, a LANGE medical book
Jawetz, Melnick, & Adelberg’s
Medical Microbiology
Twenty-Eighth Edition
Stefan Riedel, MD, PhD, D(ABMM) Thomas G. Mitchell, PhD
Associate Professor of Pathology Associate Professor Emeritus
Harvard Medical School Department of Molecular Genetics and Microbiology
Associate Medical Director, Clinical Microbiology Laboratories Duke University Medical Center
Beth Israel Deaconess Medical Center Durham, North Carolina
Boston, Massachusetts
Judy A. Sakanari, PhD
Jeffery A. Hobden, PhD Adjunct Professor
Associate Professor Department of Pharmaceutical Chemistry
Department of Microbiology, Immunology and Parasitology University of California
LSU Health Sciences Center—New Orleans San Francisco, California
New Orleans, Louisiana
Peter Hotez, MD, PhD
Steve Miller, MD, PhD Dean, National School of Tropical Medicine
Department of Laboratory Medicine Professor, Pediatrics and Molecular Virology and Microbiology
University of California Baylor College of Medicine
San Francisco, California Houston, Texas
Stephen A. Morse, MSPH, PhD Rojelio Mejia, MD
International Health Resources and Consulting, Inc. Assistant Professor of Infectious Diseases and Pediatrics
Atlanta, Georgia National School of Tropical Medicine
Baylor College of Medicine
Timothy A. Mietzner, PhD Houston, Texas
Associate Professor of Microbiology
Lake Erie College of Osteopathic Medicine at Seton Hill
Greensburg, Pennsylvania
Barbara Detrick, PhD
Professor of Pathology and Medicine, School of Medicine
Professor of Molecular Microbiology and Immunology
Bloomberg School of Public Health
The Johns Hopkins University
Baltimore, Maryland
New York Chicago San Francisco Athens London Madrid Mexico City
Milan New Delhi Singapore Sydney Toronto
Riedel-FM_pi-xii.indd 1 05/04/19 6:25
,Copyright © 2019, 2015, 2013, 2010, 2004, 2001, 1995, 1991, 1989 by McGraw-Hill Education. All rights reserved. Except as permitted
under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means,
or stored in a database or retrieval system, without the prior written permission of the publisher.
ISBN: 978-1-26-001203-3
MHID: 1-26-001203-4
The material in this eBook also appears in the print version of this title: ISBN: 978-1-26-001202-6,
MHID: 1-26-001202-6.
eBook conversion by codeMantra
Version 1.0
All trademarks are trademarks of their respective owners. Rather than put a trademark symbol after every occurrence of a trademarked
name, we use names in an editorial fashion only, and to the benefit of the trademark owner, with no intention of infringement of the
trademark. Where such designations appear in this book, they have been printed with initial caps.
McGraw-Hill Education eBooks are available at special quantity discounts to use as premiums and sales promotions or for use in corpo-
rate training programs. To contact a representative, please visit the Contact Us page at www.mhprofessional.com.
Notice
Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge, changes in treatment and drug
therapy are required. The authors and the publisher of this work have checked with sources believed to be reliable in their efforts to
provide information that is complete and generally in accord with the standards accepted at the time of publication. However, in view
of the possibility of human error or changes in medical sciences, neither the authors nor the publisher nor any other party who has been
involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or com-
plete, and they disclaim all responsibility for any errors or omissions or for the results obtained from use of the information contained in
this work. Readers are encouraged to confirm the information contained herein with other sources. For example and in particular, readers
are advised to check the product information sheet included in the package of each drug they plan to administer to be certain that the
information contained in this work is accurate and that changes have not been made in the recommended dose or in the contraindications
for administration. This recommendation is of particular importance in connection with new or infrequently used drugs.
TERMS OF USE
This is a copyrighted work and McGraw-Hill Education and its licensors reserve all rights in and to the work. Use of this work is subject
to these terms. Except as permitted under the Copyright Act of 1976 and the right to store and retrieve one copy of the work, you may
not decompile, disassemble, reverse engineer, reproduce, modify, create derivative works based upon, transmit, distribute, disseminate,
sell, publish or sublicense the work or any part of it without McGraw-Hill Education’s prior consent. You may use the work for your
own noncommercial and personal use; any other use of the work is strictly prohibited. Your right to use the work may be terminated if
you fail to comply with these terms.
THE WORK IS PROVIDED “AS IS.” McGRAW-HILL EDUCATION AND ITS LICENSORS MAKE NO GUARANTEES OR WAR-
RANTIES AS TO THE ACCURACY, ADEQUACY OR COMPLETENESS OF OR RESULTS TO BE OBTAINED FROM USING
THE WORK, INCLUDING ANY INFORMATION THAT CAN BE ACCESSED THROUGH THE WORK VIA HYPERLINK OR
OTHERWISE, AND EXPRESSLY DISCLAIM ANY WARRANTY, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED
TO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. McGraw-Hill Education
and its licensors do not warrant or guarantee that the functions contained in the work will meet your requirements or that its opera-
tion will be uninterrupted or error free. Neither McGraw-Hill Education nor its licensors shall be liable to you or anyone else for any
inaccuracy, error or omission, regardless of cause, in the work or for any damages resulting therefrom. McGraw-Hill Education has no
responsibility for the content of any information accessed through the work. Under no circumstances shall McGraw-Hill Education and/
or its licensors be liable for any indirect, incidental, special, punitive, consequential or similar damages that result from the use of or
inability to use the work, even if any of them has been advised of the possibility of such damages. This limitation of liability shall apply
to any claim or cause whatsoever whether such claim or cause arises in contract, tort or otherwise.
, Preface
As all the prior editions of this textbook before, the twenty- Chapter 48 was specifically updated to reflect clinically impor-
eighth edition of Jawetz, Melnick, & Adelberg’s Medical tant and currently emerging infectious disease cases.
Microbiology remains true to the goals of the first edition New to this edition are Peter Hotez, MD, PhD, Rojelio
published in 1954, which is to “to provide a brief, accurate Mejia, MD, and Stefan Riedel, MD, PhD, D(ABMM).
and up-to-date presentation of those aspects of medical Dr. Hotez is the Dean of the National School of Tropical Medi-
microbiology that are of particular significance to the fields cine at Baylor College of Medicine in Houston, TX, and is a
of clinical infections and chemotherapy.” Professor of Pediatrics, Molecular Virology and Microbiology;
For the twenty-seventh edition, under the authorship of he brings extensive expertise in parasitology. Dr. Mejia is an
Dr. Karen Carroll, all chapters had been extensively revised, Assistant Professor in the Department of Pediatrics, Section
reflecting the tremendous expansion of medical knowledge of Tropical Medicine, at the National School of Tropical Medi-
afforded by molecular mechanisms and diagnostics, advances cine, Baylor College of Medicine in Houston, TX. Dr. Riedel
in our understanding of microbial pathogenesis, and the dis- is the Associate Medical Director of the Clinical Microbiol-
covery of novel pathogens. While Dr. Carroll decided to step ogy Laboratories at Beth Israel Deaconess Medical Center in
down as an author and contributor for this new edition, the Boston, MA, and holds the academic rank of Associate Pro-
remaining authors would like to express their gratitude for her fessor of Pathology at Harvard Medical School. Following
leadership and contributions to the previous, greatly expanded Dr. Carroll’s departure as an author and contributor to this
edition. For the 28th edition, Chapter 47, “Principles of Diag- textbook, Dr. Riedel assumed the role as Editor-in-Chief for
nostic Medical Microbiology,” and Chapter 48, “Cases and this revised, 28th edition of the textbook.
Clinical Correlations,” were again updated to reflect the con- The authors hope that the changes to this current edition
tinued expansion in laboratory diagnostics as well as new will continue to be helpful to the student of microbiology and
antimicrobial therapies in the treatment of infectious diseases. infectious diseases.
xi
Riedel-FM_pi-xii.indd 11 05/04/19 6:25
Jawetz, Melnick, & Adelberg’s
Medical Microbiology
Twenty-Eighth Edition
Stefan Riedel, MD, PhD, D(ABMM) Thomas G. Mitchell, PhD
Associate Professor of Pathology Associate Professor Emeritus
Harvard Medical School Department of Molecular Genetics and Microbiology
Associate Medical Director, Clinical Microbiology Laboratories Duke University Medical Center
Beth Israel Deaconess Medical Center Durham, North Carolina
Boston, Massachusetts
Judy A. Sakanari, PhD
Jeffery A. Hobden, PhD Adjunct Professor
Associate Professor Department of Pharmaceutical Chemistry
Department of Microbiology, Immunology and Parasitology University of California
LSU Health Sciences Center—New Orleans San Francisco, California
New Orleans, Louisiana
Peter Hotez, MD, PhD
Steve Miller, MD, PhD Dean, National School of Tropical Medicine
Department of Laboratory Medicine Professor, Pediatrics and Molecular Virology and Microbiology
University of California Baylor College of Medicine
San Francisco, California Houston, Texas
Stephen A. Morse, MSPH, PhD Rojelio Mejia, MD
International Health Resources and Consulting, Inc. Assistant Professor of Infectious Diseases and Pediatrics
Atlanta, Georgia National School of Tropical Medicine
Baylor College of Medicine
Timothy A. Mietzner, PhD Houston, Texas
Associate Professor of Microbiology
Lake Erie College of Osteopathic Medicine at Seton Hill
Greensburg, Pennsylvania
Barbara Detrick, PhD
Professor of Pathology and Medicine, School of Medicine
Professor of Molecular Microbiology and Immunology
Bloomberg School of Public Health
The Johns Hopkins University
Baltimore, Maryland
New York Chicago San Francisco Athens London Madrid Mexico City
Milan New Delhi Singapore Sydney Toronto
Riedel-FM_pi-xii.indd 1 05/04/19 6:25
,Copyright © 2019, 2015, 2013, 2010, 2004, 2001, 1995, 1991, 1989 by McGraw-Hill Education. All rights reserved. Except as permitted
under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means,
or stored in a database or retrieval system, without the prior written permission of the publisher.
ISBN: 978-1-26-001203-3
MHID: 1-26-001203-4
The material in this eBook also appears in the print version of this title: ISBN: 978-1-26-001202-6,
MHID: 1-26-001202-6.
eBook conversion by codeMantra
Version 1.0
All trademarks are trademarks of their respective owners. Rather than put a trademark symbol after every occurrence of a trademarked
name, we use names in an editorial fashion only, and to the benefit of the trademark owner, with no intention of infringement of the
trademark. Where such designations appear in this book, they have been printed with initial caps.
McGraw-Hill Education eBooks are available at special quantity discounts to use as premiums and sales promotions or for use in corpo-
rate training programs. To contact a representative, please visit the Contact Us page at www.mhprofessional.com.
Notice
Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge, changes in treatment and drug
therapy are required. The authors and the publisher of this work have checked with sources believed to be reliable in their efforts to
provide information that is complete and generally in accord with the standards accepted at the time of publication. However, in view
of the possibility of human error or changes in medical sciences, neither the authors nor the publisher nor any other party who has been
involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or com-
plete, and they disclaim all responsibility for any errors or omissions or for the results obtained from use of the information contained in
this work. Readers are encouraged to confirm the information contained herein with other sources. For example and in particular, readers
are advised to check the product information sheet included in the package of each drug they plan to administer to be certain that the
information contained in this work is accurate and that changes have not been made in the recommended dose or in the contraindications
for administration. This recommendation is of particular importance in connection with new or infrequently used drugs.
TERMS OF USE
This is a copyrighted work and McGraw-Hill Education and its licensors reserve all rights in and to the work. Use of this work is subject
to these terms. Except as permitted under the Copyright Act of 1976 and the right to store and retrieve one copy of the work, you may
not decompile, disassemble, reverse engineer, reproduce, modify, create derivative works based upon, transmit, distribute, disseminate,
sell, publish or sublicense the work or any part of it without McGraw-Hill Education’s prior consent. You may use the work for your
own noncommercial and personal use; any other use of the work is strictly prohibited. Your right to use the work may be terminated if
you fail to comply with these terms.
THE WORK IS PROVIDED “AS IS.” McGRAW-HILL EDUCATION AND ITS LICENSORS MAKE NO GUARANTEES OR WAR-
RANTIES AS TO THE ACCURACY, ADEQUACY OR COMPLETENESS OF OR RESULTS TO BE OBTAINED FROM USING
THE WORK, INCLUDING ANY INFORMATION THAT CAN BE ACCESSED THROUGH THE WORK VIA HYPERLINK OR
OTHERWISE, AND EXPRESSLY DISCLAIM ANY WARRANTY, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED
TO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. McGraw-Hill Education
and its licensors do not warrant or guarantee that the functions contained in the work will meet your requirements or that its opera-
tion will be uninterrupted or error free. Neither McGraw-Hill Education nor its licensors shall be liable to you or anyone else for any
inaccuracy, error or omission, regardless of cause, in the work or for any damages resulting therefrom. McGraw-Hill Education has no
responsibility for the content of any information accessed through the work. Under no circumstances shall McGraw-Hill Education and/
or its licensors be liable for any indirect, incidental, special, punitive, consequential or similar damages that result from the use of or
inability to use the work, even if any of them has been advised of the possibility of such damages. This limitation of liability shall apply
to any claim or cause whatsoever whether such claim or cause arises in contract, tort or otherwise.
, Preface
As all the prior editions of this textbook before, the twenty- Chapter 48 was specifically updated to reflect clinically impor-
eighth edition of Jawetz, Melnick, & Adelberg’s Medical tant and currently emerging infectious disease cases.
Microbiology remains true to the goals of the first edition New to this edition are Peter Hotez, MD, PhD, Rojelio
published in 1954, which is to “to provide a brief, accurate Mejia, MD, and Stefan Riedel, MD, PhD, D(ABMM).
and up-to-date presentation of those aspects of medical Dr. Hotez is the Dean of the National School of Tropical Medi-
microbiology that are of particular significance to the fields cine at Baylor College of Medicine in Houston, TX, and is a
of clinical infections and chemotherapy.” Professor of Pediatrics, Molecular Virology and Microbiology;
For the twenty-seventh edition, under the authorship of he brings extensive expertise in parasitology. Dr. Mejia is an
Dr. Karen Carroll, all chapters had been extensively revised, Assistant Professor in the Department of Pediatrics, Section
reflecting the tremendous expansion of medical knowledge of Tropical Medicine, at the National School of Tropical Medi-
afforded by molecular mechanisms and diagnostics, advances cine, Baylor College of Medicine in Houston, TX. Dr. Riedel
in our understanding of microbial pathogenesis, and the dis- is the Associate Medical Director of the Clinical Microbiol-
covery of novel pathogens. While Dr. Carroll decided to step ogy Laboratories at Beth Israel Deaconess Medical Center in
down as an author and contributor for this new edition, the Boston, MA, and holds the academic rank of Associate Pro-
remaining authors would like to express their gratitude for her fessor of Pathology at Harvard Medical School. Following
leadership and contributions to the previous, greatly expanded Dr. Carroll’s departure as an author and contributor to this
edition. For the 28th edition, Chapter 47, “Principles of Diag- textbook, Dr. Riedel assumed the role as Editor-in-Chief for
nostic Medical Microbiology,” and Chapter 48, “Cases and this revised, 28th edition of the textbook.
Clinical Correlations,” were again updated to reflect the con- The authors hope that the changes to this current edition
tinued expansion in laboratory diagnostics as well as new will continue to be helpful to the student of microbiology and
antimicrobial therapies in the treatment of infectious diseases. infectious diseases.
xi
Riedel-FM_pi-xii.indd 11 05/04/19 6:25
