Schaechter S Mechanisms of Microbial Disease N Cary Engleberg MD Victor Dirita PHD Editor Michael Imperiale PH D Editor

Schaechter s Mechanisms of Microbial
Disease N Cary Engleberg Md Victor

Dirita Phd Editor Michael Imperiale Ph D
Editor
Visit to download the full and correct content document:
https://ebookmeta.com/product/schaechter-s-mechanisms-of-microbial-disease-n-car
y-engleberg-md-victor-dirita-phd-editor-michael-imperiale-ph-d-editor/
More products digital (pdf, epub, mobi) instant
download maybe you interests ...
Schaechter s Mechanisms of Microbial Disease Sixth

Edition N Cary Engleberg Md Victor Dirita Phd Editor
Michael Imperiale Ph D Editor
https://ebookmeta.com/product/schaechter-s-mechanisms-of-
microbial-disease-sixth-edition-n-cary-engleberg-md-victor-
dirita-phd-editor-michael-imperiale-ph-d-editor/
Charney Nestler s Neurobiology of Mental Illness 5th

Edition Dennis S Charney Md Editor Eric J Nestler Md
Phd Editor Pamela Sklar Md Phd Editor Joseph D Buxbaum
Phd Editor
https://ebookmeta.com/product/charney-nestler-s-neurobiology-of-
mental-illness-5th-edition-dennis-s-charney-md-editor-eric-j-
nestler-md-phd-editor-pamela-sklar-md-phd-editor-joseph-d-
buxbaum-phd-editor/
Berne Levy Physiology by Team IRA 8th Edition Bruce M

Koeppen Md Phd Bruce A Stanton Phd Julianne M Hall Phd
Editor Agnieszka Swiatecka Urban M D F A S N Editor
https://ebookmeta.com/product/berne-levy-physiology-by-team-
ira-8th-edition-bruce-m-koeppen-md-phd-bruce-a-stanton-phd-
julianne-m-hall-phd-editor-agnieszka-swiatecka-urban-m-d-f-a-s-n-
editor/
Anesthesiologist s Manual of Surgical Procedures 6th

Edition Richard A Jaffe Md Phd Editor Clifford A
Schmiesing Md Editor Brenda Golianu Md Editor
https://ebookmeta.com/product/anesthesiologist-s-manual-of-
surgical-procedures-6th-edition-richard-a-jaffe-md-phd-editor-
clifford-a-schmiesing-md-editor-brenda-golianu-md-editor/
Treating Depression with Emdr Therapy Arne Hofmann Md
Phd Luca Ostacoli Md Maria Lehnung Phd Michael Hase Md
Phd Marilyn Luber Phd
https://ebookmeta.com/product/treating-depression-with-emdr-
therapy-arne-hofmann-md-phd-luca-ostacoli-md-maria-lehnung-phd-
michael-hase-md-phd-marilyn-luber-phd/
Why Darkness Matters The Power of Melanin in the Brain

4th Edition Bynum Ph D Dr Edward Bruce King Md Dr
Richard D Moore Ph D Dr T Owens Brown Ph D Dr Ann C
https://ebookmeta.com/product/why-darkness-matters-the-power-of-
melanin-in-the-brain-4th-edition-bynum-ph-d-dr-edward-bruce-king-
md-dr-richard-d-moore-ph-d-dr-t-owens-brown-ph-d-dr-ann-c/
Atlas of Emergency Imaging from Head to Toe Michael N

Patlas Editor Douglas S Katz Editor Mariano Scaglione
Editor
https://ebookmeta.com/product/atlas-of-emergency-imaging-from-
head-to-toe-michael-n-patlas-editor-douglas-s-katz-editor-
mariano-scaglione-editor/
The Acute Management of Surgical Disease Martin D.

Zielinski (Editor)
https://ebookmeta.com/product/the-acute-management-of-surgical-
disease-martin-d-zielinski-editor/
Lymphomas And Leukemias Cancer Principles Practice Of

Oncology 10th Edition Vincent T Devita Jr Md Theodore S
Lawrence Md Phd Steven A Rosenberg Md Phd
https://ebookmeta.com/product/lymphomas-and-leukemias-cancer-
principles-practice-of-oncology-10th-edition-vincent-t-devita-jr-
md-theodore-s-lawrence-md-phd-steven-a-rosenberg-md-phd/
Schaechter’s Mechanisms of
Microbial Disease
Schaechter’s Mechanisms of
Microbial Disease
SIXTH EDITION
N. Cary Engleberg
Professor Emeritus Department of Internal Medicine
Division of Infectious Diseases
Department of Microbiology and Immunology
University of Michigan Medical School
Ann Arbor, Michigan
Victor J. DiRita
Rudolph Hugh Endowed Chair in Microbial Pathogenesis and
Department Chair
Department of Microbiology & Molecular Genetics
Michigan State University
East Lansing, Michigan
Michael J. Imperiale
Arthur F. Thurnau Professor
Ann Arbor, Michigan
Acquisitions Editor: Lindsey Porambo
Product Development Editor: Robyn Alvarez
Editorial Coordinator: Remington Fernando
Marketing Manager: Phyllis Hitner
Senior Production Project Manager: Alicia Jackson
Manager, Graphic Arts & Design: Stephen Druding
Prepress Vendor: Straive
Sixth Edition
Copyright © 2022, 2013, 2007, 1999, 1989 Wolters Kluwer
All rights reserved. This book is protected by copyright. No part of this book may be reproduced or
transmitted in any form or by any means, including as photocopies or scanned-in or other electronic
copies, or utilized by any information storage and retrieval system without written permission from
the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials
appearing in this book prepared by individuals as part of their official duties as U.S. government
employees are not covered by the above-mentioned copyright. To request permission, please contact
Wolters Kluwer at Two Commerce Square, 2001 Market Street, Philadelphia, PA 19103, via email at
[email protected], or via our website at shop.lww.com (products and services).
987654321
Printed in Mexico
Library of Congress Cataloging-in-Publication Data

Names: Engleberg, N. Cary, editor. | DiRita, Victor J., editor. | Imperiale, Michael Joseph, 1957-
editor.
Title: Schaechter's mechanisms of microbial disease / [edited by] N. Cary Engleberg, Victor J.
DiRita, Michael J. Imperiale.
Other titles: Mechanisms of microbial disease
Description: Sixth edition. | Philadelphia : Wolters Kluwer, [2022] | Includes bibliographical
references and index. | Summary: “This textbook is intended to be used in courses on medical
microbiology or infectious diseases for medical students, allied health professionals, graduate
students, or advanced undergraduates. Because the purpose of this book is to develop a conceptual
framework for understanding infection, it highlights certain agents and diseases of special biological
or clinical importance and does not attempt to describe the microbial world in an exhaustive fashion“
– Provided by publisher.
Identifiers: LCCN 2021041910 (print) | LCCN 2021041911 (ebook) | ISBN 9781975151485 | ISBN
9781975151508 (epub)
Subjects: MESH: Communicable Diseases—microbiology | Communicable Diseases—
physiopathology | Bacteria—pathogenicity | Fungi—pathogenicity | Viruses—pathogenicity | BISAC:
MEDICAL / Microbiology | MEDICAL / Tropical Medicine
Classification: LCC QR46 (print) | LCC QR46 (ebook) | NLM QW 700 | DDC 616.9/041—dc23
LC record available at https://lccn.loc.gov/2021041910
LC ebook record available at https://lccn.loc.gov/2021041911
This work is provided “as is,” and the publisher disclaims any and all warranties, express or implied,
including any warranties as to accuracy, comprehensiveness, or currency of the content of this work.
This work is no substitute for individual patient assessment based upon healthcare professionals'
examination of each patient and consideration of, among other things, age, weight, gender, current or
prior medical conditions, medication history, laboratory data and other factors unique to the patient.
The publisher does not provide medical advice or guidance and this work is merely a reference tool.
Healthcare professionals, and not the publisher, are solely responsible for the use of this work
including all medical judgments and for any resulting diagnosis and treatments.
Given continuous, rapid advances in medical science and health information, independent
professional verification of medical diagnoses, indications, appropriate pharmaceutical selections and
dosages, and treatment options should be made and healthcare professionals should consult a variety
of sources. When prescribing medication, healthcare professionals are advised to consult the product
information sheet (the manufacturer's package insert) accompanying each drug to verify, among other
things, conditions of use, warnings and side effects and identify any changes in dosage schedule or
contraindications, particularly if the medication to be administered is new, infrequently used or has a
narrow therapeutic range. To the maximum extent permitted under applicable law, no responsibility is
assumed by the publisher for any injury and/or damage to persons or property, as a matter of products
liability, negligence law or otherwise, or from any reference to or use by any person of this work.
Shop.lww.com
Not authorised for sale in United States, Canada, Australia, New Zealand, Puerto Rico, and
U.S. Virgin Islands.
Acquisitions Editor: Lindsey Porambo
Product Development Editor: Robyn Alvarez

Editorial Coordinator: Remington Fernando
Marketing Manager: Phyllis Hitner
Senior Production Project Manager: Alicia Jackson
Manager, Graphic Arts & Design: Stephen Druding
Prepress Vendor: Straive
Sixth Edition
Copyright © 2022, 2013, 2007, 1999, 1989 Wolters Kluwer
All rights reserved. This book is protected by copyright. No part of this book may be reproduced or
transmitted in any form or by any means, including as photocopies or scanned-in or other electronic
copies, or utilized by any information storage and retrieval system without written permission from
the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials
appearing in this book prepared by individuals as part of their official duties as U.S. government
employees are not covered by the above-mentioned copyright. To request permission, please contact
Wolters Kluwer at Two Commerce Square, 2001 Market Street, Philadelphia, PA 19103, via email at
[email protected], or via our website at shop.lww.com (products and services).
987654321
Printed in Mexico
Library of Congress Cataloging-in-Publication Data

Names: Engleberg, N. Cary, editor. | DiRita, Victor J., editor. | Imperiale, Michael Joseph, 1957-
editor.
Title: Schaechter's mechanisms of microbial disease / [edited by] N. Cary Engleberg, Victor J.
DiRita, Michael J. Imperiale.
Other titles: Mechanisms of microbial disease
Description: Sixth edition. | Philadelphia : Wolters Kluwer, [2022] | Includes bibliographical
references and index. | Summary: “This textbook is intended to be used in courses on medical
microbiology or infectious diseases for medical students, allied health professionals, graduate
students, or advanced undergraduates. Because the purpose of this book is to develop a conceptual
framework for understanding infection, it highlights certain agents and diseases of special biological
or clinical importance and does not attempt to describe the microbial world in an exhaustive fashion“
– Provided by publisher.
Identifiers: LCCN 2021041910 (print) | LCCN 2021041911 (ebook) | ISBN 9781975151485 | ISBN
9781975151508 (epub)
Subjects: MESH: Communicable Diseases—microbiology | Communicable Diseases—
physiopathology | Bacteria—pathogenicity | Fungi—pathogenicity | Viruses—pathogenicity | BISAC:
MEDICAL / Microbiology | MEDICAL / Tropical Medicine
Classification: LCC QR46 (print) | LCC QR46 (ebook) | NLM QW 700 | DDC 616.9/041—dc23
LC record available at https://lccn.loc.gov/2021041910
LC ebook record available at https://lccn.loc.gov/2021041911
This work is provided “as is,” and the publisher disclaims any and all warranties, express or implied,
including any warranties as to accuracy, comprehensiveness, or currency of the content of this work.
This work is no substitute for individual patient assessment based upon healthcare professionals'
examination of each patient and consideration of, among other things, age, weight, gender, current or
prior medical conditions, medication history, laboratory data and other factors unique to the patient.
The publisher does not provide medical advice or guidance and this work is merely a reference tool.
Healthcare professionals, and not the publisher, are solely responsible for the use of this work
including all medical judgments and for any resulting diagnosis and treatments.
Given continuous, rapid advances in medical science and health information, independent
professional verification of medical diagnoses, indications, appropriate pharmaceutical selections and
dosages, and treatment options should be made and healthcare professionals should consult a variety
of sources. When prescribing medication, healthcare professionals are advised to consult the product
information sheet (the manufacturer's package insert) accompanying each drug to verify, among other
things, conditions of use, warnings and side effects and identify any changes in dosage schedule or
contraindications, particularly if the medication to be administered is new, infrequently used or has a
narrow therapeutic range. To the maximum extent permitted under applicable law, no responsibility is
assumed by the publisher for any injury and/or damage to persons or property, as a matter of products
liability, negligence law or otherwise, or from any reference to or use by any person of this work.
Shop.lww.com
Contributors
Emily A. Abdoler, MD, MAEd

Clinical Assistant Professor
Department of Medicine
University of Michigan
Ann Arbor, Michigan
C. Alan Anderson, MD
Professor of Neurology, Psychiatry, and Emergency Medicine
Department of Neurology
University of Colorado School of Medicine
Aurora, Colorado
Elliot J. Androphy, MD
Kampen-Norins Professor
Chair, Department of Dermatology
Indiana University School of Medicine
Indiana University Health
Indianapolis, Indiana
Gabriela M. Andujar Vazquez, MD

Attending Physician
Director, COVID-19 Vaccine Program
Associate Hospital Epidemiologist
Associate Director, Antimicrobial Stewardship
Division of Geographic Medicine and Infectious Diseases
Assistant Professor of Medicine
Tufts University School of Medicine
Boston, Massachusetts
Robert L. Atmar, MD
John S. Dunn Clinical Research Professor in Infectious Diseases
Section of Infectious Diseases
Departments of Medicine and Molecular Virology & Microbiology
Baylor College of Medicine
Chief, Infectious Diseases Service
Ben Taub Hospital
Harris Health System
Houston, Texas
Joseph T. Barbieri, PhD

Professor of Microbiology and Immunology
Medical College of Wisconsin
Milwaukee, Wisconsin
Joel B. Baseman, MSc, PhD

Professor Emeritus
Department of Microbiology, Immunology and Molecular Genetics
University of Texas Health San Antonio
San Antonio, Texas
Jeffrey M. Bergelson, MD
Professor of Pediatrics, Emeritus
The Children’s Hospital of Philadelphia
University of Pennsylvania Perelman School of Medicine
Philadelphia, Pennsylvania
Adam C. Bortner, MD, AAHIVS

Chief Resident
Family Medicine Residency Training Program
Family Health Centers of San Diego
San Diego, California
Suzanne F. Bradley, MD
Professor
Department of Internal Medicine
Hospital Epidemiologist
Infectious Diseases Section
Veterans Affairs Ann Arbor Healthcare System
Ann Arbor, Michigan
William J. Britt, MD
Charles A. Alford Professor of Pediatrics
Department of Pediatrics and Microbiology
University of Alabama School of Medicine
Attending Physician
Children’s Hospital of Alabama
University of Alabama Hospital
Birmingham, Alabama
Niels E. Bruun, MD, DMSc

Professor, Senior Consultant,
Department of Cardiology
Zealand University Hospital, Roskilde, Denmark
Sandro K. Cinti, MD
Clinical Professor of Internal Medicine
Michigan Medicine
Ann Arbor VA Healthcare System
Ann Arbor, Michigan
Kathleen L. Collins
Associate Dean for Physician Scientist Education and Training
Director, Medical Scientist Training Program
Professor of Internal Medicine and Microbiology and Immunology
Ann Arbor, Michigan
Peggy A. Cotter, PhD

Professor and Associate Chair
School of Medicine
University of North Carolina at Chapel Hill
Chapel Hill, North Carolina
Toni Darville, MD
Distinguished Professor of Pediatrics and Microbiology & Immunology
Chief, Division of Pediatric Infectious Diseases
North Carolina Children’s Hospital
Suzanne R. Dawid, MD, PhD

Associate Professor
Departments of Pediatrics and Microbiology and Immunology
C. S. Mott Children’s Hospital
Ann Arbor, Michigan
Roberta L. DeBiasi, MD, MS

Chief, Division of Pediatric Infectious Diseases
Children’s National Hospital and Research Institute
Professor of Pediatrics and Microbiology, Immunology, & Tropical
Medicine
The George Washington University School of Medicine
Washington, District of Columbia
Neal A. DeLuca, PhD

Professor
Department of Microbiology and Molecular Genetics
University of Pittsburgh School of Medicine
Pittsburgh, Pennsylvania
Terence S. Dermody, MD
Vira I. Heinz Distinguished Professor and Chair of Pediatrics
Professor of Microbiology and Molecular Genetics
Physician-in-Chief and Scientific Director
UPMC Children’s Hospital of Pittsburgh
Victor J. DiRita, PhD

Rudolph Hugh Endowed Chair in Microbial Pathogenesis and Department
Chair
Department of Microbiology & Molecular Genetics
Michigan State University
East Lansing, Michigan
Shira Doron, MD
Attending Physician
Hospital Epidemiologist
Director, Antimicrobial Stewardship
Associate Professor of Medicine
Roman Dziarski
Professor Emeritus of Microbiology and Immunology
Indiana University School of Medicine–Northwest
Gary, Indiana
Barry I. Eisenstein, MD
Chief Medical Officer, CARB-X
Boston University
Washington, District of Columbia
N. Cary Engleberg, MD, DTM&H
Professor Emeritus
Departments of Internal Medicine
Ann Arbor, Michigan
Mary K. Estes, PhD

Distinguished Service Professor
Departments of Molecular Virology and Microbiology and Medicine
Baylor College of Medicine
Houston, Texas
Christina T. Fiske, MD, MPH

Assistant Professor
Vanderbilt University Medical Center
Nashville, Tennessee
James M. Fleckenstein, MD
Professor of Medicine & Molecular Microbiology
School of Medicine
Washington University in Saint Louis
Attending Physician
Infectious Diseases
Veterans Affairs Health Care System, St. Louis
St. Louis, Missouri
Emil L. Fosbøl, MD, PhD

Senior Consulting Cardiologist
Department of Valvular Heart Diseases
The Heart Centre
University Hospital of Copenhagen, Rigshospitalet
Copenhagen, Denmark
Tejal N. Gandhi, MD, FIDSA
Clinical Associate Professor of Medicine
Ann Arbor, Michigan
Joanna B. Goldberg, PhD

Professor
Division of Pulmonary, Allergy & Immunology, Cystic Fibrosis, and Sleep
Department of Pediatrics
Emory University School of Medicine
Atlanta, Georgia
Diane E. Griffin, MD, PhD

University Distinguished Service Professor
W. Harry Feinstone Department of Molecular Microbiology and
Immunology
Johns Hopkins Bloomberg School of Public Health
Baltimore, Maryland
David W. Haas, MD
Professor of Medicine, Pharmacology, and Pathology, Microbiology &
Immunology
Vanderbilt University School of Medicine
Adjunct Professor of Internal Medicine
Meharry Medical College
Natasha B. Halasa, MD, MPH

Professor
Pediatric Infectious Diseases
Ann E. Jerse, PhD

Professor
School of Medicine
Uniformed Services University of the Health Sciences
Bethesda, Maryland
Adolf W. Karchmer, MD
Professor of Medicine
Beth Israel Deaconess Medical Center
Harvard Medical School
Carol A. Kauffman, MD, MACP

Professor of Internal Medicine
Chief, Infectious Diseases Section
Veterans Affairs Ann Arbor Healthcare System
Ann Arbor, Michigan
David W. Kimberlin, MD
Professor and Vice Chair for Clinical and Translational Research
The University of Alabama at Birmingham
Birmingham, Alabama
Paul R. Kinchington, PhD

JF Novak MD Endowed Chair in Ophthalmic Research
Professor of Ophthalmology and Microbiology and Molecular Genetics
Department of Ophthalmology
F. Matthew Kuhlmann, MD, MSCI

Washington University School of Medicine
St. Louis, Missouri
Jose M. Lemme-Dumit, PhD

Postdoctoral Fellow
Center for Vaccine Development & Global Health
University of Maryland School of Medicine
Baltimore, Maryland
Yi-Pin Lin, PhD

Research Scientist
Wadsworth Center
New York State Department of Health
Albany, New York
Preeti N. Malani, MD, MSJ

Chief Health Officer
Infectious Diseases Physician
Michigan Medicine
Ann Arbor, Michigan
Roshni Mathew, MD
Clinical Associate Professor
Pediatric Infectious Diseases
Stanford University School of Medicine
Stanford, California
Associate Medical Director of Infection Prevention and Control
Lucile Packard Children’s Hospital at Stanford
Palo Alto, California
Beth A. McCormick, PhD

Professor and Vice Chair
Department of Microbiology and Physiological Systems
Director of the Program in Microbiome Dynamics
University of Massachusetts Medical School
Worcester, Massachusetts
Kevin S. McIver, PhD

Professor and Interim Chair
Cell Biology and Molecular Genetics
University of Maryland
College Park, Maryland
Stephen B. Melville, PhD

Associate Professor of Microbiology
Department of Biological Sciences
Virginia Tech
Blacksburg, Virginia
Raffael Nachbagauer, MD, PhD

Assistant Professor
Department of Microbiology
Icahn School of Medicine at Mount Sinai
New York, New York
Jennifer M. Noto, PhD

Research Assistant Professor
Division of Gastroenterology, Hepatology, and Nutrition
Jane A. O’Halloran, MB BCh BAO, PhD

Assistant Professor
Attending Physician
Barnes-Jewish Hospital
St. Louis, Missouri
Mark M. Painter, PhD
Postdoctoral Research Fellow
Institute for Immunology
Perelman School of Medicine
University of Pennsylvania
Philadelphia, Pennsylvania
Peter Palese
Horace W. Goldsmith Professor and Chair
Professor
Icahn School of Medicine at Mount Sinai
New York, New York
Marcela F. Pasetti, PhD

Professor of Pediatrics
Microbiology and Immunology
Chief, Applied Immunology Section
Center for Vaccine Development & Global Health
University of Maryland School of Medicine
Baltimore, Maryland
Richard M. Peek Jr, MD

Mina Cobb Wallace Professor of Medicine, Pathology, Microbiology and
Immunology, and Cancer Biology
Division of Gastroenterology, Hepatology, and Nutrition
Brett W. Petersen, MD, MPH

Commander, U.S. Public Health Service
Deputy Chief, Poxvirus and Rabies Branch
Division of High-Consequence Pathogens and Pathology
National Center for Emerging and Zoonotic Infectious Diseases
Centers for Disease Control and Prevention
Atlanta, Georgia
Marnie L. Peterson, PharmD, PhD

Chief Executive Officer and Founder
Extherid Biosciences
Jackson, Wyoming
Lindsay A. Petty, MD
Ann Arbor, Michigan
Claudette L. Poole, MD, MSPH

Assistant Professor of Pediatrics
Division of Pediatric Infectious Diseases
University of Alabama School of Medicine
Children’s of Alabama
Birmingham, Alabama
William G. Powderly, MD, FRCPI, FRCP

J. William Campbell Professor of Medicine
Larry J. Shapiro Director, Institute for Public Health
Chief, Division of Infectious Diseases
Washington University in St. Louis
Attending Physician
Barnes-Jewish Hospital
St Louis, Missouri
Laura E. Power, MD, MPH

Clinical Assistant Professor
Departments of Epidemiology
School of Public Health, and
Ann Arbor, Michigan
Christian B. Ramers, MD, MPH, AAHIVS

Clinical Associate Professor
Medicine/Infectious Diseases
UC San Diego School of Medicine
Adjunct Associate Professor
Global Public Health
Graduate School of Public Health
San Diego State University
Medical Director
Laura Rodriguez Research Institute
Noah Robbins, MD, CM, FACP, FIDSA

Montefiore Medical Center
Albert Einstein College of Medicine
Bronx, New York
Charles E. Rupprecht, VMD, MS, PhD

CEO, LYSSA LLC
Cumming, Georgia
Moselio Schaechter
Distinguished Professor Emeritus
Tufts University
Adjunct Professor
San Diego State University and University of California, San Diego
Patrick M. Schlievert, PhD
Professor, Microbiology and Immunology and Internal Medicine
University of Iowa Hospital and Clinics
University of Iowa Carver College of Medicine
Iowa City, Iowa
David R. Snydman, MD
Emeritus Chief
Division of Geographic Medicine and Infectious Disease
Emeritus Hospital Epidemiologist
Tufts Medical Center
Dennis L. Stevens, PhD, MD, FACP, FIDSA

University of Washington School of Medicine
Seattle, Washington
Program Director
NIH Center of Excellence for Emerging and Re-Emerging Pathogens
Veterans Affairs Medical Center
Boise, Idaho
Klemen Strle, PhD

Research Scientist
Laboratory of Microbial Pathogenesis and Immunology
Wadsworth Center
New York State Department of Health
Albany, New York
Michele S. Swanson, PhD

Professor
Department of Microbiology & Immunology
Ann Arbor, Michigan
Andrew W. Tai, MD, PhD

Associate Professor of Internal Medicine
Associate Professor of Microbiology & Immunology
Staff Physician
VA Ann Arbor Healthcare System
Ann Arbor, Michigan
H. Keipp Talbot, MD, MPH

Associate Professor of Medicine
Division of infectious Diseases
Thao P. Tran, MD, FAAFP

Program Director
Family Medicine Residency Program
Breanna J. Turman, BS
Graduate Student
Kenneth L. Tyler, MD
Louise Baum Endowed Chair and Chairman of Neurology
Professor of Medicine and Microbiology & Immunology
University of Colorado School of Medicine
Aurora, Colorado
Ken B. Waites, MD, F(AAM)
Professor of Pathology
University of Alabama at Birmingham
Birmingham, Alabama
David H. Walker, MD
The Carmage and Martha Walls Distinguished University Chair in Tropical
Diseases
Professor
Department of Pathology
Executive Director
Center for Biodefense and Emerging Infectious Diseases
The University of Texas Medical Branch
Galveston, Texas
Juliane Bubeck Wardenburg, MD, PhD

Donald B. Strominger Professor of Pediatrics
Chief, Pediatric Critical Care
St. Louis Children’s Hospital
St. Louis, Missouri
Jason B. Weinberg, MD
Associate Professor of Pediatrics
Associate Professor of Microbiology and Immunology
Division of Pediatric Infectious Diseases
C.S. Mott Children’s Hospital
Michigan Medicine
The University of Michigan
Ann Arbor, Michigan
Jeffrey N. Weiser, MD
Professor and Chair
New York University Grossman School of Medicine
New York, New York
John V. Williams, MD, FPIDS
Professor of Pediatrics, Microbiology & Molecular Genetics
Chief, Pediatric Infectious Diseases
Henry L. Hillman Chair in Pediatric Immunology
Director, i4Kids
UPMC Children’s Hospital of Pittsburgh
Vincent B. Young, MD, PhD

William Henry Fitzbutler Collegiate Professor
Infectious Diseases Division
Ann Arbor, Michigan
Mark A. Zacharek, MD, FACS

Clinical Professor
Division of Rhinology and Skull Base Surgery
Department of Otolaryngology–Head and Neck Surgery
University of Michigan Health
Ann Arbor, Michigan
PAST CONTRIBUTORS
We acknowledge several individuals who contributed to previous editions
of this book and whose work formed a basis for many of the updated
chapters in this edition:
David W.K. Acheson
George M. Baer
Neil Barg
Michael Barza
Karen C. c
Jenifer Coburn
John M. Coffin
Laurie Comstock
James E. Crowe, Jr.Richard T. D'Aquila
Christoph Dehio
Mark R. Denison
Peter Dull
John R. Ebright
Kathryn M. Edwards
Roger G. Faix
Bernard N. Fields
Kevin Flaherty
George Fogg
Vance G. Fowler
Donald E. Ganem
Janet Gilsdorf
Sherwood L. Gorbach
Richard K. Groger
Phillip C. Hanna
Penelope J. Hitchcock
Mollie Jewett
Gary Ketner
Gerald T. Keusch
George S. Kobayashi
Donald Krogstad
Michael A. Lane
David W. Lazinski
John Leong
Zell A. McGee
Gerald Medoff
Roger W. Melvold
Cody Meissner
Roger Melvold
Melissa Miller
Joseph J. Nania
James Nataro
Lindsay E. Nicolle
E. Turner Overton
Timothy G. Palzkill
Jeffrey Parsonnet
Charles G. Prober
Vincent R. Racaniello
Rasmus Vedby Rasmussen
Jane E. Raulston
Julie E. Reznicek
Edward N. Robinson Jr
David Schlessinger
Robert T. Schooley
Daniel S. Shapiro
Jack D. Sobel
Arnold L. Smith
Patricia Spear
John Spitznagel
David Stephens
Gregory A. Storch
Stephen E. Straus
Francis P. Tally
Debbie S. Toder
Joseph G. Tully
Carl Waltenbaugh
Ellen Whitnak
Priscilla B. Wyrick
Victor L. Yu
Preface
The previous editions of this book were designed by its original editor-in-
chief, Moselio Schaechter, to present major concepts in microbiology and
infectious diseases in a pathobiological framework and within the context
of clinical cases. This format lends itself to an active form of studying and
is easily adaptable to problem-based learning. It is particularly appropriate
for use in revised medical curricula that feature a synthesis of basic
microbiology and clinical infectious diseases or those that follow an “organ
system” approach to the basic sciences.
KEY FEATURES AND APPROACH

The use of the text in these variously structured courses is facilitated by the
presentation of the material in three distinct sections. Part I presents basic
concepts of microbiology as well as immunology and pharmacology as
these disciplines relate to infections. Part II describes the major infectious
agents and the diseases that they cause. Part III illustrates how the major
systems of the body are affected by infection.
This textbook is intended to be used in courses on medical
microbiology or infectious diseases for medical students, allied health
professionals, graduate students, or advanced undergraduates. Because the
purpose of this book is to develop a conceptual framework for
understanding infection, it highlights certain agents and diseases of special
biological or clinical importance and does not attempt to describe the
microbial world in an exhaustive fashion.
One of the most distinctive features of the previous editions has been
retained: in many of the chapters on individual infectious agents, the reader
will find boxed sections labeled “Paradigm.” Those sections present
discussions of certain general principles that are best illustrated by the
agents described in that chapter but also can be applied to other organisms.
NEW TO THIS EDITION

This new edition retains the basic conceptual framework of past editions
credited to Dr. Schaechter in its new title, but it has been revised to reflect
many of the recent changes that have taken place in the field as well as new
features to facilitate learning. Every chapter in the book has been revised
and updated, many by new authors. The updated text is as current as
possible, realizing that new information in the field is accumulating at such
dazzling speed that it risks becoming outdated before the ink dries. Updates
for this edition include the following:
New content and illustrations of molecular methods used in studying
microbial pathogenesis, new pathways within the immune system, new
arthropod-borne viruses of global significance (eg, Zika), and new
diagnostic methods, such as MALDI-TOF, immunochromatographic
assays, and multiplex PCR.
A reorganization of Section II, “Viruses,” to reflect the organization by
organ system rather than by virological categories that most medical
curricula use. For example, the major agents of the common cold—
rhinoviruses, adenoviruses, and coronaviruses—are covered in the same
chapter (Chapter 34) in spite of their distinct virological classification.
Similarly, enteroviruses are now covered in Chapter 35 (“Viral Agents
of the GI Tract”). Making associations of the viral pathogens with organ
systems may help early learners with retention.
A de-emphasis on bioterrorism and enhanced emphasis on surveillance
for global pandemic disease.
New content related to the COVID-19 pandemic. As knowledge
concerning the virology, clinical features, treatment, and prevention of
coronaviruses has developed during 2020 and 2021, we have added new
insights into these features to several relevant chapters: Chapter 34
(“The Common Cold and Beyond”) now covers the virology of
pandemic coronaviruses; Chapter 61 (“Respiratory Infections”) now
includes a case study and discussion of clinical features of COVID-19;
Chapter 56 (“Surveillance for and Response to the Emergence of
Threatening Pathogens”) discusses the prevention of global pandemics,
including the recent history of pandemic coronaviruses; and Chapter 44
(“Vaccine and Antisera…”) describes the novel vaccine methods
deployed during the COVID-19 pandemic. We have included the most
up-to-date information as of early 2021, but as the pandemic continues,
researchers are still learning more about the virus and the disease it
causes.An extensive glossary containing the definitions of all key terms
identified in the text.
This book is accompanied by online resources, which include an e-
book, an image bank, and self-assessments, including separate quizzes
covering each section of the book and a comprehensive test to assess
preparedness. Individual items are written in the “single best answer”
format commonly used in high-stakes examinations, and each question
includes feedback on the correct and incorrect options. Additionally, the e-
book includes an interactive glossary with definitions that appear when
hovering over the key term, as well as hyperlinks between chapters. Student
resources can be accessed through Lippincott® Connect with the code
provided on the inside front cover. Instructor resources, including
downloadable image bank, can be accessed at www.thePoint.lww.com.
Although the printed text contains all of the important core information, the
online resources allow for further enrichment for students.
N. Cary Engleberg
Victor J. DiRita
Michael J. Imperiale
Acknowledgments
Many colleagues and friends have helped us in the past in preparing this
book. Their names appear in the previous editions. For this revision, we
received invaluable advice from Terry Dermody concerning the
organization of the virology section, from Alexander Engleberg for review
of illustrations from a student perspective, and from David Friedman for
advice concerning quiz items. Our heartfelt thanks go to them for their kind
and thoughtful suggestions. We also express our appreciation to the students
and faculty members who provided helpful insights and reviews on the last
edition that helped focus our improvements for this one.
We are particularly grateful to Cory Adams, Robyn Alvarez, Remington
Fernando, Linda Cristina, and Andrea Vosburgh who provided expert
editorial assistance and helped greatly in organizing the diverse elements in
the book. Their support, hard work, patience, and persistence were
instrumental in bringing this book to completion. We thank Lindsey
Porambo, acquisitions editor, for helping to formulate the framework of the
sixth edition and for her support through the course of the project. We offer
special thanks to art director Jennifer Clements and artist Matt Chansky for
optimizing the color artwork and maintaining a style that is both coherent
and visually pleasing.
A special debt of gratitude is owed to the members of the Old Orchard
Philosophical Society for their engaging biweekly reflections and
contributions of spirit and fellowship. Finally, our appreciation and love go
to Kathleen, Victor, Amalia, Chris, Jenny, Amanda, Roderick, and Suzy for
their support and indulgence through the arduous task of making this book a
reality.
Figure Credits
Cover (C): Graphical abstract from Hurdis DL, Frank M, Snowden JS, et al.
The structure of an infectious human pyomavirus and its interactions with
cellular receptors. Structure. 2018;26(6):839.
Figure 3-2. Adapted with permission of Annual Reviews, Inc. from
DiRienzo JM, Nakamura K. The outer membrane proteins of the Gram-
negative bacteria: biosynthesis, assembly, and function. Ann Rev Biochem.
1978;47:481-532; permission conveyed through Copyright Clearance
Center, Inc.
Figure 3-8. Adapted with permission from American Society for
Microbiology, from Blumberg PM, Strominger JL. Interaction of penicillin
with the bacterial cell: penicillin-binding proteins and penicillin-sensitive
enzymes. Microbiol Mol Biol Rev. 1974;38(3):291-335.
Figure 3-9. Adapted by permission from Springer: Kaback HR. Active
transport in Escherichia Coli from membrane to molecule. In: Andreoli TE,
Hoffman JS, Sanastil DD, et al., eds. Physiology of Membrane Disorders.
New York, NY: Plenum Publications; 1986:387-407.
Figure 3-12. Courtesy of Drs. C. C. Brinton and J. Carnham.
Figure 4-4. Adapted from Neidhardt, et al. Physiology of the Bacterial Cell.
Sunderland, MA: Sinauer Associates, Inc.; 1990, with permission.
Figure 5-1. Adapted by permission from Springer: Strehler B. L.
Implications of aging research for society. In: Thorbecke GJ, ed. Biology of
Aging and Development. Faseb Monographs, vol 3. Boston, MA: Springer;
1975. https://doi.org/10.1007/978-1-4684-2631-1_2. Copyright © 1975
Federation of American Societies.
Figure 5-2. Adapted with permission of John Wiley & Sons, from Gale EF,
Cundliffe E, Reynolds PE, et al. The Molecular Basis of Antibiotic Action.
2nd ed. New York, NY: John Wiley & Sons; 1981; permission conveyed
through Copyright Clearance Center, Inc.
Figure 6-1. Modified with permission from RCSB PDB, Goodsell DS.
Molecule of the Month (2011) under a CC-BY-4.0 license.
https://creativecommons.org/licenses/by/4.0/.
Figure 6-6. Reproduced with permission from Phillips AE, Toth J, Dodds
AW, et al. Analogous interactions in initiating complexes of the classical
and lectin pathways of complement. J Immunol. 2009;182(12):7708-7717.
Copyright © 2009 by The American Association of Immunologists, Inc.
Figure 6-7. From Aleshin AE, Schraufstatter IU, Stec B, et al. Structure of
complement C6 suggests a mechanism for initiation and unidirectional,
sequential assembly of membrane attack complex (MAC). J Biol Chem.
2012;287(13):10210-10222. Copyright © 2012 The American Society for
Biochemistry and Molecular Biology, Inc. All rights reserved.
https://creativecommons.org/licenses/by/4.0/
Figure 6-8. Adapted and colorized with permission from Rubin E, Farber
JL. Pathology. 3rd ed. Baltimore, MD: Lippincott Williams & Wilkins;
1999:fig 2-30.
Table 7-1. Adapted by permission from Nature: Vivier E, Malissen B.
Innate and adaptive immunity: specificities and signaling hierarchies
revisited. Nat Immunol. 2005;6:17-21.
Figures 7-1 through 7-4, 7-6, 7-7, and 7-10 through 7-14. Adapted with
permission from Doan TT, Melvold R, Waltenbaugh C. Concise Medical
Immunology. Baltimore, MD: Lippincott Williams & Wilkins; 2005.
Figure 9-3. Reprinted with permission from Bell CE, Eisenberg D. Crystal
structure of nucleotide-free diphtheria toxin. Biochemistry. 1997;36(3):481-
488. Copyright © 1997 American Chemical Society.
Figure 11-1. Reprinted with permission from Koneman EW, et al.
Diagnostic Microbiology. 5th ed. Baltimore, MD: Lippincott Williams &
Wilkins; 1997:color plate 11-1C.
Figure 12-4. From Public Health Image Library-PHIL, CDC/Dr. Edwin P.
Ewing Jr.
Figure 13-1. Courtesy of Dr. Stuart S. Sagel.
Figure 13-2. Reprinted with permission from Marler LM, Siders JA, Allen
SD. Direct Smear Atlas: A Monograph of Gram-Stained Smear
Preparations of Clinical Specimens. Baltimore, MD: Lippincott Williams &
Wilkins; 2001.
Figure 13-3. Modified with permission from American Society for
Microbiology, from Kim JO, Romero-Steiner S, Skov Sørensen UB, et al.
Relationship between cell surface carbohydrates and intrastrain variation on
opsonophagocytosis of Streptococcus pneumoniae. Infect Immun.
1999;67(5):2327-2333.
Figure 13-4. From Wood WB, Jr. Studies on the cellular immunology of
acute bacterial infections. Harvey Lect. 1951-1952;47:72-98.
Figure 13-5. Reprinted wih permission from Marler LM, Siders JA, Allen
SD. Direct Smear Atlas: A Monograph of Gram-Stained Smear
Preparations of Clinical Specimens. Baltimore, MD: Lippincott Williams &
Wilkins; 2001.
Figure 14-1. Reprinted with permission from McClatchey KD, Alkan S,
Hackel E, et al. Clinical Laboratory Medicine. 2nd ed. Philadelphia, PA:
Lippincott Williams & Wilkins; 2001.
Figure 15-2. Courtesy of Dr. Craig Hill.
Figure 15-3. Courtesy of A. Tzianabos.
Figure 17-1. Adapted with permission of John Wiley & Sons, from Taussig
MJ. Processes in Pathology and Microbiology. 2nd ed. Oxford, UK:
Blackwell Scientific Publications; 1984; permission conveyed through
Copyright Clearance Center, Inc.
Figure 17-2. Reprinted with permission from Rubin E, Farber JL.
Pathology. 3rd ed. Baltimore, MD: Lippincott Williams & Wilkins;
1999:fig 9-21.
Figure 17-3A. Courtesy of Dr. Stanley Falkow.
Figure 17-3B. Panel B reprinted with permission of Rockfeller University
Press, from Jones BD, Ghori N, Falkow SJ. Salmonella typhimurium
initiates murine infection by penetrating and destroying the specialized
epithelial M cells of the Peyer’s patches. J Exp Med. 1994;180(1):15-23;
permission conveyed through Copyright Clearance Center, Inc.
Figure 19-1. Reprinted by permission of Oxford University Press, from
Muse KE, Collier AM, Baseman JB. Scanning electron microscopy study of
hamster tracheal organ cultures infected with Bordetella pertussis. J Infect
Dis. 1977;136(6):771-777.
Figure 19-3. Adapted from a figure provided courtesy of Dr. W. E.
Goldman.
Figure 20-2. From Schering Slide Library, Schering Corp., Kenilworth, NJ,
copyright owner. All rights reserved.
Figure 23-2. Redrawn after Centers for Disease Control and Prevention
(CDC). Trends in tuberculosis—United States, 2018. MMWR Morb Mortal
Wkly Rep. 2019;68(11):257-262.
Figure 24-1. Courtesy of Dr. E. M. Walker, Department of Microbiology
and Immunology, UCLA School of Medicine, Los Angeles, CA.
Figure 24-3. Reprinted with permission from Goodheart HP. A Photoguide
of Common Skin Disorders: Diagnosis and Management. Baltimore, MD:
Figure 25-2. Courtesy of James Gathany, Centers for Disease Control.
Figure 25-3. Courtesy of Dr. Mollie Jewett, Dr. Cristina Fernandez-Valle,
Angelika Linowski, and Stephanie Kurhanewicz, Burnett School of
Biomedical Sciences, University of Central Florida.
Figure 25-4A. Courtesy of Kent Loeffler, Dr. Laura Harrington, Renee
Anderson, Cornell Department of Entomology.
Figure 25-4B. Courtesy of Dr. Nancy Hinkle, Department of Entomology,
University of Georgia.
Figure 25-5. Adapted with permission from a figure from the Web site of
the American Lyme Disease Foundation,
http://www.aldf.com/DeerTickEcology.asp.
Figure 25-6. Courtesy of the Centers for Disease Control.
Figure 26-2. Reprinted with permission from Goodheart HP. Goodheart’s
Photoguide of Common Skin Disorders. 2nd ed. Philadelphia, PA:
Figure 29-1. Courtesy of Dr. Gary Shackleford.
Wilkins; 1997:color plate 16-1B.
Figure 29-3. Reprinted with permission from Rockfeller University Press
from Hu PC, Collier AM, Baseman JB. Surface parasitism by Mycoplasma
pneumoniae of respiratory epithelium. J Exp Med. 1977;145(5):1328-1343;
permission conveyed through Copyright Clearance Center, Inc.
Figure 30-1. Courtesy of Dr. D. J. Krogstad.
Table 31-1. Adapted with permission from Condit RC. Principles of
virology. In: Knipe DM, Howley PM, eds. Fields Virology. 6th ed.
Philadelphia, PA: Lippincott Williams & Wilkins; 2013:21-51.
Figure 31-1. Used with permission from Dr. Linda M. Stannard, University
of Cape Town/Science Source. Smallpox virus: Courtesy of Frederick A.
Murphy, DVM, PhD, University of California-Davis, Davis, California.
Influenza virus: Courtesy of Pete Palese, PhD, Mount Sinai School of
Medicine, New York, New York. All other images reprinted with
permission from American Society for Microbiology, from Baker TS, Olson
NH, Fuller SD. Adding the Third Dimension to Virus Life Cycles: Three-
Dimensional Reconstruction of Icosahedral Viruses from Cryo-Electron
Micrographs. Microbiol Mol Biol Rev. 1999;63(4):862–922.
Figure 31-2. Redrawn from Dermody TS, Tyler KL. Introduction to viruses
and viral diseases. In: Mandell GL, Bennett JE, Dolin R, eds. Mandell,
Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 5th
ed. New York, NY: Churchill Livingstone; 2000:1536-1552. Copyright ©
2000 Elsevier. With permission.
Figure 31-3. Redrawn with permission of John Wiley & Sons, from Taussig
Figure 31-4. Redrawn with permission of John Wiley & Sons, from Taussig
Figure 32-1. Adapted with permission from Knipe DM, Howley PM, eds.
Field’s Virology. 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins;
2001:ch 41, fig 2.
Figure 32-3. Permission from Rubin E, Farber JL. Pathology. 3rd ed.
Baltimore, MD: Lippincott Williams & Wilkins; 1999:fig 12-32.
Figure 33-6. Images courtesy of Gina Conenello and Nicole Bouvier.
Figure 34-1A. From Stewart PL, Burnett RM, Cyrklaff M, Fuller SD.
Image reconstruction reveals the complex molecular organization of
adenovirus. Cell. 1991;67:145-154.
Figure 34-1B. Reprinted with permission from Knipe DM, Howley PM,
Griffin DE, et al. Fields Virology. Philadelphia, PA: Lippincott Williams &
Wilkins; 2007.
Figure 34-3. Courtesy CDC/Cynthia S. Goldsmith and A. Tamin, 2020.
Public domain.
Figure 34-9A. From Public Health Image Library, Centers for Disease
Control and Prevention, Atlanta, GA, http://phil.cdc.gov.
Figure 35-1. Courtesy of A. Kapikian.
Figure 35-2. Adapted with permission from Field BN, et al. Field Virology.
New York, NY: Raven Press; 1990.
Figure 36-2. Adapted with permission from Ganem D, Schneider RJ.
Hepadnaviruses. In: Knipe DM, Howley PM, eds. Field’s Virology. 4th ed.
Philadelphia, PA: Lippincott Williams & Wilkins; 2001:ch 86, fig 2.
Figure 36-3. Courtesy of Dr. John Jerin.
Figure 36-4. Reprinted from Tsukuda S, Watashi K. Hepatitis B virus
biology and life cycle. Antiviral Res. 2020;182:104925.
https://doi.org/10.1016/j.antiviral.2020.104925. Copyright © 2020 The
Author(s), with permission.
Figure 36-7. Redrawn by permission from Nature: Lindenbach D, Rice C.
Unraveling hepatitis C virus replication: from genome to function. Nature.
2005;436:933-938.
Figure 37-1. Courtesy of Dr. Makonnen Fedaku, Centers for Disease
Control and Prevention, Atlanta, GA.
Figure 38-3. Redrawn after Lindsey NP, Staples E, Lehman JA, et al.
Surveillance for human West Nile Virus disease—United States, 1999–
2008. Centers for Disease Control and Prevention. MMWR Surveill Summ.
2010;59(SS02):1-17.
Figure 39-1. Courtesy of Dr. K. V. Shah.
Photoguide of Common Skin Disorders. 2nd ed. Philadelphia, PA:
Figure 39-3. Courtesy of Dr. Benjamin Barankin.
1999:fig 17-19A.
Figure 40-1. Reprinted with permission from AAAS, from Grünewald K,
Desai P, Winkler DC, et al. Three-dimensional structure of herpes simplex
virus from cryo-electron tomography. Science. 2003;302(5649):1396-1398.
Figure 40-3. Redrawn from Fig. 28.44 in Mims CA, Playfair JHL. Medical
Microbiology. Mosby; 1993. Copyright © 1993 Elsevier, with permission.
Figure 40-4A-C. Reprinted with permission from Goodheart HP.
Goodheart’s Photoguide of Common Skin Disorders. 2nd ed. Philadelphia,
PA: Lippincott Williams & Wilkins; 2003.
Figure 40-4D. Reprinted with permission from Sweet RL, Gibbs RS. Atlas
of Infectious Diseases of the Female Genital Tract. Philadelphia, PA:
Figure 40-5B. Reprinted with permission from Fleisher GR, Ludwig W,
Baskin MN. Atlas of Pediatric Emergency Medicine. Philadelphia, PA:
Figure 40-5C and D. Reprinted with permission from Goodheart HP.
Goodheart’s Photoguide of Common Skin Disorders. 2nd ed. Philadelphia,
PA: Lippincott Williams & Wilkins; 2003.
Figure 41-1. Modified from a figure provided by Dr. Jay Nelson and
Andrew Townsend, Oregon Health Sciences University, Portland, Oregon.
Figure 41-3. Photographs provided by Dr. D. Kelly, Dept. of Pathology,
Children’s Hospital of Alabama, Birmingham.
Figure 42-1. Data from UNAIDS and WHO estimates.
Figure 42-5. Courtesy of Dr. M. Gonda.
Figure 43-2. Adapted with permission from Freed EO, Martin MA. HIVs
and their replication. In: Knipe DM, Howley PM, eds. Field’s Virology. 4th
ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2001:ch 59, fig 30.
Figure 43-4. Adapted with permission from Crumpacker C. Antiviral
therapy. In: Knipe DM, Howley PM, eds. Field’s Virology. 4th ed.
Philadelphia, PA: Lippincott Williams & Wilkins; 2001:ch 15, fig 12.
Figure 43-6. Reprinted with the permission of American College of
Physicians, Inc. from Corey L, Fife KH, Benedetti JK, et al. Intravenous
acyclovir for the treatment of primary genital herpes. Ann Intern Med.
1983;98:914-921. Copyright © 2021 American College of Physicians. All
Rights Reserved.
Figure 43-7. Redrawn with permission of John Wiley & Sons, from Straus
S, Seidlin M, Takiff HE, et al. Suppression of recurrent genital herpes with
oral acyclovir. Trans Assoc Am Physicians. 1983;96:278-283.
Wilkins; 1997:color plate 19-6E.
Figure 45-5. Adapted with permission from Koneman EW, et al.
Wilkins; 1997:fig 19-5.
Kauffman CA. Fungal infections in older adults. Clin Infect Dis.
2001;33(4):550-555.
Figure 46-4B. Reprinted with permission from Rubin E, Farber JL.
Pathology. 3rd ed. Baltimore, MD: Lippincott Williams & Wilkins; 1999:
fig 9-59B.
1999:fig 9-62.
Figure 46-8B. Reprinted with permission from Rubin E, Farber JL.
fig 9-60.
fig 9-61.
fig 9-54A.
Figure 47-4. Courtesy of Dr. Leonor Haley, Centers for Disease Control
and Prevention, Atlanta, GA.
Figure 47-10. Reprinted with permission from Grossman ME, Roth J.
Cutaneous manifestations of infection in the immunocompromised host.
Philadelphia, PA: Lippincott Williams & Wilkins; 1995:fig 1-51.
fig 9-72A.
fig 9-72B.
Watanakunakorn C. Photo quiz. Clin Infect Dis. 1996;22(5):765.
Figure 50-1A. Based on estimates for 2018 from the WHO Preventive
Chemotherapy Program.
Figure 50-1B. Based on estimates for 2018 from the WHO Preventive
Chemotherapy Program.
Figure 51-2. Data from Friedman MJ. Erythrocytic mechanism of sickle
cell resistance to malaria. Proc Natl Acad Sci USA. 1978;75:1994.
Figure 51-7. Courtesy of Drs. Bartlett MS, Smith JW. Indiana University
School of Medicine.
Figure 51-10. Redrawn from Ross R, Thompson D. A case of sleeping
sickness studied by precise enumerative methods: regular periodical
increase of the parasites disclosed. Proc Roy Soc London, Series B.
1910;82(557):411-415.
Figure 52-3. Courtesy of Dr. Stanley L. Erlandsen, Washington University
School of Medicine, St. Louis, MO.
Figure 53-2A-E. A. CDC (PHIL 5229). B. CDC/B.G. Partin (PHIL 14779).
C. CDC/Dr. Moore; B.G. Partin (PHIL 18736). D. Courtesy of the Centers
for Disease Control.
https://www.cdc.gov/parasites/images/ascariasis/home_page_image_ascaria
sis2.jpg. E. From the CDC Public Health Image Library, 1982.
Figure 54-3. Source: CDC.
Figure 54-9A. From Kean BH, Sun T, Ellsworth RM. Ophthalmic
Parasitology. Igaku-Shoin; 1991:212.
Figure 54-9B. Courtesy of Dr. Zaiman H, Charlottesville, VA. Reprinted
with permission from a pictorial presentation of parasites. In: Sun T, ed.
Parasitic Disorders: Pathology, Diagnosis, and Management. 2nd ed.
Baltimore, MD: Lippincott Williams & Wilkins; 1999.
Figure 55-2A. Reprinted from Mead S, Rudge P. CJD mimics and
chameleons. Pract Neurol. 2017;17(2):113-121. Copyright © Article
author(s) 2017. http://creativecommons.org/licenses/by/4.0/
Figure 55-2B. Reprinted from Mead S, Rudge P. CJD mimics and
chameleons. Pract Neurol. 2017;17(2): 113-121. Copyright © Article
author(s) 2017. http://creativecommons.org/licenses/by/4.0/
1999:fig 28-109.
Figure 55-4. Adapted by permission of Oxford University Press, from
Beisel CE, Morens DM. Variant Creutzfeldt-Jakob disease and the acquired
and transmissible spongiform encephalopathies. Clin Infect Dis.
2004;38(5):697-704.
Figure 55-5. Republished with permission of American Society of
Neuroradiology, from Collie DA. Diagnosing variant Creutzfeldt-Jakob
disease with the pulvinar sign: MR imaging findings in 86
neuropathologically confirmed cases. AJNR. 2003;24:1560; permission
conveyed through Copyright Clearance Center, Inc.
Figure 56-1. From Public Health Image Library, Centers for Disease
Control and Prevention, http://phil.cdc.gov.
Figure 56-2. Jernigan JA, Stephens DS, Ashford DA, et al. Bioterrorism-
related inhalation anthrax: the first 10 cases reported in the United States.
Emerg Infect Dis. 2001;7(6):933-944.
Figure 59-5. Courtesy of Dr. Pamela Sylvestre.
Figure 59-6. Courtesy of Dr. Pamela Sylvestre.
Figure 59-7. Data from Troeger C, Blacker BF, Khalil IA, et al. Estimates
of the global, regional, and national morbidity, mortality, and aetiologies of
diarrhea in 195 countries: a systematic analysis for the Global Burden of
Disease Study 2016. Lancet Infect Dis. 2018;18:1211-1228.
Figure 60-2. From Menkes JH. Viral neurological infections in children.
Hosp Pract. 1977;12(11):100-109. Redrawn by permission of the Taylor &
Francis Ltd, http://www.tandfonline.com.
Figure 60-4. Courtesy of Dr. E. J. Bottone, Mount Sinai Hospital, New
York, NY.
Figure 60-5. From Reprinted with permission from Gilden DH. Brain
imaging abnormalities in CNSA virus infections. Neurology. 2008;70(1):84.
Figure 61-4. Reprinted from Bernheim A, Mei X, Huang M, et al. Chest
CT findings in coronavirus disease-19 (COVID-19): relationship to
duration of infection. Radiology. 2020;295(3):685-691. Copyright © 2020
Radiological Society of North America. (Figure 1a and 1b)
Figure 62-2. Redrawn from Fass RJ, et al. Urinary tract infection: practical
aspects of diagnosis and treatment. JAMA. 1973;225:1509-1513.
Figure 63-1. Reprinted with permission from Fleisher GR, Ludwig W,
Baskin MN. Atlas of Pediatric Emergency Medicine. Philadelphia, PA:
Lippincott Williams & Wilkins; 2003:fig 11-37.`
Photoguide of Common Skin Disorders: Diagnosis and Management. 2nd
ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2003:fig 5-2.
Figure 63-3. Reprinted with permission from Barankin B. The Barankin
Dermatology Collection. Baltimore, MD: Lippincott Williams & Wilkins;
2003.
1999:fig 9-11.
Figure 63-5. Reprinted with permission from Smeltzer SC, Bare BG.
Brunner and Suddarth’s Textbook of Medical-Surgical Nursing. 9th ed.
Philadelphia, PA: Lippincott Williams & Wilkins; 2000:fig 51-01.
Figure 63-7. Reprinted with permission from Sweet RL, Gibbs RS. Atlas of
Infectious Diseases of the Female Genital Tract. Philadelphia, PA:
Lippincott Williams & Wilkins; 2005:fig 9-2.
Figure 66-1. Adapted with permission from Rodbard S. Blood velocity and
endocarditis. Circulation. 1963;27(1):18-28.
1999:fig 11-34.
Figure 66-7A. Reprinted with permission from Rubin E, Farber JL.
fig 11-34.
Table 66-2. Data from Everett ED, Hirschmann JV. Transient bacteremia
and endocarditis prophylaxis. A review. Medicine. 1977;56:61-77, and
Murdoch DR, et al. Clinical presentation, etiology, and outcome of infective
endocarditis in the 21st century. Arch Intern Med. 2009;169(5):463-473.
Figure 72-3. Data from the Centers for Disease Control and Prevention,
Atlanta, GA.
Contents
Contributors
Preface
Acknowledgments
Figure Credits
PART I: PRINCIPLES
1 Establishment of Infection
Barry I. Eisenstein and Moselio Schaechter
2 The Normal Microbiota

Vincent B. Young
3 Biology of Infectious Agents

Moselio Schaechter
4 Genetic Approaches to Studying Bacterial Pathogenesis

Peggy A. Cotter and Victor J. DiRita
5 Biological Basis for Antibacterial Action

N. Cary Engleberg and Victor J. DiRita
6 Innate Immunity
Roman Dziarski
7 Adaptive Immunity
Marcela F. Pasetti and Jose M. Lemme-Dumit
8 The Parasite’s Way of Life

Victor J. DiRita
9 Damage by Microbial Toxins

Joseph T. Barbieri
PART II: INFECTIOUS AGENTS
10 Introduction to the Pathogenic Bacteria

Victor J. DiRita
11 Staphylococci: Abscesses and Toxin-Mediated Diseases

Patrick M. Schlievert and Marnie L. Peterson
12 Streptococci and Enterococci: “Strep Throat” and Beyond

Kevin S. McIver
13 Pneumococcus and Bacterial Pneumonia

Suzanne R. Dawid and Jeffrey N. Weiser
14 Neisseriae: Gonococcus and Meningococcus

Ann E. Jerse and Victor J. DiRita
15 Bacteroides and Abscesses

Juliane Bubeck Wardenburg
16 Enteric Bacteria: Secretory Diarrhea

Victor J. DiRita
17 Invasive and Tissue-Damaging Enteric Bacterial Pathogens: Bloody

Diarrhea and Dysentery
Beth A. McCormick and Victor J. DiRita
18 Pseudomonas aeruginosa: A Ubiquitous Opportunist

Joanna B. Goldberg
19 Bordetella and Whooping Cough

Victor J. DiRita and Peggy A. Cotter
20 Clostridia: Diarrheal Disease, Tissue Infection, Botulism, and Tetanus
Stephen B. Melville
21 Legionella: Parasite of Amoebae and Macrophages

Michele S. Swanson
22 Helicobacter pylori: Persistent With a Potential for Menace

Jennifer M. Noto and Richard M. Peek Jr.
23 Mycobacteria: Tuberculosis and Leprosy

Christina T. Fiske and David W. Haas
24 Syphilis: The Great Imitator

Noah Robbins
25 Borrelia burgdorferi and Lyme Disease

Yi-Pin Lin and Klemen Strle
26 Bartonella Infections: Catscratch Disease, Bacillary Angiomatosis,

and Other Diseases
Tejal N. Gandhi
27 Chlamydiae: Genital, Ocular, and Respiratory Pathogens

Breanna J. Turman and Toni Darville
28 Rocky Mountain Spotted Fever and Other Rickettsioses

David H. Walker
29 Mycoplasma: Curiosity and Pathogen

Joel B. Baseman and Ken B. Waites
30 Strategies to Combat Bacterial Infections

N. Cary Engleberg
31 Biology of Viruses
Terence S. Dermody and Jeffrey M. Bergelson
32 Viral Infections and Exanthems of Early Childhood

John V. Williams
Another random document with
no related content on Scribd:
THE CORSAIR DROPS A MINE AND SHAKES UP FRITZ
Several of us were standing by the engine-room hatch

[wrote Quartermaster Augustus Smith of the Corsair],
watching the Finland as she steamed along in that very
slow convoy. We were discussing her chances of getting
through, and the story that the U-boats were laying for her,
when suddenly a white burst of water rose under her
bridge and climbed to the top of the foremast. It seemed to
be followed by a pillar of dark smoke. At the same time the
Corsair was fairly lifted out of the sea by the force of the
explosion. All hands made a run for battle stations without
waiting for the call.
The first boat from the Finland was dangling from the
davits, half-filled with men, when somebody either cut or
let go the forward falls. The bow of this big whaleboat
crashed down to the water, dumping most of them out. A
few managed to hang on and were struggling desperately
when the after falls carried away and the boat dropped
upon the heads of the men already in the sea. The next
boat reached the water only to be up-ended by the
headway of the ship. Other boats then waited for the ship
to lose way and these got clear all right, but we saw one
or two more upset and smashed.
When Commander Freeman, then on the Corsair as
division commander, realized that the Finland was not
sinking, he semaphored the message:
“Do you think you can make Saint-Nazaire?”
The answer came right back from the Finland’s skipper:
“Why not New York?”
The Corsair cracked on speed to search for the submarine,
instructing the Wakiva and Alcedo to aid the Finland’s people who
were adrift in boats or upon rafts. Three destroyers proceeded on the
voyage with the two other transports while the fourth destroyer
remained to operate with the Corsair. Investigation had disclosed the
fact that the Finland was able to move under her own steam and the
task in hand was to put the crew back on board and escort her into
Brest for repairs. Meanwhile the Corsair, in quest of the enemy, was
letting a real barrage of depth charges slide over her stern, and her
wake was one thundering geyser after another. Eleven of these
bombs jarred her rivets when they went off, and if a man had any
loose teeth in his head he was liable to lose them entirely. Alas, no
débris, such as dead German sailors, rose to the surface.
The report of the senior naval officer of the Finland, Captain
Stephen V. Graham, is a lucid narrative and it is worth while to let
him tell the tale:
Due to the congested condition at the port of
debarkation, which was often serious in the early days of
our transport service, the Finland had been unable to
accompany the group of fast troop transports to which she
belonged and which had proceeded on the return voyage
about two weeks earlier. On this occasion she was in
company with two freight transports of the armed-guard
category which were not able to make more than eleven
knots, but the three vessels had an escort of four
destroyers and three converted yachts, which was
uncommonly large at that time when the demand
exceeded the supply. It was frequently necessary for the
Finland to slow down to such a speed as would enable an
enemy submarine to take a favorable position for attack.
By daylight of October 28th the convoy had reached a
position near the line extending from the island of Ushant
to Cape Finisterre, which experience had shown to be a
particularly dangerous area. From that time on, the senior
naval officer of the Finland remained on the bridge
constantly and all the lookouts were exercising the utmost
vigilance.
The weather was cloudy and a moderate sea running,
and I was engaged in searching the water on both sides
with powerful binoculars. I had just finished gazing at the
starboard side when the naval signal quartermaster on
watch called out, “Commander! Torpedo!” I turned and
saw a torpedo about fifty or a hundred yards distant
making a surface run directly toward the ship. The whirring
of the torpedo’s propellers could be heard when they
broke the surface of the water. To avoid it was impossible.
The effect of the explosion was considerable but not as
great as had been anticipated. No one on the bridge was
injured.
I directed a radio operator to send out an S.O.S. call but
it was found that the aerial had been carried away by the
force of the explosion. The first report that reached the
bridge was that the forward fire-room was flooded. At this
time it did not appear probable that the ship would sink but
in a short time she began to list to starboard and seemed
to be settling. I ordered the lowering of the remaining
boats which were hanging on their falls at the level of the
promenade deck. These boats were scarcely in the water
when the ship began to right herself, and the acting
master, Chief Officer John Jensen, who had gone below to
investigate the extent of the damage, returned to the
bridge and reported to me that the destruction was
confined to No. 4 hold, the bulkheads of which were intact.
In the meantime I observed Third Assistant Engineer
George Mikkelson who had been on watch in the engine-
room when the torpedo struck the ship, moving about the
main deck with a wooden mallet in his hand and
endeavoring to drive the frightened firemen back to their
stations. He came to the bridge and reported to me that
the boilers and engines were not damaged and that the
ship could be got under way again in a short time if the
men could be induced to go to work.
The damaged compartment, just forward of the fire-
rooms, was used as a reserve coal bunker. At that time it
contained about six hundred tons of coal. After the ship
had been placed in dry-dock, upon her return to France, it
was found that most of this coal had run out through the
immense hole made in the side by the explosion of the
torpedo.
When I received the master’s report that the damage
was confined to this one compartment, I hailed the boats
which were close to the ship and directed them to come
alongside and also sent a signal to the escorting yachts to
turn back the Finland’s boats which were approaching
them and tell them to return to the ship. These yachts, the
Alcedo and Wakiva, had come close to the Finland and
lowered boats to rescue people who had been cast into
the water by the dropping of two of the Finland’s boats.
The converted yacht Corsair and one of the destroyers
were circling at high speed around the Finland and
dropping depth charges in order to prevent the enemy
submarine from delivering a second attack on the crippled
Finland.
THE FINLAND, JUST AFTER SHE WAS TORPEDOED
DESTROYER PRESTON, WHICH WAS CAUGHT IN THE
HURRICANE AND ALSO FOUND REFUGE AT LISBON
While the Finland’s boats were in the water, a heavy

squall came up and rendered the return of the heavily
laden boats very difficult. They could come close only on
the starboard side and getting the people back on board
was very slow work. Hoisting the boats was not to be
thought of, for every moment that this large ship remained
stopped was to risk grave danger of receiving a second
torpedo. As soon as the passengers were aboard, the
boats were cast adrift.
The ship got under way to return to the port of Brest,
150 miles distant. She was escorted by the Corsair and
one of the destroyers, while another destroyer remained
with the Alcedo and Wakiva to afford them protection until
they had picked up the rest of the Finland’s crew. During
the return to port it became necessary to send every one
to the fire-room who could shovel coal. Deck-hands,
stewards, and even passengers, including some of the
discharged American ambulance drivers, responded with
alacrity to this call and within a short time after starting
ahead the ship was making nearly fifteen knots, which
was about as good speed as she had made at any time
during her employment in the transport service. The
bulkheads of the damaged compartment held and there
was no leakage through the water-tight doors.
It is regrettable that eight men lost their lives. The
coolness and resourcefulness of the acting master and the
engineer of the watch deserve commendation. Cadet
Officer David MacLaren was the youngest officer on board
—just eighteen years old. After I had ordered the boats
lowered, this lad, who was in charge of one of them, would
have been justified in leaving the ship which he believed
to be sinking, but he returned to the bridge and reported to
me that his boat was lowered and clear of the ship and
asked if he could be of any service. He stayed on the
bridge, giving valuable assistance, and displaying courage
and readiness worthy of the best traditions of the sea.
One of the Navy youngsters was down in the living
compartment cleaning up when the ship was struck. Some
one in a boat hanging at the davits, seeing him hurry
along the promenade deck, asked which boat he belonged
in.
“Number Four boat,” he replied.
“This is Number Four. Jump in,” urged the other, and the
boy answered:
“Not on your life! I’ve got to go to my gun.”
Unfaltering, the stricken Finland ploughed along at fifteen knots
with a great chasm in her side, while the anxious Corsair and the
destroyer Smith hovered close and felt unspeakable relief when the
Ushant Light was seen on the port bow in the early evening. Before
midnight the Finland had passed through the Raz de Sein and was
safely anchored in Morgat Bay, beyond reach of submarines. Next
morning her escort led her into Brest Harbor and the Finland, Smith,
and Corsair, three weary ships, rested at the mooring buoys. The
Corsair courteously signalled the Finland:
The officers and men of the Corsair express their
admiration of the spirit shown by your officers and men in
sticking by their ship and bringing her safely into port.
The Finland gratefully signalled back to the Corsair:
Thank you. I congratulate the spirit and efficiency of
your command and thank you for the personal assistance
in a trying time.
Ships and men are much alike. Some are tenacious, hard to knock
out, standing punishment, and gallant in adversity. Others crumple
under defeat and surrender at one blow. The Finland had a long
record of faithful and successful service as one of the favorite
passenger steamers of the Red Star Line between New York and
Antwerp. She had the reputation of having lived up to the
expectations of her builders. They had tried to make her a staunch
ship that would hang together. When the cruel test came, the
bulkheads stood fast, the water-tight doors did their duty, and the
concussion failed to start the engines from the bed-plates.
The Finland was placed in dry-dock in France, but mechanics
were scarce and the work dragged. Thereupon the American Army
was called upon, and from the ranks came riveters, structural
workers, machinists, who turned to and repaired the ship in record
time. The Corsair had been spared the unhappiness of seeing this
fine ship lost while under her protection. And of all the ships which
went in and out while the Corsair was engaged in convoy duty, it was
her good fortune to behold only the Antilles sunk by torpedo attack.
CHAPTER VI
ADMIRAL WILSON COMES TO BREST
D URING all this time the fleet of yachts had gone clear of
misfortune. In fog and mist and blackness they were banging up
and down the rock-bound Breton coast amid ragged reefs and
pinnacles, through crooked passages, and over German mine-fields.
Offshore they dodged collisions by a hair or steered where the “Allo,
Allo,” of the wireless submarine warnings indicated that the enemy
was active. Good luck and good seamanship had saved them from
disaster. It seemed as though these yachts bore charmed lives, but
the pitcher can go too often to the well and the Alcedo was fated to
be the victim. She had often cruised with the Corsair on escort duty,
and between them there was bound to be a feeling of
companionship. In port the officers and men had become
acquainted, either visiting aboard or meeting ashore. And together
they had stood by to aid the people of the Antilles and the Finland at
the risk of destruction by torpedo attack.
CHIEF YEOMAN PAULSON GUNNER’S MATE WILEY
The Alcedo left Quiberon Bay in the afternoon of November 4th

with a convoy bound to the United States. In the middle of that same
night, with murky weather, the yacht was fairly blown to pieces and
twenty men were killed or drowned with no chance to try to save
themselves. It was assumed by the survivors, and quite plausibly,
that in the darkness the yacht might have been mistaken for one of
the transports by the commander of the U-boat, who, if he knew his
business, would have preferred to pot one of the big troop-ships
rather than a small escort vessel.
Commander W. T. Conn, Jr., of the Alcedo, was carried down with
his ship, but somehow came to the surface and fought his way clear
of the suction and the fearful confusion of débris and agitated water.
He described the disaster as almost instantaneous, a disintegration
of the yacht whose frames, bulkheads, and plates must have been
ripped apart from end to end as though they were so much
cardboard.
While asleep in the emergency cabin immediately under
the upper bridge [said he], I was awakened by a
commotion and received a report from some man
unknown, “A submarine, sir.” I jumped out of the bunk and
went to the upper bridge where the officer of the deck,
Lieutenant Drexel Paul, informed me that he had sounded
general quarters at sighting a submarine on the surface
about three hundred yards on the port bow, and that a
torpedo had been fired. From the port wing of the bridge I
was in time to see the white wake of the torpedo as it
drove straight for the ship. Lieutenant Paul had put the
rudder full right before I arrived, hoping to avoid the blow.
The ship answered slowly to her helm, however, and
before any other action could be taken I saw the torpedo
strike the ship’s side just under the forward port chain
plates.
I was thrown down and dazed, for a few seconds, by
falling wreckage and torrents of water. On regaining my
feet, I sounded the submarine alarm on the siren to call all
hands if they had not heard the general alarm gong, and
to direct the attention of the convoy and the other
escorting vessels. I shouted to the forward gun crews to
see if they were at their stations, but by this time the
forecastle was awash. The foremast had fallen, carrying
away the radio aerial. I passed the word to abandon ship.
I then left the bridge and went into the chart-house to
obtain the ship’s position from the chart, but the lights had
gone out and I was unable to see. Stepping out of the
chart-house, I met the Navigator, Lieutenant Leonard, and
asked him if he had been able to send a radio and he
said, “No.” I then went with him to the main deck and told
him to take charge of cutting away the forward dories and
life-rafts.
At the starboard gangway I stumbled over a man lying
face down. I rolled him over and spoke to him, but
received no reply and was unable to make out who he
was, as we were all in darkness. It is my opinion that he
was already dead. Moving to the after end of the ship, I
took station on a gun platform. The ship was filling rapidly
and her bulwarks amidships were level with the water. I
sung out to cut away the after dories and life-rafts and
throw them in the water, and told the men near me to jump
over the side.
Before I could follow them, however, the ship listed
heavily to port, plunging down by the head and sinking. I
was dragged down with her, but came up again and swam
to a life-raft to which three men were clinging. We
managed to lift ourselves upon it, and then, looking
around, I observed Doyle, chief boatswain’s mate, and
one other man in the whaleboat. We paddled over to them
and crawled into the boat. It was half-filled with water and
we started to bale and to rescue survivors from the
wreckage. The whaleboat was quickly crowded to capacity
and no more could be taken aboard. We then picked up
two overturned dories which were nested together,
separated and righted them only to find that their sterns
had been smashed. Presently we discovered another nest
of dories which were found to be seaworthy. We shifted
some of the men into them from the whaleboat and
proceeded to pick more men from the wreckage. During
this time, cries of distress were heard from others adrift
who had floated some distance away. Two of them were
believed to be Ernest M. Harrison, mess attendant, and
John Winne, seaman. We proceeded to where they were
last seen, but could find no trace of them.
About this time, which was probably an hour after the
ship sank, a German submarine approached the scene of
the torpedoing and lay to near some of the dories and life-
rafts. No effort was made to assist the men freezing in the
water. Three Germans, presumably the officers, were
visible upon the top of the conning tower as they stood
and watched us. The U-boat remained on the surface
about half an hour and then steered off and submerged. I
then made a further search through the wreckage to be
sure that none of my men were left in the water. At 4.30 in
the morning we started away from the scene to attempt to
make the nearest land.
The flare of Penmarch Light was visible and I headed
for it, observing the star Polaris and reckoning the light to
be about northeast. We rowed the boats all through the
forenoon and sighted the Penmarch Lighthouse at 1.15
p.m. Keeping steadily at the oars, turn and turn about, we
moved toward the coast until 5.15 in the afternoon when a
French torpedo boat took us aboard. There were three
officers and forty men of us, who were promptly carried
into Brest, where I was informed that two other dories,
containing three officers and twenty-five men, had landed
at Penmarch Point. This was the first news that these had
been saved, for they had not been seen by any of my
party near the place of the disaster.
It was true of the Alcedo that in the moment of gravest crisis the
cohesion and discipline of the Navy manifested itself. Orders were
given and obeyed while the shattered yacht was dropping from
under the feet of the young men and boys who had worn the uniform
only a few months. It was a nightmare of an experience in which
panic might have been expected, but officers and bluejackets were
groping to find their stations or endeavoring to cut away boats so
that others might be saved. Such behavior was fairly typical of the
patrol fleet, although no other yacht was doomed to such a fate as
this, but there was the stuff in the personnel to stand the test and the
spirit of fidelity burned like a flame.
The yachts had been playing the game lone-handed, hoping to be
reinforced by enough destroyers to move the American convoys
which were subjected to long and costly delays in the French ports
for lack of escort vessels to carry them out through the danger zone.
The news that the United States proposed to build two hundred
destroyers sounded prodigious, but it failed to fit the immediate
occasion. To the Queenstown base were assigned the up-to-date oil-
burning destroyers as fast as more of them could be diverted from
home, and they were doing superb and indispensable service in
cruising a thousand miles offshore to meet and escort the troop
convoys in to France, but they could not tarry to take the ships out
again nor to protect the slower supply convoys and undertake the
other work of the Breton Patrol.
The French coast was compelled to do the best it could with the
cards that were dealt. There was no such thing as discouragement in
the Corsair or her sister ships, but the feeling grew that the job was
vastly bigger than the resources. It was singularly cheering,
therefore, when the flotilla of veteran coal-burning destroyers came
storming in from the Azores, all stripped and taut and ready for
business, looking for trouble and unhappy until they could find it.
They became close kindred of the yachts, sharing the rough weather
cruises with the convoys and, when in port, taking their doses of the
dirty, back-breaking work of eternally shovelling coal in little baskets.
And by the same token, their men wore the common mark of the
trade, the shadows of grime beneath the eyes which soap and water
could never entirely remove. Yachts and destroyers took orders from
each other at sea and seldom disagreed. The authority depended
upon which commander held the senior naval rank to qualify him to
direct the movements of the patrol division.
Reid, Smith, Flusser, Lamson, and Preston, they were rated as no
longer young and in size were lightly referred to as the “flivver” class
when compared with the thousand-ton destroyers operating out of
Queenstown, while bets were made that a winter in the Bay of
Biscay would be too much for them. But they stood the gaff and
sailed home again after the war, while the unterrified crews bragged
of the merits of their sturdy boats and forgot all the hardships. Like
the yachts they had a sprinkling of college rookies among the
bluejackets, and of Reserve officers on the bridge, while the Regular
Navy leavened the lump.
BUCKING INTO THE WINTER SEAS
SHE TAKES ’EM ABOARD GREEN

When the November winds began to show their temper, blowing
strong from the west and north, the Corsair had a foretaste of what
the winter service would be like. There happened to be no one
aboard who took the trouble to set down on paper, in diaries or
letters home, just what the life was in the crowded compartments
below decks when the ship was bucking and rolling five hundred
miles offshore and the combers toppled green over the bows. In the
Reid destroyer, however, was a young lawyer from Wisconsin,
Timothy Brown, who was not only a very able seaman, but also
something of an artist with a pen, and he managed to convey very
adequately what all these young mariners put up with in order to
make the seas safe for democracy. Almost word for word, he might
have been writing of the Corsair:
A wave suddenly lifted us and I went down on my right
hip, sustaining severe contusions and abrasions, not to
mention a general shaking up. Our chief pharmacist’s
mate rushed up with a tourniquet, iodiform gauze, and
sticking plaster and asked me what I needed worst.
Thanking him, I made my way below and moored to a
stanchion for chow. I call attention to the stanchions
because our tureens, containing food and silverware, were
hitched to them while the rest of the food was in aluminum
platters which the mess cooks surrounded as best they
could with their feet and knees. Occasionally a platter
would get away from our inexperienced mess cook of the
Reserve Force and he would dive across the compartment
to nab it, only to lose other dishes which he was
safeguarding. The hungry sailors would assemble the
chow again, whereupon each man would help himself and
eat under whatever endurable circumstances he could
find.
Gentle reader, imagine yourself perched upon a camp-
stool with your face to port and your back to starboard, at
the seamen’s dining-table, trying to steer a bowl of soup
safely into your face. The ship rolls forty-five degrees and
your stool and soup bowl begin to slide at the same time.
You hold the edge of the table with your left hand, clamp
your spoon down hard into the bottom of the bowl to
secure it, then cautiously push yourself to your feet, for the
stool threatens to carry you across the compartment in a
jiffy. The angle of the bowl now being constant with the
relation it bears to the table, the angle described by the
ship’s lurch spills half your soup. You quickly release your
grip on the table edge and take the soup in both hands to
steady it. This leaves the soup suspended perfectly
between zenith and nadir, fixed in its relation to the bowl, if
you don’t weaken. Your spoon and slice of bread have
been sliding all over the table, kept from hitting the wet
deck only by a wooden flange. Before you can plan a
campaign to absorb the soup, your feet begin to slip and
ere you can blink an eye you have slid four yards across
to the starboard mess table, your feet tangled with a stool,
and you bump into a shipmate who turns loose his own
soup so that it fits perfectly down the back of your neck.
The other day a tureen of canned salmon skidded off a
near-by locker and landed under the starboard table. The
mess cook plunged after it, but missed it by a hair. The
tureen bounded into the lap of our Irish oiler, who shouted
gleefully, as he clutched it with both hands, “I’ve got the
bloody thing.” I was reminded of a fat football player
receiving the ball on the kick-off in his centre of gravity and
not knowing what to do with it. The ship’s swing back
upset our hero and the salmon slipped away from him,
landing on the locker of a gunner’s mate and spoiling a
brand-new suit of liberty blues.
I had the misfortune, at this sad moment, to let a ration
of stew get away from me to the deck. There was no use
in staying below to hear the mess cook rave, so I seized a
cold potato between my teeth and followed it madly all the
way to the chart-house where I feasted in peace. I was
thankful to be alive, thankful that I had a slippery deck to
skate on, a speaking-tube to cling to, and an oilskin coat
which fitted so snugly about my neck that not more than a
quart of briny water seeped into it every time our good
ship did a courtesy to the waves. Only a third arm could
have made me happier. Every sailor needs one in his
business.
The deck continued to be a sort of good-natured
joggling board which playfully teased you, smashed you,
and tried to exterminate you. In another hour I had
contracted decorations on my knees that stuck out like
hens’ eggs, slivers of skin had been peeled off my shins,
and pains of various kinds convinced me that, although
my heart, lungs, and diaphragm were still working, they
had shifted from their accustomed places. I had grown so
feeble from underfeeding and excitement that you could
have knocked me flat with a dried herring. It would have
been an advantage to go below and try to sleep, but the
ship was as unsteady down there and the stifling air was
not tempting.
When it was time to go below, a sudden encounter with
a wave sent me to my hands and knees. Bethlehem steel
is hard, so I crawled the distance to the ladder and fell to
the quarter-deck, then fell down the other ladder to the
head of my bunk. Only one light was burning and it was all
wrapped up in black cotton socks so the submarines
couldn’t see us. I groped my way into the bunk and
removed my shoes, this being an old custom with sailors,
to rest the feet. Then I stretched out and was ready for a
few hours of slumber. However, the waves continued to
pound us and made the night hideous. The machinery
creaked and groaned and a leaky steam-pipe kept
whistling like a peanut roaster. To stay in my bunk it was
necessary to run my arms beneath an elastic strap that
goes over the middle of the mattress and under the metal
frame.
In this position I remained doggedly silent until midnight
when our watch was called again. I was so sleepy that I
remembered little of what happened during the next four
hours, except that at the end of it I noticed a radio man
swinging around a smokestack in an effort to snag our
flying wireless apparatus and put it to rights again. After
two or three hours more of misery in the bunk, breakfast
time came, with beans and loaf bread on the menu, and I
felt sure that I would be lucky if I could stomach a single
bean. Beans didn’t look a bit good to me, yet I was forced
to eat something or I couldn’t stand another watch.
At the table we did not waste much time on etiquette. To
wash your face for breakfast during a gale was considered
a decided economic disutility, and we didn’t care what
place we occupied just so we got a mouthful of grub. But
one thing was always insisted on, and that was for a man
to remove his headgear at meals. It didn’t make any
difference whether a fellow had any pants on or not, but
he must not presume to wear a white hat or a watch-cap.
All hands would howl him out of the compartment.
The foregoing fragment of a deep-sea idyll is included in a war
story of the Reid destroyer as deftly compiled by George M. Beatty,
Jr., one of that dashing crew, and published with the title, “Seventy
Thousand Miles on a Submarine Destroyer.” This young man was
heartless enough to print in the volume a ballad of his own devising
which had such things as these to say of the author of this chronicle
of the Corsair:
“Grim Father Neptune has his throne

In the Bay of Biscay, all alone,
And on the day of which we speak,
He served out weather rough and bleak;
He sent us hail and he sent us rain,
And ’twas not long ere Ralph D. Paine
Did hie himself to the skipper’s bunk
And swear the writing game was punk.”

Schaechter S Mechanisms of Microbial Disease N Cary Engleberg MD Victor Dirita PHD Editor Michael Imperiale PH D Editor

Uploaded by

Copyright:

Available Formats

Schaechter S Mechanisms of Microbial Disease N Cary Engleberg MD Victor Dirita PHD Editor Michael Imperiale PH D Editor

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Schaechter S Mechanisms of Microbial Disease N Cary Engleberg MD Victor Dirita PHD Editor Michael Imperiale PH D Editor

Uploaded by

Copyright:

Available Formats

Schaechter s Mechanisms of Microbial

Disease N Cary Engleberg Md Victor

Schaechter s Mechanisms of Microbial Disease Sixth

Charney Nestler s Neurobiology of Mental Illness 5th

Berne Levy Physiology by Team IRA 8th Edition Bruce M

Anesthesiologist s Manual of Surgical Procedures 6th

Why Darkness Matters The Power of Melanin in the Brain

Atlas of Emergency Imaging from Head to Toe Michael N

The Acute Management of Surgical Disease Martin D.

Lymphomas And Leukemias Cancer Principles Practice Of

Copyright © 2022, 2013, 2007, 1999, 1989 Wolters Kluwer

Library of Congress Cataloging-in-Publication Data

Acquisitions Editor: Lindsey Porambo

Product Development Editor: Robyn Alvarez

Copyright © 2022, 2013, 2007, 1999, 1989 Wolters Kluwer

Library of Congress Cataloging-in-Publication Data

Emily A. Abdoler, MD, MAEd

Gabriela M. Andujar Vazquez, MD

Joseph T. Barbieri, PhD

Joel B. Baseman, MSc, PhD

Adam C. Bortner, MD, AAHIVS

Niels E. Bruun, MD, DMSc

Peggy A. Cotter, PhD

Suzanne R. Dawid, MD, PhD

Roberta L. DeBiasi, MD, MS

Neal A. DeLuca, PhD

Victor J. DiRita, PhD

Mary K. Estes, PhD

Christina T. Fiske, MD, MPH

Emil L. Fosbøl, MD, PhD

Joanna B. Goldberg, PhD

Diane E. Griffin, MD, PhD

Natasha B. Halasa, MD, MPH

Ann E. Jerse, PhD

Carol A. Kauffman, MD, MACP

Paul R. Kinchington, PhD

F. Matthew Kuhlmann, MD, MSCI

Jose M. Lemme-Dumit, PhD

Yi-Pin Lin, PhD

Preeti N. Malani, MD, MSJ

Beth A. McCormick, PhD

Kevin S. McIver, PhD

Stephen B. Melville, PhD

Raffael Nachbagauer, MD, PhD

Jennifer M. Noto, PhD

Jane A. O’Halloran, MB BCh BAO, PhD

Marcela F. Pasetti, PhD

Richard M. Peek Jr, MD

Brett W. Petersen, MD, MPH

Marnie L. Peterson, PharmD, PhD

Claudette L. Poole, MD, MSPH

William G. Powderly, MD, FRCPI, FRCP

Laura E. Power, MD, MPH

Christian B. Ramers, MD, MPH, AAHIVS

Noah Robbins, MD, CM, FACP, FIDSA

Charles E. Rupprecht, VMD, MS, PhD

Dennis L. Stevens, PhD, MD, FACP, FIDSA

Klemen Strle, PhD

Michele S. Swanson, PhD