Microbiology

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Anthrax
Cutaneous anthrax

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Most (about 95%) anthrax infections occur when the bacterium enters a cut or abrasion on the skin, such as when handling contaminated wool, hides, leather or hair products (especially goat hair) of infected animals. Skin infection begins as a raised itchy bump that resembles an insect bite but within 1-2 days develops into a vesicle and then a painless ulcer, usually 1-3 cm in diameter, with a characteristic black necrotic (dying) area in the center. Lymph glands in the adjacent area may swell. About 20% of untreated cases of cutaneous anthrax will result in death. Deaths are rare with appropriate antimicrobial therapy.

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Anthrax
Inhalation anthrax

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Initial symptoms may resemble a common cold – sore throat, mild fever, muscle aches and malaise. After several days, the symptoms may progress to severe breathing problems and shock. Inhalation anthrax is usually fatal.

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Anthrax
Gastrointestinal anthrax

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The intestinal disease form of anthrax may follow the consumption of contaminated meat and is characterized by an acute inflammation of the intestinal tract. Initial signs of nausea, loss of appetite, vomiting, fever are followed by abdominal pain, vomiting of blood, and severe diarrhea. Intestinal anthrax results in death in 25% to 60% of cases.

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Brucellosis (Brucella spp.)

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An illness characterized by acute or insidious onset of fever, night sweats, undue fatigue, anorexia, weight loss, headache, and arthralgia

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Chancroid (Haemophilus ducreyi)

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A sexually transmitted disease characterized by painful genital ulceration and inflammatory inguinal adenopathy. The disease is caused by infection with Haemophilus ducreyi.

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Psittacosis (Chlamydia psittaci) (Ornithosis)

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An illness characterized by fever, chills, headache, photophobia, cough, and myalgia

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Cholera (Vibrio cholerae)

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An illness characterized by diarrhea and/or vomiting; severity is variable.

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Coccidioidomycosis (Coccidioides spp., Valley fever)

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An illness characterized by one or more of the following:

* Influenza-like signs and symptoms (e.g., fever, chest pain, cough, myalgia, arthralgia, and headache)
* Pneumonia or other pulmonary lesion, diagnosed by chest radiograph
* Erythema nodosum or erythema multiforme rash
* Involvement of bones, joints, or skin by dissemination
* Meningitis
* Involvement of viscera and lymph nodes

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Cryptosporidiosis (Cryptosporidium parvum)

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An illness caused by the protozoan Cryptosporidium parvum and characterized by diarrhea, abdominal cramps, loss of appetite, low-grade fever, nausea, and vomiting. Infected persons may be asymptomatic. The disease can be prolonged and life-threatening in severely immunocompromised persons.

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Cyclosporiasis (Cyclospora cayetanensis)

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An illness of variable severity caused by the protozoan Cyclospora cayetanensis and commonly characterized by watery diarrhea, loss of appetite, weight loss, abdominal bloating and cramping, increased flatus, nausea, fatigue, and low-grade fever. Vomiting also may be noted. Relapses and asymptomatic infections can occur.

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Diphtheria (Corynebacterium diphtheriae)

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An upper respiratory tract illness characterized by sore throat, low-grade fever, and an adherent membrane of the tonsil(s), pharynx, and/or nose

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Ehrlichiosis/Anaplasmosis

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A tick-borne illness characterized by acute onset of fever and one or more of the following symptoms or signs: headache, myalgia, malaise, anemia, leukopenia, thrombocytopenia, or elevated hepatic transaminases. Nausea, vomiting, or rash may be present in some cases. Intracytoplasmic bacterial aggregates (morulae) may be visible in the leukocytes of some patients.
Clinical evidence

Any reported fever and one or more of the following: headache, myalgia, anemia, leukopenia, thrombocytopenia, or any hepatic transaminase elevation.
Laboratory evidence

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Giardiasis (Giardia lamblia)

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An illness caused by the protozoan Giardia lamblia and characterized by diarrhea, abdominal cramps, bloating, weight loss, or malabsorption. Infected persons may be asymptomatic.

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Gonorrhea (Neisseria gonorrhoeae)

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A sexually transmitted infection commonly manifested by urethritis, cervicitis, or salpingitis. Infection may be asymptomatic.

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Haemophilus influenzae (Invasive Disease) (H. influenzae)

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nvasive disease caused by Haemophilus influenzae may produce any of several clinical syndromes, including meningitis, bacteremia, epiglottitis, or pneumonia.

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Hansen's Disease (Leprosy) (Mycobacterium leprae)

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A chronic bacterial disease characterized by the involvement primarily of skin as well as peripheral nerves and the mucosa of the upper airway. Clinical forms of Hansen's disease represent a spectrum reflecting the cellular immune response to Mycobacterium leprae. The following characteristics are typical of the major forms of the disease:

* Tuberculoid: one or a few well-demarcated, hypopigmented, and anesthetic skin lesions, frequently with active, spreading edges and a clearing center; peripheral nerve swelling or thickening also may occur
* Lepromatous: a number of erythematous papules and nodules or an infiltration of the face, hands, and feet with lesions in a bilateral and symmetrical distribution that progress to thickening of the skin
* Borderline (dimorphous): skin lesions characteristic of both the tuberculoid and lepromatous forms
* Indeterminate: early lesions, usually hypopigmented macules, without developed tuberculoid or lepromatous features

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Hantavirus Pulmonary Syndrome (HPS)

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Hantavirus Pulmonary Syndrome (HPS)

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1996 Case Definition
Clinical description
Hantavirus pulmonary syndrome (HPS), commonly referred to as hantavirus disease, is a febrile illness characterized by bilateral interstitial pulmonary infiltrates and respiratory compromise usually requiring supplemental oxygen and clinically resembling acute respiratory disease syndrome (ARDS). The typical prodrome consists of fever, chills, myalgia, headache, and gastrointestinal symptoms. Typical clinical laboratory findings include hemoconcentration, left shift in the white blood cell count, neutrophilic leukocytosis, thrombocytopenia, and circulating immunoblasts.
Clinical case definition
An illness characterized by one or more of the following clinical features:

* A febrile illness (i.e., temperature greater than 101.0 F [greater than 38.3 C]) characterized by bilateral diffuse interstitial edema that may radiographically resemble ARDS, with respiratory compromise requiring supplemental oxygen, developing within 72 hours of hospitalization, and occurring in a previously healthy person
* An unexplained respiratory illness resulting in death, with an autopsy examination demonstrating noncardiogenic pulmonary edema without an identifiable cause

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Hemolytic Uremic Syndrome, Post-diarrheal (HUS)

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The following are both present at some time during the illness:

* Anemia (acute onset) with microangiopathic changes (i.e., schistocytes, burr cells, or helmet cells) on peripheral blood smear and
* Renal injury (acute onset) evidenced by either hematuria, proteinuria, or elevated creatinine level (i.e., greater than or equal to 1.0 mg/dL in a child aged less than 13 years or greater than or equal to 1.5 mg/dL in a person aged greater than or equal to 13 years, or greater than or equal to 50% increase over baseline)

Note: A low platelet count can usually, but not always, be detected early in the illness, but it may then become normal or even high. If a platelet count obtained within 7 days after onset of the acute gastrointestinal illness is not less than 150,000/mm3, other diagnoses should be considered.