiotic regimens used for the different stages and manifestations of Lyme disease. Leptospirosis is a worldwide zoonosis caused by spirochetes from the genus Leptospira; these spirochetes are shown in a photomicrograph. The disease is acquired by contact with infected animals or exposure to contaminated soil or freshwater and can cause illness ranging from asymptomatic infection to severe multisystem disease with a significant mortality. Relapsing fever is an acute louse-borne or tick-borne infection caused by spirochetes of the genus Borrelia and is characterized by recurrent febrile episodes separated by asymptomatic intervals. Rat-bite fever is infection caused by Streptobacillus moniliformis in the United States and Europe or by Spirillum minus in Asia. 

This review 6 figures, 13 tables, and 95 references.

Keywords: Spirochete, borreliosis, tick, Lyme disease, rat bite fever, leptospirosis, zoonosis, target rash, relapsing fever, louse

Infections caused by organisms of the genus Rickettsia, Orientia, Ehrlichia, Anaplasma, and Coxiella occur throughout the world and are important, yet often overlooked, causes of febrile illness. They are transmitted by ticks, lice, mites, fleas, and, in the case of Coxiella, infected aerosols. Some are considered emerging and reemerging infectious diseases, as exemplified by the emergence of Rocky Mountain spotted fever in the American Southwest and Mexico; the reemergence of murine typhus in parts of Texas; and the discovery of new pathogens, such as Ehrlichia muris–like agent. Manifestations are usually of an acute undifferentiated febrile illness, with associated headache, malaise, myalgias, and varying frequency of rash. Since confirmation of diagnosis is often retrospective, requiring the dynamic change in antibody titers from acute and convalescent phase sera, clinical recognition for empirical treatment is imperative. Indeed, timely treatment is effective at abating symptoms and preventing complications. This review discusses important aspects of the epidemiology, clinical manifestations, diagnostic methods, and treatment of infections caused by Rickettsia and related organisms. 

This review contains 5 figures, 9 tables, and 50 references.

Key words: anaplasmosis, ehrlichiosis, Q fever, Rocky Mountain spotted fever, scrub typhus, spotted fever group rickettsioses, typhus group rickettsioses

The class Mollicutes includes organisms in the genera Mycoplasma and Ureaplasma. They are prokaryotes that lack a cell wall, and are among the smallest known living organisms in both cellular dimensions and genome sizes. At least 17 different species inhabit the mucosae of the respiratory and urogenital tracts of humans, several of which are pathogenic in a variety of clinical illnesses. Their fastidious nature and often slow growth in vitro have hampered understanding of their roles as agents of human disease. Mycoplasma pneumoniae is an important cause of community acquired respiratory infections that occur endemically and epidemically worldwide in persons of all ages and ranges in severity from mild to life-threatening. Molecular-based laboratory techniques have resulted in increased understanding of the pathogenesis and epidemiology M. pneumoniae infections as well as improved means for laboratory detection. Resistance of M. pneumoniae to macrolide antimicrobials has emerged worldwide over the past several years, complicating treatment strategies.

This review contains 2 figures, 1 table and 58 references

Key Words: Antimicrobial Resistance, Ciliated respiratory epithelium, Community Acquired Pneumonia, Cytadherence, Mycoplasma pneumoniae, Reinfections

Tuberculosis (TB) is a bacterial disease caused by Mycobacterium tuberculosis, a relatively slow-growing, aerobic, acid-fast bacillus (AFB). Classically, TB is a pulmonary disease, but disseminated and extrapulmonary manifestations may also occur, especially in immunocompromised persons. TB is transmitted person to person and is usually contracted by inhalation of M. tuberculosis droplet nuclei generated by an infectious person. If infection occurs after M. tuberculosis enters the body, the host’s cell-mediated immunity may contain the organism but not eradicate all the bacilli, resulting in latent tuberculosis infection (LTBI). M. tuberculosis can remain dormant and persist (e.g., within macrophages); persons with LTBI are at risk for reactivation and development of active TB.

This review contains 5 figures, 7 tables, and 75 references.

Key Words: tuberculosis, pulmonary tuberculosis, extrapulmonary tuberculosis, tuberculosis in hiv-infected patients

Mycobacterium leprae infection (i.e., leprosy) is a disease that has been recognized—and often misunderstood—since ancient times. The emergence of HIV/AIDS and the development of newer culture methodologies and molecular diagnostic tools have brought about increased interest in the epidemiology, diagnosis, and treatment of human infections from nontuberculous mycobacteria (NTM). More than 140 species of NTM have been identified; approximately 50 of these may be pathogenic for humans, causing a broad spectrum of disease. This chapter covers both M. leprae and selected NTM organisms, including M. avium complex; M. kansasii; M. marinum; and rapidly growing mycobacteria such as M. chelonae, M. fortuitum, and M. abscessus. The section on leprosy encompasses subsections on diagnosis, clinical manifestations and classification, laboratory studies, treatment, and leprosy reactions. Treatments for nontuberculous mycobacteria infections are also covered. Figures include a natural history of leprosy, tuberculoid leprosy, lepromatous leprosy, and various forms of borderline leprosy, as well as type 1 and type 2 leprosy reaction. Tables include the Ridley-Jopling classification of leprosy, recommendations for treatment of leprosy, clinical characteristics and treatment of leprosy, major clinical syndromes associated with nontuberculous mycobacterial infections, diagnosing nontuberculous mycobacterial lung disease, a listing of slow and rapidly growing mycobacteria that are human pathogens, plus treatment regimens for selected nontuberculous mycobacterial infections in adults.

This review contains 59 references.

Endemic mycoses are caused by fungi that share several important characteristics but differ greatly in other respects. They include histoplasmosis, blastomycosis, coccidioidomycosis, and sporotrichosis. Discussions on their epidemiology, pathogenesis, clinical presentation, diagnosis, differential diagnosis, treatment, and prognosis are included. A section on antifungal therapy is included, discussing the use of azoles and amphotericin B. Figures show photomicrographs of biopsy samples from patients with histoplasmosis, blastomycosis, and coccidioidomycosis. Tables list selected drugs that may interact with azoles to change serum levels and information on the administration of amphotericin B for treatment of endemic mycoses.

This review contains 3 highly rendered figures, 3 tables, and 71 references.

Opportunistic fungal infections have become increasingly important over the past several decades, paradoxically because advances in medical practice have improved the survival of debilitated and immunosuppressed patients. The mycotic infections that appear in the compromised host are candidiasis, cryptococcosis, pneumocystosis, aspergillosis, zygomycosis, and fusariosis. The aspergillosis section addresses allergic bronchopulmonary aspergillosis and invasive aspergillosis separately. Timely diagnosis of opportunistic fungal infection depends on understanding host characteristics, environmental risk factors, clinical presentation, and diagnostic testing, which each section covers. There is also a section on infection by dematiaceous fungi. Figures illustrate the cysts of Pneumocystis and the bimodal distribution of Aspergillus infection after bone marrow transplantation. Tables describe the desensitization of adult patients with sulfa allergy; the stages of allergic bronchopulmonary aspergillosis; the treatment of infections caused by Candida, Cryptococcus, Aspergillus, and Fusarium species; and the treatment and prophylaxis of Pneumocystis jiroveci pneumonia. 

This review contains 2 highly rendered figures, 7 tables, and 108 references.

Salmonella, which is acquired via ingestion, is classified as nontyphoidal or typhoidal disease. Typhoidal disease is caused by S typhi or S paratyphi,and nontyphoidal disease is caused by all other serovars. Salmonella causes a range of infectious syndromes that include gastroenteritis, bacteremia, endovascular infections, and enteric fever. For immunocompromised hosts or patients with extraintestinal disease, antibiotic therapy should be provided. Effective agents often include third-generation cephalosporins and fluoroquinolones, although rates of resistance of Salmonella isolates to many antibiotics are increasing. A carrier state exists whereby patients may shed bacteria despite being asymptomatic. To eradicate the carrier state, longer courses of antibiotics and, in rare instances, surgical removal of the reservoir, which is most commonly the gallbladder, may be required. 

This review contains 2 figures, 4 tables, and 24 references.

Key Words: Salmonella, typhoidal, non-typhoidal, enteric fever, endovascular infection, gastroenteritis, carrier, food-borne, antibiotic resistance

Protozoans cause a number of important infectious diseases. This chapter discusses malaria, babesiosis, toxoplasmosis, trichomoniasis, leishmaniasis, and trypanosomiasis; in addition, the chapter describes the intestinal protozoan infections caused by Giardia lamblia; Dientamoeba fragilis; Entamoeba histolytica; Blastocystis hominis; the coccidial organisms Cystoisospora belli, Cryptosporidium, and Cyclospora cayetanensis; Balantidium coli; and microsporidia. Figures illustrate the taxonomy of pathogenic protozoans; the life cycle of malaria; identification of species of malaria based on forms seen on blood smears; Babesia parasites in erythrocytes; the life cycle, tachyzoites, and tissue cysts ofToxoplasma gondii; G. lamblia trophozoites and cysts; a D. fragilis trophozoite; E. histolytica cyst and trophozoite forms; Entamoeba coli; clinical involvement in amebiasis; B. hominis; cysts of Cryptosporidium, Cyclospora, and Cystoisospora; Acanthamoeba polyphaga cyst and histopathologic features; histopathology of Naeglaria meningoencephalitis;Leishmania (Viannia) braziliensis cutaneous infection; amastigotes of Old World leishmaniasis; the insect vector for Chagas disease; Romaña sign in acute Chagas disease;Trypanosoma cruzi, and T. brucei. Tables list the differentiating features of Plasmodium species that cause malaria; dosages, principal side effects, and main limitations of antimalarial drugs; and forms of New World leishmaniasis. A sidebar provides Internet links on protozoan infection. 

This review contains 22 highly rendered figures, 3 tables, and 121 references.

Helminthic parasites are multicellular worms that possess differentiated organ systems. They (with a few exceptions) do not replicate in the human host, and they tend to elicit eosinophilia within the tissues and blood of infected humans. Helminthic parasites include nematodes (roundworms), cestodes (tapeworms), and trematodes (flukes). The major intestinal nematodes are roundworm, pinworm, hookworm, whipworm, and Strongyloides stercoralis. Trichinellosis is caused by five species of the nematode Trichinella and develops after ingestion of infected meat, usually pork or the meat of certain carnivores. Nematode infections of the major tissue are anisakiasis, visceral larva migrans,Angiostrongylus cantonensis infection, mammomonogamosis (syngamosis), gnathostomiasis, dracunculiasis, and filariasis. Trematode and cestode infections are also described in this chapter, including infections by fish, beef, and pork tapeworms, as well as cysticercosis. Disease from Paragonimus, Clonorchis, Fasciola, Fasciolopsis, and Schistosoma is covered. Echinococcus infection and hydatid cyst disease are discussed. Tables describe intestinal nematode infection and treatment and filarial parasites of humans. Figures illustrate a variety of helminthic parasites and their life cycles.

This review contains 136 references.

Staphylococci are nonsporulating, nonmotile, gram-positive cocci that have an average diameter of 1 µm. Microscopically, staphylococci tend to be larger and rounder than streptococci. Because cell division occurs on three planes, these organisms are typically found in grapelike clusters and tetrads, as well as in pairs and sometimes in short chains. Staphylococci are very hardy organisms and can withstand much more physical and chemical stress than pneumococci and streptococci. Because staphylococci are facultative anaerobes, they will grow in the presence or absence of oxygen. Staphylococci are catalase positive. Of the species of staphylococci, Staphylococcus aureus is by far the most important human pathogen. This review covers the epidemiology and pathogenesis of S. aureus, clinical infections associated with S. aureus, treatment of staphylococcal infections, and staphylococcal toxic shock syndrome. Clinically important coagulase-negative staphylococci such as S. epidermidis and S. saprophyticus are also discussed. Tables list antibiotic treatment for staphylococcal infections, clinical manifestations of staphylococcal toxic shock syndrome, and antibiotic treatment for staphylococcal toxic shock syndrome.

This review contains 3 figures, 6 tables, and 54 references.

Key words: Staphylococcus aureus;Staphylococcal infections;Coagulase-negative staphylococci; Skin and soft tissue infections; S. aureus bacteremia; MRSA; Methicillin-resistant S. aureus; Toxic shock syndrome

Pneumococci, or Streptococcus pneumoniae, are gram-positive, lancet-shaped diplococci but may also grow in short chains. The polysaccharide polymer that forms the outer capsule of S pneumoniae is chemically and antigenically unique and is crucial to virulence. There are at least 90 distinct serotypes. The capsule allows the bacteria to resist phagocytosis by leukocytes unless the organisms have been opsonized by antibody or serum complement components. Certain pneumococcal serotypes, such as the heavily encapsulated type 3 pneumococcus, are particularly virulent. In fact, only 23 serotypes account for 80% of bacteremic pneumococcal infections in the United States; capsular polysaccharides from these 23 serotypes are incorporated into the polyvalent polysaccharide pneumococcal vaccine (PPSV23), which has been available since 1983. This review covers the epidemiology and pathogenesis of pneumococcal infections, clinical pneumococcal infections, and prevention of pneumococcal infections. Adverse outcomes in pneumococcal pneumonia, antibiotic treatment for penicillin-resistant S pneumoniae, and Centers for Disease Control and Prevention child and adolescent immunization schedules are discussed.

This review contains 1 figure, 6 tables, and 41 references. 

Key words: bacterial pneumonia, PCV13, penicillin-resistant Streptococcus pneumoniae, pneumococcal pneumonia, pneumococcus, PPSV23, pneumonia vaccine, Streptococcus pneumoniae

Yeast-based fungal infections have become increasingly important over several decades, paradoxically because advances in medical practice have allowed patients with chronic medical conditions to live longer and have more productive lives. Many of these yeast infections are superficial in nature, such as thrush and candidal vaginitis among persons treated with antibiotics or with short courses of steroids. A minority of the yeast infections are associated with significant morbidity and mortality, generally among debilitated or otherwise immunosuppressed patients who have survived major surgeries or extensive chemotherapy regimens. These opportunistic yeast pathogens may originate as human commensals (e.g., Candida albicans) or have an environmental reservoir (e.g., Cryptococcus neoformans). Opportunistic Pneumocystis infections are inhaled. Knowledge of the host characteristics associated with specific infections will allow high suspicion for the type of yeast infection that may be occurring. Standard methods for making a diagnosis have included antigen testing, culture, and cytology. Newer methods for making the diagnosis include nucleic acid testing and nanotechnology. There are three general classes of antifungal agents. Treatment with antifungal agents for the most serious of these infections requires source control for cure. In addition, correction of predisposing conditions will also assist with prevention of recurrence. Immunocompromised patients require either prophylaxis or early empirical treatment during high-risk periods.

This review contains 1 figure, 4 tables, and 74 references.

Key words: Candida, Candidiasis, Cryptococcus, Malassezia, Trichosporon, Pneumocystis

Although risk reduction counseling and barrier protection remain important strategies for prevention of HIV acquisition and other sexually transmitted infections, there have been significant advances in medication-based prevention strategies in recent years following advances in HIV treatment. There are now many safe and highly effective methods for HIV prevention, components of a prevention toolkit that clinicians may choose from or use in combination as appropriate for each patient. Treatment of HIV-infected individuals to achieve virologic suppression prevents transmission to others in nearly all cases. Treatment of HIV-infected pregnant women with combination antiretroviral therapy also prevents transmission to the infant in nearly all cases. Treating HIV-uninfected individuals with antiretroviral agents either before or after possible exposure has also been shown to be effective in significantly reducing the risk of HIV acquisition. Clinicians should use these effective tools to compose an HIV prevention strategy that is individualized to each patient. 

This review contains 1 figure, and 34 references.

Key words: circumcision, dolutegravir, emtricitabine, needle exchange, preexposure prophylaxis, prevention of mother-to-child transmission, postexposure prophylaxis, raltegravir, tenofovir, treatment as prevention

Clostridium difficile is one of the most common causes of healthcare associated infection in the United States. Despite significant attention and resources, national rates increased dramatically between 2000-2011 and have only started to decline in the last five years.. The Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) updated their clinical practice guidelines on the diagnosis and management of C. difficile disease in 2017. The recommended changes in therapeutic guidelines, recommendations for pediatric patient populations, and overview of available diagnostics are described herein. Additionally, this review discusses the changing epidemiology, examines the pathophysiology of the disease process, and outlines current infection control and prevention strategies.

 This review has 6 figures, 9 tables and 53 references.

Key Words: Clostridium difficile, diarrhea, colitis, antibiotics, spores, nosocomial, hospital

Fevers in individuals with recent tropical travel require rapid assessment because many of the potential causes are treatable and/or have important public health implications. History and clinical findings are essential to identify the likely causes of the fever and, thus, recognize those that require urgent intervention.This review outlines obtaining the travel history, incubation periods, undifferentiated fever, and evaluation based on syndromes. Figures show the most common diagnoses and range of incubation periods; the top specific diagnoses in febrile returned travelers by geographic region; countries/areas at risk for dengue transmission; images of Aedes aegypti and Aedes albopictus, vectors of dengue virus and chikungunya virus; countries and territories where chikungunya cases have been reported (as of March 10, 2015), excluding where imported cases only are documented; cases of Ebola virus disease in Africa, 1976–2015, by species and size; and an algorithm for approach to workup. Tables list Web sites and resources for travel medicine; the epidemiology of fever in travelers; key areas of exposure queries in returned travelers; obtaining exposure history in febrile returned travelers; estimated protective effect of previous vaccination; common posttravel infections, by incubation period; guiding principles for care of febrile patients returning from tropical travel; common clinical findings and associated infections; key cannot-miss diagnoses with fever; malaria antigens; fever syndromes, diagnoses, and diagnostic tests to be considered; and major hemorrhagic fevers and their distribution based on world regions.

This review contains 7 highly rendered figures, 12 tables, and 151 references.

Infection is a common complication in cancer patients who receive cytotoxic chemotherapy and other targeted therapies. A clear understanding of the underlying host risk factors, the immunologic effects of specific cancer therapies, and the anatomic location of the tumor and its impact on surrounding structures helps predict the types of infection to which the host is most vulnerable. This review covers fever in the setting of neutropenia, infection risk with biological and targeted cancer therapy, and infections in patients with solid tumors. Figures show risk for fever and neutropenia, and empirical antibiotic algorithm for initial management of febrile neutropenia in patients at high risk for complications, radiographic findings associated with invasive fungal disease, a schematic of hepatitis B virus infection and reactivation after anti-CD20 therapy, and management of nonpurulent cellulitis in cancer patients. Tables list the Multinational Association of Supportive Care in Cancer (MASCC) risk index score, the Clinical Index of Stable Febrile Neutropenia (CISNE) scoring system, common bacterial pathogens that cause infection in neutropenic patients, assessment of specific signs and symptoms during febrile neutropenia, empirical antibiotic management of febrile neutropenia, criteria for addition of vancomycin to empirical antibiotic regimen for febrile neutropenia, and biological and targeted agents commonly used to treat hematologic malignancy and associated infections.

This review contains 5 highly rendered figures, 7 tables, and 107 references