3
INFECTIOUS DISEASES ENDEMIC TO SOUTHWEST AND SOUTH-CENTRAL ASIA THAT HAVE LONG-TERM ADVERSE HEALTH OUTCOMES
In Chapter 2, the committee developed an extensive list of infectious diseases that are endemic to southwest and south-central Asia (Table 2.1) and then narrowed the list to diseases or syndromes with known long-term adverse health outcomes (Box 2.2). Although most diseases in that subset have not been reported in military personnel deployed to southwest and south-central Asia, they have historically been diagnosed in local populations and thus pose a theoretical risk to US troops deployed to the region. Also, given the nature and duration of Operation Iraqi Freedom and Operation Enduring Freedom, some of the diseases in Box 2.2 could be diagnosed after a person’s deployment or period of military service.
The committee decided that the most effective way to give additional information on the diseases listed in Box 2.2 would be to present them in tables containing
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A description of the acute syndrome in adults,
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A description of the potential long-term adverse health outcomes in adults with clinical disease,
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The frequency with which the long-term adverse health outcomes occur in adults with clinical disease,
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The delay, if any, between acute infection and onset of long-term adverse health outcomes.
Tables 3.1-3.4 categorize the infections of interest by type of pathogen (viral, bacterial, helminthic, or protozoan), and Table 3.5 describes sexually transmitted diseases. The infectious diseases with long-term adverse health outcomes that have been diagnosed in military personnel and that the committee reviewed in depth (see Chapter 5) are also included here.
TABLE 3.1 Bacterial Diseases That Are Endemic to Southwest and South-Central Asia and Have Potential Long-Term Adverse Health Outcomes
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Potential Long-Term Outcomes in Adults with Clinical Disease |
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Disease or Syndrome |
Acute Syndrome(s) in Adults |
Disease(s), Syndrome(s), or Clinical Features |
Frequency of Occurrence of Outcomesa |
Delay Between Acute Infection and Onset of Outcomesb |
More Prevalent in Southwest and South- Central Asia Than in the United States |
||||
Anthrax (Bacillus anthracis) |
Abdominal anthrax: initially fever, acute gastroenteritis, vomiting, bloody diarrhea; hemorrhagic lesions of intestinal lumen followed by massive infected ascites, septicemia, death |
Sepsis or infection-related organ damage |
Frequent |
No |
|
Inhalational anthrax: fever, chills, malaise, cough, nausea or vomiting, dyspnea, sweats, chest discomfort or pleuritic pain, muscle aches, headache followed by respiratory distress due to hemorrhagic mediastinitis and mediastinal lymphadenitis with pleural effusions; often terminates in respiratory damage, shock, death |
Sepsis or infection-related organ damage |
Frequent |
No |
|
Oropharyngeal anthrax: fever, lesion in oral cavity, pharyngeal pain, cervical edema, local lymphadenitis |
Sepsis or infection-related organ damage |
Frequent |
No |
|
Cutaneous anthrax: eschar with surrounding edema, regional lymphadenopathy, fever, malaise, headache; bacteremia in 5% of untreated persons |
Sepsis or infection-related organ damage |
Rare |
No |
Brucellosisc (Brucella spp) (see Chapter 5 for detailed discussion) |
Fever, headache, myalgia, hepatosplenomegaly, arthritis, meningoencephalitis |
Arthritis |
Common (if untreated) |
Yes (weeks to years) |
|
Fatigue |
Common |
Yes (weeks to years) |
|
|
Hepatic abnormalities |
Rare |
Yes (weeks to years) |
|
|
Mental inattention |
Rare |
Yes (weeks to years) |
|
|
Neurologic disease |
Rare |
Yes (weeks to years) |
|
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Potential Long-Term Outcomes in Adults with Clinical Disease |
||
Disease or Syndrome |
Acute Syndrome(s) in Adults |
Disease(s), Syndrome(s), or Clinical Features |
Frequency of Occurrence of Outcomesa |
Delay Between Acute Infection and Onset of Outcomesb |
|
|
Osteomyelitis; cardiovascular, splenic, renal, hepatic, respiratory, nervous system, other abscesses |
Rare |
Yes (weeks to years) |
|
|
Sepsis or infection-related organ damage |
Very rare |
No |
|
|
Chronic meningitis and meningoencephalitis |
Very rare |
Yes (weeks to years) |
|
|
Eye involvement (including uveitis) |
Very rare |
Yes (weeks to years) |
Enteric fever (typhoid fever, Salmonella enterica serovar Typhi; paratyphoid fever, S. enterica serovars Paratyphi A, B, C) |
Fever, bacteremia, headache, lymphadenopathy, enlarged liver or spleen, encephalopathy, intestinal rupture and hemorrhage |
Endovascular infection |
Rare |
No |
Postinfection enteropathyd |
Rare |
No |
||
Sepsis or infection-related organ damage |
Rare |
No |
||
Chronic intestinal carriage |
Rare |
Yes (months to years) |
||
Infection of gall bladder or gall stones |
Rare |
Yes (months to years) |
||
Focal infections or abscesses |
Very rare |
Yes (weeks to months) |
||
Helicobacter pylori infection |
Usually asymptomatic; occasionally gastritis |
Atrophic gastritis |
Common |
Yes (years to decades) |
|
|
Duodenal ulcer disease |
Rare |
Yes (months to years) |
|
|
Gastric ulcer disease |
Rare |
Yes (months to years) |
|
|
Gastric cancer |
Very rare |
Yes (years to decades) |
Plague (Yersinia pestis) |
Bubonic plague: sudden onset of high fever, enlarged and tender lymph nodes; patchy bleeding under skin, may progress to pneumonia or septicemic forms |
Sepsis or infection-related organ damage |
Frequent |
No |
Pneumonic plague: headache, fever, malaise, muscle pain, pneumonia with cough and bloody sputum; often terminates in respiratory collapse, hemodynamic collapse, death |
Sepsis or infection-related organ damage |
Frequent |
No |
|
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Potential Long-Term Outcomes in Adults with Clinical Disease |
||
Disease or Syndrome |
Acute Syndrome(s) in Adults |
Disease(s), Syndrome(s), or Clinical Features |
Frequency of Occurrence of Outcomesa |
Delay Between Acute Infection and Onset of Outcomesb |
|
Septicemic plague: skin infection leads to bacteremia and severe endotoxemia, often followed by shock, disseminated intravascular coagulation, acute respiratory distress syndrome; fatal if untreated |
Sepsis or infection-related organ damage |
Frequent |
No |
Q feverc (Coxiella burnetti) (see Chapter 5 for detailed discussion) |
Fever, headache, myalgia, pneumonitis, hepatosplenomegaly, meningoencephalitis |
Neurologic residua of meningoencephalitis |
Very rare |
No |
Endovascular infections, osteomyelitis |
Very rare |
Yes (weeks to months) |
||
Chronic hepatitis |
Very rare |
Yes (weeks to months) |
||
Post-Q fever fatigue syndrome |
Unknown |
Unknown |
||
Tuberculosisc (Mycobacterium tuberculosis) (see Chapter 5 for detailed discussion) |
Initial infection asymptomatic (positive tuberculosis skin test or gamma interferon release assay); progression to active tuberculosis in 1-5% |
Tuberculosis of lungs, pleura, lymph nodes; meningitis; musculoskeletal, genitourinary, other system effects |
Common |
Yes (months to decades) |
Long-term adverse health outcomes of active tuberculosis |
Common |
Yes (months to decades) |
||
Enteric infections |
|
|
|
|
Campylobacter infectionc (Campylobacter jejuni) (see Chapter 5 for detailed discussion) |
Diarrhea, fever, abdominal pain |
Postinfection enteropathyd |
Very rare |
No |
Guillain-Barré syndrome |
Very rare |
Yes (weeks) |
||
Reactive arthritis |
Very rare |
Yes (weeks) |
||
Uveitis |
Very rare |
Yes (weeks) |
||
Ankylosis spondylitis |
Very rare |
Yes (months) |
||
Cholera (Vibrio cholerae) |
Watery diarrhea, may be severe |
Shock-related organ damage |
Rare |
No |
Escherichia coli gastroenteritis |
|
|
|
|
Enterohemorrhagic E. coli |
Bloody diarrhea, low or absent fever, hemolytic uremic syndrome, 5-10 days after onset of gastroenteritis |
Renal damage |
Common |
No |
|
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Potential Long-Term Outcomes in Adults with Clinical Disease |
||
Disease or Syndrome |
Acute Syndrome(s) in Adults |
Disease(s), Syndrome(s), or Clinical Features |
Frequency of Occurrence of Outcomesa |
Delay Between Acute Infection and Onset of Outcomesb |
Other pathogenic strains of E. coli |
Watery diarrhea, may be severe |
Postinfection enteropathyd |
Very rare |
No |
Shock-related organ damage |
Very rare |
No |
||
Melioidosis (Burkholderia pseudomallei) |
Fever, chills, pneumonia, cellulitis, osteomyelitis, abscesses, bacteremia |
Sepsis or infection-related organ damage |
Rare |
No |
Abscesses, osteomyelitis |
Rare |
Yes (weeks to years) |
||
Relapses of pulmonary disease |
Rare |
Yes (weeks to years) |
||
Plesiomonas shigelloides infection |
Intestinal manifestations—watery diarrhea or colitis-like dysentery; fever |
Chronic diarrhea |
Rare |
No |
Sepsis or infection-related organ damage |
Very rare |
No |
||
Salmonellosis (nontyphoid)c (Salmonella spp.) (see Chapter 5 for detailed discussion) |
Diarrhea, abdominal pain, nausea, fever |
Endovascular infection |
Very rare |
No |
Postinfection enteropathyd |
Very rare |
No |
||
Prosthesis infection |
Very rare |
No |
||
Sepsis or infection-related organ damage |
Very rare |
No |
||
Reactive arthritis |
Very rare |
Yes (weeks) |
||
Reiter’s syndrome (inflammatory arthritis, conjunctivitis, urethritis) |
Very rare |
Yes (weeks) |
||
Abscesses, local infection |
Very rare |
No |
||
Chronic intestinal colonization |
Very rare |
No |
||
Gall bladder infection |
Very rare |
No |
||
Shigellosisc (Shigella spp.) (see Chapter 5 for detailed discussion) |
Diarrhea (may be bloody), fever, abdominal pain |
Postinfection enteropathyd |
Very rare |
No |
Sepsis or infection- related organ damage |
Very rare |
No |
||
S. dysenteriae: hemolytic uremic syndrome (HUS) |
Renal failure (HUS-related) |
Very rare |
Yes (days) |
|
|
Reactive arthritis |
Very rare |
Yes (weeks) |
|
|
Uveitis |
Very rare |
Yes (weeks) |
|
|
Ankylosis spondylitis |
Very rare |
Yes (months) |
|
Yersinia enterocolitica infection |
Diarrhea, abdominal pain, fever, mesenteric lymphadenopathy, intestinal obstruction, |
Reactive arthritis |
Common |
Yes (weeks) |
|
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Potential Long-Term Outcomes in Adults with Clinical Disease |
||
Disease or Syndrome |
Acute Syndrome(s) in Adults |
Disease(s), Syndrome(s), or Clinical Features |
Frequency of Occurrence of Outcomesa |
Delay Between Acute Infection and Onset of Outcomesb |
|
hemorrhage perforation, sepsis |
|
|
|
|
|
Abscesses, local infections |
Very rare |
No |
|
Sepsis or infection-related organ damage |
Very rare |
No |
|
|
Reiter’s syndrome |
Very rare |
Yes (weeks) |
|
|
Ankylosing spondylitis |
Very rare |
Yes (weeks to months) |
|
Rickettsioses |
|
|
|
|
Boutonneuse fever (Rickettsia conorii and related species) |
Dermal eschar followed by fever; headache; myalgias; rash on trunk, extremities, and face; disseminated vascular infection and vascular leakage; focal hepatocellular necrosis; granuloma-like lesions |
Shock or infection-related organ damage |
Rare |
No |
Ehrlichiosis (Ehrlichia chaffeensis) and anaplasmosis (Anaplasma phagocytophilum) |
Abrupt onset of fever, severe headache, myalgia, vomiting, nausea, rash, lymphadenopathy, confusion, decreased blood counts, liver abnormalities |
Shock or infection-related organ damage |
Very rare |
No |
Louse-borne typhus (R. prowazekii) |
Abrupt onset of headache, fever, chills, myalgia; rash begins at axillary folds of trunk and spreads to extremities; sometimes also nonproductive cough, deafness, tinnitus; high fever causes altered mental state |
Shock or infection-related organ damage |
Rare |
No |
Recurrence of acute symptoms, sometimes without rash (Brill-Zinnser disease) |
Very rare |
Yes (years to decades) |
||
Murine typhus (R. typhi) |
Abrupt onset of fever, severe headache, chills, myalgia, nausea, rash, enlarged liver and spleen, cough, confusion, mental-status changes |
Shock or infection-related organ damage |
Rare |
No |
Spirochetal illnesses |
|
|
|
|
Leptospirosis (Leptospira interrogans and |
Wide range of symptoms from subclinical to severe; abrupt onset of flu-like illness, |
Sepsis or infection-related organ damage |
Rare |
No |
|
|
Potential Long-Term Outcomes in Adults with Clinical Disease |
||
Disease or Syndrome |
Acute Syndrome(s) in Adults |
Disease(s), Syndrome(s), or Clinical Features |
Frequency of Occurrence of Outcomesa |
Delay Between Acute Infection and Onset of Outcomesb |
others) |
lymphadenopathy, jaundice, hepatosplenomegaly, conjunctival suffusion, aseptic meningitis, uveitis, pneumonitis, bleeding, diathesis, sepsis |
|
|
|
Rat-bite fever (Spirillum minus) |
Painful, swollen, ulcerated bite site; swollen lymph nodes, fever, headache, rash, relapses if untreated |
Relapses (if acute syndrome untreated) |
Rare |
No |
Sepsis or infection-related organ damage |
Rare |
No |
||
Endocarditis |
Very rare |
No |
||
Relapsing fever (Borrelia recurrentis louse-borne; other species, tick-borne) |
Range of severity; fever, headache, myalgia, jaundice, enlarged liver and spleen, rash, central nervous system infection, iritis, iridocyclitis, hemorrhage, mycocarditis, relapses |
Sepsis or infection-related organ damage |
Rare |
No |
Yaws (nonvenereal treponemal infection, Treponema pertenue) |
Rash, osteitis |
Rash (if untreated) |
Very rare |
No |
Of special concern to US troops or veterans |
||||
Mycoplasmal infection (primary atypical pneumonia) |
Fever, malaise, cough, headache, rash, cryoglobulinemia, myocarditis, arthritis, meningitis, myelitis, encephalitis, hemolytic anemia, glomerulonephritis, Stevens-Johnson syndrome, arthritis |
Sepsis or infection-related organ damage |
Very rare |
No |
Bacterial diseases against which all military personnel were immunized and vaccines are highly or fully protective |
||||
Diphtheria (Corynebacterium diphtheriae) |
Pharyngeal or wound infection with necrotic membrane formation, respiratory damage, myocarditis |
Sepsis or infection-related organ damage |
Frequent |
No |
Haemophilus influenzae type B infection |
Meningitis, epiglottitis, arthritis, osteomyelitis |
Sepsis or infection-related organ damage |
Rare |
No |
|
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Potential Long-Term Outcomes in Adults with Clinical Disease |
||
Disease or Syndrome |
Acute Syndrome(s) in Adults |
Disease(s), Syndrome(s), or Clinical Features |
Frequency of Occurrence of Outcomesa |
Delay Between Acute Infection and Onset of Outcomesb |
Tetanus (Clostridium tetani) |
Wound infection leading to muscle spasm, respiratory damage, autonomic instability |
Sepsis or infection- related organ damage, lockjaw |
Frequent |
No |
Bacterial diseases against which all military personnel were immunized and vaccines are partly protective |
||||
Meningococcal disease (Neisseria meningitidis) |
Meningitis, sepsis |
Sepsis or infection-related organ damage |
Frequent |
No |
Pertussis (whooping cough, Bordetella pertussis) |
Respiratory tract infection, secondary infections, encephalopathy |
Trauma from severe cough |
Rare |
No |
Bacterial diseases not more prevalent in Southwest and South-Central Asia than in the United States |
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Actinomycosis (Actinomyces) |
Abscesses, soft-tissue infection |
Orofacial, pulmonary, genitourinary disease; osteomyelitis |
Common |
Yes (months) |
Bartonellosis (Bartonella) |
Cat-scratch disease, systemic infection, encephalopathy, retinopathy |
Sepsis or infection-related organ damage |
Rare |
No |
Capnocytophaga infection |
Bite-site infection (dogs), bacteremia, sepsis |
Sepsis or infection-related organ damage |
Rare |
No |
Chlamydia pneumoniae infection |
Respiratory tract infections |
Sepsis or infection-related organ damage, focal infection |
Rare |
No |
Botulism (Clostridium botulinum) |
Neurotoxicity, cranial nerve palsies, respiratory damage |
Sepsis or infection-related organ damage |
Rare |
No |
Gas gangrene (Clostridium perfringens) |
Gas gangrene, wound infection |
Sepsis or infection-related organ damage |
Rare |
No |
Tularemia (Francisella tularensis) |
Pneumonia, typhoidal illness, sepsis |
Sepsis or infection-related organ damage |
Rare |
No |
|
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Potential Long-Term Outcomes in Adults with Clinical Disease |
||
Disease or Syndrome |
Acute Syndrome(s) in Adults |
Disease(s), Syndrome(s), or Clinical Features |
Frequency of Occurrence of Outcomesa |
Delay Between Acute Infection and Onset of Outcomesb |
Haemophilus influenzae infection |
Exacerbation of chronic obstructive pulmonary disease |
Pneumonia |
Common |
No |
Acute maxillary sinusitis |
Chronic sinusitis |
Common |
No |
|
Empyema, brain abscess, cavernous sinus thrombosis |
Very rare |
No |
||
Community-acquired pneumonia |
Infection-related organ damage |
Very rare |
No |
|
Middle-ear infection |
Meningitis, brain abscess, sinus thrombosis, mastoiditis, acute petrositis, facial paralysis |
Very rare |
No |
|
Purulent conjunctivitis |
Keratitis |
Very rare |
No |
|
Legionnaire’s disease (Legionella) |
Respiratory tract infections |
Sepsis or infection-related organ damage |
Rare |
No |
Listeriosis (Listeria monocytogenes) |
Diarrhea, meningoencephalitis, endocarditis |
Sepsis or infection-related organ damage |
Very rare |
No |
Lyme disease (Borrelia burghdorferi) |
Fever, flu-like illness, arthritis, rash, myocarditis, meningoencephalitis |
Chronic arthritis |
Common (if untreated) |
Yes (weeks to months) |
Moraxella catarrhalis infection |
Respiratory tract infection |
Sepsis or infection-related organ damage |
Common |
No |
Nocardiosis (Nocardia) |
Soft-tissue infection, pneumonia, brain infection |
Chronic and progressive tissue damage (Madura foot) |
Rare |
Yes (months) |
Noncholera Vibrio infection |
Wound infections, diarrhea, bacteremia, sepsis |
Sepsis or infection-related organ damage |
Rare |
No |
Nontuberculosis mycobacteria infection |
Chronic soft-tissue infections |
Chronic focal infections |
Common |
No |
Pasteurella infection |
Bite-site soft-tissue infection (from cats, dogs), bacteremia, sepsis |
Sepsis or infection-related organ damage |
Rare |
No |
|
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Potential Long-Term Outcomes in Adults with Clinical Disease |
||
Disease or Syndrome |
Acute Syndrome(s) in Adults |
Disease(s), Syndrome(s), or Clinical Features |
Frequency of Occurrence of Outcomesa |
Delay Between Acute Infection and Onset of Outcomesb |
Staphylococcus infection |
Focal infections, pneumonia, bacteremia |
Sepsis or infection-related organ damage |
Rare |
No |
Streptococcus infection |
Pharyngitis, bacteremia, pneumonia, focal infections |
Sepsis or infection-related organ damage |
Rare |
No |
Glomerulonephritis |
Very rare |
No |
||
Rheumatic fever |
Very rare |
No |
||
Streptococcus pneumoniae infection |
Respiratory tract infection, meningitis, bacteremia, sepsis |
Sepsis or infection-related organ damage |
Rare |
No |
Antibiotic-resistant or common nosocomial bacterial infections |
||||
Acinetobacter infectionc (multiple-drug-resistant) |
Skin and soft-tissue infections, abscesses, pneumonia, bacteremia, urinary tract infections |
Sepsis or infection-related organ damage |
Rare |
No |
Enterococcus infection (vancomycin resistant) |
Skin and soft-tissue infections, abscesses, bacteremia, urinary tract infections |
Sepsis or infection-related organ damage, endocarditis |
Rare |
No |
Klebsiella infection (multiple-drug-resistant) |
Skin and soft-tissue infections, abscesses, pneumonia, bacteremia, urinary tract infections |
Sepsis or infection-related organ damage |
Rare |
No |
Pseudomonas aeruginosa infection |
Skin and soft-tissue infections, abscesses, pneumonia, bacteremia, urinary tract infections |
Sepsis or infection-related organ damage |
Rare |
No |
Staphylococcus aureus infection (methicillin-resistant) |
Skin and soft-tissue infections, abscesses, pneumonia, bacteremia |
Sepsis or infection-related organ damage, endocarditis |
Rare |
No |
Osteomyelitis |
Rare |
Yes (months) |
||
Stenotrophomonas maltophilia infection |
Respiratory tract infection, bacteremia |
Sepsis or infection-related organ damage |
Very rare |
No |
TABLE 3.2 Viral Diseases That Are Endemic to Southwest and South-Central Asia and Have Potential Long-Term Adverse Health Outcomes
|
|
Potential Long-Term Outcomes in Adults with Clinical Disease |
||
Disease or Syndrome |
Acute Syndrome(s) in Adults |
Disease(s), Syndrome(s), or Clinical Features |
Frequency of Occurrence of Outcomesa |
Delay Between Acute Infection and Onset of Outcomesb |
More Prevalent in Southwest and South-Central Asia Than in the United States |
||||
Crimean-Congo hemorrhagic fever (Nairovirus spp.) |
Severe hemorrhagic fever with shock, disseminated intravascular coagulation, frequent extensive bleeding, severely decreased number of platelets |
Organ failure |
Common |
No |
Dengue fever (Flavivirus spp.) |
Sudden onset of fever, intense headache, myalgia, arthralgia, retro-orbital pain, anorexia, nausea, vomiting, rash; lymphadenopathy and leukopenia with relative lymphocytosis |
Prolonged fatigue and mental depression |
Common |
No |
In some cases: minor bleeding, early onset of generalized erythema |
|
|
|
|
In some adults with underlying conditions: major bleeding phenomena |
|
|
|
|
Rarely: increased transaminases |
|
|
|
|
Dengue hemorrhagic fever (DHF) and Dengue shock syndrome (Flavivirus spp.) |
Fever, hemorrhagic manifestation, thrombocytopenia, evidence of plasma leakage; preceded by intense, continuous abdominal pain with persistent vomiting |
Severe liver damage, sepsis, hemorrhage, disseminated intravascular coagulation |
Common |
No |
In severe cases: marked weakness, restlessness, facial pallor, often diaphoresis, severe abdominal pain, circumoral cyanosis, signs of shock |
|
|
|
|
Hepatitis B (hepatitis B virus [HBV]) |
Severe cases: acute hepatic necrosis |
Clinically evident cases: |
|
|
Most cases: no clinical signs |
Chronic infection |
Rare |
Yes (months to years) |
|
|
Potential Long- Term Outcomes in Adults with Clinical Disease |
||
Disease or Syndrome |
Acute Syndrome(s) in Adults |
Disease(s), Syndrome(s), or Clinical Features |
Frequency of Occurrence of Outcomesa |
Delay Between Acute Infection and Onset of Outcomesb |
|
Clinically evident cases: insidious onset with anorexia, vague abdominal discomfort, jaundice, nausea, vomiting; sometimes arthralgias and rash |
Cirrhosis |
Rare |
Yes (years) |
Hepatocellular carcinoma |
Very rare |
Yes (years to decades) |
||
Hepatitis C (hepatitis C virus [HCV]) |
Asymptomatic or acute hepatitis; rarely, associated with arthritis when virus induces cryoglobulinemia |
Cirrhosis |
Common |
Yes (years to decades |
Hepatocellular carcinoma |
Rare |
Yes (years to decades) |
||
Rift Valley fever (Phlebovirus spp.) |
Acute, undifferentiated, febrile illness; retinitis; vasculitis; hepatitis (may be fulminant); encephalitis |
Fulminant disease with infection-related organ dysfunction |
Rare |
No |
Macular and perimacular retinitis and blindness |
Very rare |
No |
||
Severe encephalopathy |
Very rare |
No |
||
Sand fly fever (Phlebovirus spp.) |
Headache, fever, injected sclerae, malaise, nausea, pain in limbs and back, leukopenia |
Prolonged mental depression |
Rare |
No |
Sindbis virus infection (Alphavirus spp.) |
Fever, often with shaking chills; severe polyarticular arthralgia; rash with headache, photophobia, retro-orbital pain, sore throat, pharyngitis, nausea, vomiting |
Arthralgia and myalgia |
Frequent |
No |
Potentially More Prevalent Among Troops in Southwest and South-Central Asia Than Among US Population |
||||
Adenovirus infection (Adenovirus spp.) |
Usually: asymptomatic |
Chronic hemorrhagic cystitis |
Very rare |
Yes (weeks to months) |
Sometimes: acute respiratory disease (most often tracheobronchitis) and atypical pneumonia, hemorrhagic cystitis |
Keratitis |
Rare |
No |
|
Sometimes: epidemic keratoconjunctivitis |
|
|
|
|
Avian influenza (H5N1) |
Fever, cough pneumonia, myalgia, headache, respiratory failure, encephalitis |
Infection-related organ damage |
Unknown |
Unknown |
|
|
Potential Long-Term Outcomes in Adults with Clinical Disease |
||
Disease or Syndrome |
Acute Syndrome(s) in Adults |
Disease(s), Syndrome(s), or Clinical Features |
Frequency of Occurrence of Outcomesa |
Delay Between Acute Infection and Onset of Outcomesb |
Hantaviral hemorrhagic fever with renal syndrome (Bunyaviridae spp.) |
Severe form (due to Hantaan virus): toxic fever, severe shock, bleeding; sometimes renal failure, death |
Renal failure: sepsis or hypertension-related organ dysfunction |
Common |
No |
Chronic hypertensive renal failure |
Rare |
No |
||
Renal insufficiency: can include anuria, oliguria, mucosal bleeding diathesis, electrolyte and acid-base abnormalities, hypertension, pneumotitis complicated by pulmonary edema |
Renal failure, thrombocytopenia |
Common |
No |
|
Mild to moderately severe (due to Seoul virus): fever, bleeding, abdominal pain, hyposphenuria |
|
|
|
|
Mild (due to Puumala virus): asymptomatic (90%); abdominal pain, hyposphenuria (10%) Headache, backache, myalgia, diarrhea, vomiting, conjunctivitis, hemorrhage, azotemia, proteinuria, decreased number of platelets |
|
|
|
|
Hantavirus pulmonary syndrome (Hanta spp.) |
Fever of sudden onset and generalized myalgia, sometimes with abdominal pain, gastrointestinal disturbances |
Renal failure |
Very rare |
No |
Within 1-10 days: onset of respiratory symptoms; these can progress from modest cough and dyspnea to florid pulmonary edema with respiratory failure in hours |
|
|
|
|
Shock |
|
|
|
|
In patients who survive shock, vascular leak reverses in a few days; recovery is apparently complete |
|
|
|
|
Influenza (influenza A, B, C spp.) |
In healthy adults, infection may be asymptomatic, mild illness, or classic influenza |
Exacerbation of chronic pulmonary disease (for example, asthma, cystic fibrosis, chronic |
Common |
No |
|
|
Potential Long-Term Outcomes in Adults with Clinical Disease |
||
Disease or Syndrome |
Acute Syndrome(s) in Adults |
Disease(s), Syndrome(s), or Clinical Features |
Frequency of Occurrence of Outcomesa |
Delay Between Acute Infection and Onset of Outcomesb |
|
Classic uncomplicated influenza: Systemic symptoms: abrupt onset of fever, chills, headache, myalgia, malaise, anorexia Common: arthralgias |
bronchitis) |
|
|
|
More severe cases: prostration Respiratory symptoms (overshadowed by systemic symptoms): dry cough, severe pharyngeal pain, nasal obstruction and discharge |
|
|
|
|
|
Lower respiratory tract infection |
Common |
No |
|
|
Cardiac complications |
Common (in patients with cardiac disease) |
Yes (days to months) |
|
|
Encephalitis |
Rare |
No |
|
|
Myositis and myoglobinuria with tender leg muscles and increased serum creatine kinase |
Rare |
No |
|
|
Secondary bacterial pneumonia |
Rare |
No |
|
|
Guillain-Barré syndrome |
Rare |
Yes (days to weeks) |
|
|
Transverse myelitis |
Rare |
Yes (days) |
|
|
Toxic shock syndrome |
Very rare |
No |
Varicella (Varicella- zoster virus) |
Generalized exanthemous rash, low-grade fever, malaise |
In all cases: Herpes zoster (shingles) |
Common |
Yes (years to decades) |
In complicated cases: acute cerebellar ataxia, encephalitis, pneumonitis, meningitis, transverse myelitis, Reye’s syndrome, myocarditis, nephritis, bleeding diatheses, hepatitis |
Posttherapeutic neuralgia |
Common |
No delay after herpes zoster |
|
Ophthalmicus |
Rare |
No delay after herpes zoster |
||
Ramsey-Hunt syndrome |
Very Rare |
No delay after herpes zoster |
||
Meningoencephalitis or encephalitis |
Very Rare |
No delay after herpes zoster |
||
Guillain-Barré syndrome |
Very Rare |
No delay after herpes |
|
|
Potential Long-Term Outcomes in Adults with Clinical Disease |
||
Disease or Syndrome |
Acute Syndrome(s) in Adults |
Disease(s), Syndrome(s), or Clinical Features |
Frequency of Occurrence of Outcomesa |
Delay Between Acute Infection and Onset of Outcomesb |
|
|
|
|
zoster |
|
|
Varicella pneumonitis |
Very Rare |
No delay after herpes zoster |
|
|
Hepatitis |
Very Rare |
No delay after herpes zoster |
|
|
In complicated cases: Infection-related organ damage |
Rare |
No |
Viral enteritis (Enterovirus spp.) |
Fever and pharyngitis, rash, aseptic meningitis, epidemic conjunctivitis, herpangina, hand-foot-and-mouth disease, myocarditis, pericarditis, pleurodynia, acute flaccid paralysis, conjunctivitis |
Heart failure due to myocarditis |
Very rare |
No |
Chronic meningoencephalitis |
Very rare |
No |
||
West Nile feverc (Flavivirus spp.) (see Chapter 5 for detailed discussion) |
Usually: asymptomatic |
If symptomatic: West Nile neurologic disease |
Very rare |
No |
Sometimes: fever, headache, body aches, nausea, vomiting, swollen lymph glands, rash |
Acute flaccid paralysis |
Very rare |
No |
|
Cognitive, physical, or functional impairment |
Very rare |
No |
||
Uncommon: high fever, headache, neck stiffness, stupor, disorientation, coma, tremors, convulsions, muscle weakness, vision loss, numbness and paralysis |
|
|
|
|
NOTE: The term infection refers to a primary infection that leads to disease. aProbability calculated as percentage of acute cases. Frequent, >50% of cases; common, >5- 50% of cases; rare, 1-5% of cases; very rare, <1% of cases. b Delay defined as adverse health outcome not evident at time of acute illness. c Reported in military personnel in Gulf War, Operation Enduring Freedom, or Operation Iraqi Freedom as of December 2005. SOURCE: GIDEON 2006; Heymann 2004; Mandell et al. 2005; Nester et al. 2004; Wilson 1991. |
TABLE 3.3 Protozoan Diseases That Are Endemic to Southwest and South-Central Asia and Have Potential Long-Term Adverse Health Outcomes
|
|
Potential Long-Term Outcomes in Adults with Clinical Disease |
||
Disease or Syndrome |
Acute Syndrome(s) in Adults |
Disease(s), Syndrome(s), or Clinical Feature |
Frequency of Occurrence of Outcomesa |
Delay Between Acute Infection and Onset of Outcomesb |
Amebiasis (Entamoeba histolytica) |
Diarrhea, fever, abdominal pain, intestinal perforation and hemorrhage, fulminant colitis, hepatomegaly, liver abscesses, fistulae, rarely amebic empyema or amebic pericarditis |
Postinfection enteropathyc |
Rare |
No |
Liver abscesses |
Rare |
Yes (weeks to years) |
||
Empyema, pericarditis |
Very rare |
Yes (weeks to years) |
||
Intra-abdominal and cutaneous fistulae |
Very rare |
Yes (weeks to years) |
||
Cryptosporidiosis (Cryptosporidium spp.) |
Diarrhea (may last 1-4 weeks), nausea, fever, myalgia |
Chronic diarrhea (in people immunocompromised at time of infection, diarrhea may be persistent despite treatment) |
Rare |
No |
Postinfection enteropathyc |
Rare |
No |
||
Cryptosporidial cholangitis and acalculous cholecystitis (only in people immunocompromised at time of initial infection) |
Very rare |
Yes (weeks to months) |
||
Cyclosporiasis (Cyclospora cayetanensis) |
Diarrhea, nausea |
Postinfection enteropathyc |
Rare |
No |
Giardiasis (Giardia lamblia) |
Diarrhea, abdominal cramps, bloating, flatulence, malaise, nausea, anorexia |
Chronic diarrhea, malabsorption, weight loss |
Common (if untreated) |
No |
Postinfection enteropathyc |
Rare |
No |
||
Isosporiasis (Isospora belli) |
Diarrhea, nausea, eosinophilia |
Persistent diarrhea (if untreated) |
Rare |
No |
Postinfection enteropathyc |
Rare |
No |
||
Leishmaniasisd (Leishmania spp.) (see Chapter 5 for detailed discussion) |
Cutaneous leishmaniasis (CL): any of variety of skin lesions ranging from small, dry, crusted areas to large, deep, disfiguring ulcers |
CL: Lesions may persist 3-24 months |
Common |
No |
Scarring |
Common |
No |
||
Contractures over joints |
Very rare |
Yes (weeks to months) |
|
|
Potential Long-Term Outcomes in Adults with Clinical Disease |
||
Disease or Syndrome |
Acute Syndrome(s) in Adults |
Disease(s), Syndrome(s), or Clinical Feature |
Frequency of Occurrence of Outcomesa |
Delay Between Acute Infection and Onset of Outcomesb |
|
Visceral leishmaniasis (VL [kala-azar]): fever, chills, weight loss, hepatosplenomegaly, anemia, leukopenia, hypergammaglobulinemia |
VL: Reactivation (if immunosuppressed) |
Common |
Yes (months to years) |
|
Delayed presentation of acute syndrome |
Rare |
Yes (months to years) |
|
|
Viscerotropic leishmaniasis: fever, chills, weight loss, headache, splenomegaly, lymphadenopathy |
Post-kala-azar dermal leishmaniasis (disseminated nodular infiltration of skin with parasites after treatment of visceral leishmaniasis) |
Very rare |
Yes (weeks to years) |
Malariad (Plasmodium spp.) (see Chapter 5 for detailed discussion) |
P. falciparum: fever, chills, anemia, headache, myalgia, cerebral malaria (including seizures, coma, neurologic complications), hypoglycemia, acidosis, severe anemia, splenic disease, renal failure, respiratory failure |
P. falciparum: Anemia |
Common |
Yes (months) |
Shock or hypoperfusion-related organ damage |
Rare |
No |
||
Recrudescence |
Rare |
Yes (months) |
||
Ophthalmologic manifestations |
Very rare |
Yes (months to years) |
||
P. ovale and P. vivax: fever, chills, headache, myalgia, anemia, splenic disease, rarely respiratory failure |
Persistent neurologic deficits (consequence of cerebral malaria) |
Very rare |
Yes (months to years) |
|
P. malariae: Fever, chills, headache, myalgia, anemia, splenomegaly; if untreated, infection may be chronic |
P. ovale and P. vivax: Relapse of acute syndrome |
Common (if untreated) |
Yes (weeks to years) |
|
Splenic rupture |
Very rare |
Yes (weeks to months) |
||
P. malariae: Late presentation |
Rare |
Yes (years) |
||
Glomerulonephritis/nephrotic syndrome |
Very rare |
Yes (months to decades) |
||
Myelodysplastic syndrome |
Very rare |
Yes (months to decades) |
||
Microsporidiosis (Microsporidia spp.) |
Diarrhea (usually self-limited), kerato-conjunctivitis |
Postinfection enteropathyc |
Rare |
No |
If immunocompromised: persistent diarrhea, sinusitis, acalculous cholecystitis, pneumonitis, nephritis, systemic infection |
Self-limited diarrhea, unless immunocompromised at time of infection |
Very rare |
No |
|
|
Potential Long-Term Outcomes in Adults with Clinical Disease |
||
Disease or Syndrome |
Acute Syndrome(s) in Adults |
Disease(s), Syndrome(s), or Clinical Feature |
Frequency of Occurrence of Outcomesa |
Delay Between Acute Infection and Onset of Outcomesb |
Toxoplasmosis (Toxoplasma gondii) |
Range of symptoms: may be asymptomatic, fever, cervical lymphadenopathy, myositis, mononucleosis-like syndrome (pharyngitis, fever, hepatosplenomegaly, lymphadenopathy), encephalitis, myocarditis, chorioretinitis, rarely pneumonitis; congenital infection can occur if acute infection occurs during pregnancy |
Reactivation of disease (if immunocompromised) |
Common (if immuno-compromised) |
Yes (years) |
|
Toxoplasmic brain abscesses (only in severely immunocompromised) |
Rare |
Yes (years) |
|
|
Chorioretinitis |
Very rare (if infected as adult); Common (if infected in utero) |
Yes (years) |
|
a Probability calculated as percentage of acute cases. Frequent, >50% of cases; common, >5- 50% of cases; rare, 1-5% of cases; very rare, <1% of cases. b Delay defined as adverse health outcome not evident at time of acute illness. c Postinfection enteropathy: syndrome of chronic or intermittent diarrhea and/or constipation that follows elimination of previous infectious enteropathy; poorly defined etiology and pathogenic mechanism; often self-limited over months to years. d Reported in military personnel in the Gulf War, Operation Enduring Freedom, or Operation Iraqi Freedom as of December, 2005. SOURCE: GIDEON 2006; Heymann 2004; Mandell et al. 2005; Nester et al. 2004; Wilson 1991. |
TABLE 3.4 Helminthic Diseases That Are Endemic to Southwest and South-Central Asia and Have Potential Long-Term Adverse Health Outcomes
|
|
Potential Long-Term Outcomes in Adults with Clinical Disease |
||
Disease or Syndrome |
Acute Syndrome(s) in Adults |
Disease(s), Syndrome(s), or Clinical Feature |
Frequency of Occurrence of Outcomesa |
Delay Between Acute Infection and Onset of Outcomesb |
Nematodes |
|
|
|
|
Ascariasis (Ascaris spp.) |
Largely asymptomatic Transient respiratory symptoms associated with pulmonary infiltration and peripheral blood eosinophilia, intestinal obstruction or blockage |
Biliary duct obstruction, ascending cholangitis, acute pancreatitis, obstructive jaundice, peritonitis |
Very rare |
Yes (months to years) |
Enterobiasis (pinworm infection, Enterobius vermicularis) |
Largely asymptomatic |
Appendicitis |
Very rare |
Yes (months to years) |
Pelvic infection |
Very rare |
Yes (months to years) |
||
Symptomatic: perianal or perineal pruritus |
|
|
|
|
Occasionally: abdominal pain |
|
|
|
|
Filariasis (Wuchereria bancrofti) |
Lymphangitis, lymphadenitis, eosinophilia |
Episodes of fever and lymphangitis, may recur over several years |
Rare |
Yes (years) |
Lymphedema |
Rare |
Yes (years) |
||
Persistent adenopathy |
Rare |
Yes (years) |
||
Epididymitis |
Very rare |
Yes (years) |
||
Chyluria |
Very rare |
Yes (years) |
||
Orchitis |
Very rare |
Yes (years) |
||
Hookworm disease (Ancylostoma duodenale and Necata americanus) |
Largely asymptomatic Pruritus at dermal site of larval penetration |
Iron-deficiency anemia |
Common |
Yes (months to years) |
Onchocerciasis (river blindness, Onchocerca volvulus) |
Dermatitis, keratitis |
Skin hyperpigmentation, depigmentation, chronic dermatitis, dermal atrophy |
Common |
Yes (years to decades) |
Sclerosing keratitis |
Common (if untreated) |
Yes (years to decades) |
|
|
Potential Long-Term Outcomes in Adults with Clinical Disease |
||
Disease or Syndrome |
Acute Syndrome(s) in Adults |
Disease(s), Syndrome(s), or Clinical Feature |
Frequency of Occurrence of Outcomesa |
Delay Between Acute Infection and Onset of Outcomesb |
|
|
Visual loss |
Common (if untreated) |
Yes (years to decades) |
|
|
Iridocyclitis |
Rare |
Yes (years to decades) |
Strongyloidiasis (Strongyloides stercoralis) |
Diarrhea, intestinal irregularities, gluteal or perineal pruritus and rash, eosinophilia |
Hyperinfection syndrome, generalized strongyloidiasis |
Common (in immunosuppressed patients on steroids) |
Yes (months to decades) |
Cestodes |
|
|
|
|
Cysticercosis (Taenia solium larvae [cysticerci]) |
Cerebral, ocular, or subcutaneous cysts usually without eosinophilia; involvement of central nervous system may present as seizures, increased intracranial pressure, altered mental status, eosinophilic meningitis, focal neurologic deficits, spinal-cord mass, or encephalitis |
Chronic seizure disorder |
Common |
Yes (years) |
Recurrence of acute symptoms |
Very rare |
Yes (months to years) |
||
Echinococcosis (Echinococcus multilocularis) |
Usually: asymptomatic Rarely: abdominal pain with or without apalpable mass in right upper quadrant, fever, pruritus, urticaria, eosinophilia, anaphylactic shock, cough, hemoptysis, chest pain |
Hepatic and metastatic cysts |
Common |
Yes (years to decades) |
Trematodes |
|
|
|
|
Schistosomiasis (Schistosoma haematobium) |
Often asymptomatic Bladder inflammation, urinary obstruction, scarring, eosinophilia |
Recurrent urinary tract infection |
Common (if untreated) |
Yes (years) |
Cerebral mass, generalized encephalopathy, or focal epilepsy |
Very rare |
Yes (weeks to years) |
||
Transverse myelitis |
Very rare |
Yes (weeks to years) |
||
Bladder cancer (squamous |
Very rare |
Yes (decades) |
|
|
Potential Long-Term Outcomes in Adults with Clinical Disease |
||
Disease or Syndrome |
Acute Syndrome(s) in Adults |
Disease(s), Syndrome(s), or Clinical Feature |
Frequency of Occurrence of Outcomesa |
Delay Between Acute Infection and Onset of Outcomesb |
|
|
cell) |
|
|
|
|
Urinary obstruction (hydronephrosis) |
Very rare |
Yes (decades) |
Schistosomiasis (S. mansoni) |
Often asymptomatic Gastrointestinal symptoms, colonic polyps, hepatosplenomegaly, jaundice, cirrhosis, eosinophilia |
Fatigue, abdominal pain, intermittent diarrhea or dysentery, moderate anemia |
Common |
Yes (weeks to years) |
Gastrointestinal symptoms |
Common |
Yes (weeks to years) |
||
Hepatosplenomegaly and variceal hemorrhage |
Rare |
Yes (years) |
||
Cirrhosis |
Rare |
Yes (years to decades) |
||
Portal hypertension |
Rare |
Yes (years to decades) |
||
Transverse myelitis |
Very rare |
Yes (weeks to years) |
||
Right ventricular congestion or cor pulmonale |
Very rare |
Yes (years) |
||
Cerebral masses |
Very rare |
Yes (years to decades) |
||
a Probability calculated as percentage of acute cases. Frequent, >50% of cases; common, >5- 50% of cases; rare, 1-5% of cases; very rare, <1% of cases. b Delay defined as adverse health outcome not evident at time of acute illness. SOURCE: GIDEON 2006; Heymann 2004; Mandell et al. 2005; Nester et al. 2004; Wilson 1991. |
TABLE 3.5 Sexually Transmitted Diseases That Are Endemic to Southwest and South-Central Asia and Have Potential Long-Term Adverse Health Outcomes
|
|
Potential Long-Term Outcomes in Adults with Clinical Disease |
||
Disease or Syndrome |
Acute Syndrome(s) in Adults |
Disease(s), Syndrome(s), or Clinical Features |
Frequency of Occurrence of Outcomesa |
Delay Between Acute Infection and Onset of Outcomesb |
More prevalent in Southwest and South-Central Asia Than in the United States |
||||
Chancroid (Haemophilus ducreyi) |
Genital ulcers, inguinal lymphadenopathy |
Scarring |
Very rare |
Yes (weeks) |
Hepatitis A (hepatitis A virus [HAV]) |
Acute hepatitis (jaundice, nausea, anorexia, fever) if symptomatic |
Liver failure |
Very rare |
No |
Hepatitis B (hepatitis B virus [HBV]) |
Severe cases: acute hepatic necrosis |
Chronic infection |
Rare |
Yes (months to years) |
Cirrhosis |
Rare |
Yes (years) |
||
Most cases: no clinical signs |
Hepatocellular carcinoma |
Very rare |
Yes (years to decades) |
|
Clinically evident cases: insidious onset with anorexia, vague abdominal discomfort, nausea, vomiting Sometimes arthralgias and rash Jaundice: 30-50% of cases |
|
|
|
|
Lymphogranuloma venereum (Chlamydia trachomatis serovars L1-L3) |
Genital ulcers, inguinal lymphadenopathy, proctitis |
Genital scarring and fistulae; perirectal abscess |
Unknown, but presumably rare |
Yes (month to years) |
Syphilis (Treponema pallidum) |
Genital ulcers (primary stage) Rash, fever, meningitis, stroke, nephrotic syndrome, hepatitis (secondary stage) Spontaneous abortion (any stage) |
Gummas, tabes dorsalis, dementia, meningovascular disease, generalized paresis, aortitis (tertiary stage) |
Common (if untreated) |
Yes (months to years) |
Potentially More Prevalent Among Troops in Southwest and South-Central Asia Than Among US Adult Population |
||||
Chlamydia (Chlamydia trachomatis serovars D-K) |
Usually: asymptomatic |
Chronic pelvic pain, tubal infertility, ectopic pregnancy |
Common in untreated women |
Yes (months to years) |
Sometimes: cervicitis, pelvic inflammatory |
In infants born to infected |
|
|
|
|
Potential Long-Term Outcomes in Adults with Clinical Disease |
||
Disease or Syndrome |
Acute Syndrome(s) in Adults |
Disease(s), Syndrome(s), or Clinical Features |
Frequency of Occurrence of Outcomesa |
Delay Between Acute Infection and Onset of Outcomesb |
|
disease, urethritis, conjunctivitis |
mothers: |
|
|
|
In infants born to infected mothers: pneumonia, conjunctivitis |
Reactive airways disease |
Unknown |
Yes (years) |
Gonorrhea (Neisseria gonorrhoeae) |
Usually: asymptomatic |
Chronic pelvic pain, tubal infertility, ectopic pregnancy |
Common in untreated women |
Yes (months to years) |
Sometimes: cervicitis, pelvic inflammatory disease, urethritis, conjunctivitis |
|
|
|
|
Uncommon: disseminated gonococcal infection (arthritis, tenosynovitis, rash, meningitis, endocarditis) |
|
|
|
|
Of Concern to US troops, but No Evidence of Increased Frequency or Association with Service in Southwest or South-Central Asia |
||||
Genital herpes (herpes simplex virus [HSV]) |
Usually: asymptomatic |
Recurrent genital herpes |
Common |
Yes (weeks to years) |
Sometimes: genital ulcers |
(HSV-2) |
|
|
|
|
Uncommon: meningitis, radiculitis |
Recurrent meningitis (Mollaret’s) |
Very rare |
Yes (weeks to years) |
Human immunodeficiency virus Type 1 (HIV-1) |
Asymptomatic Primary infection syndrome (acute retroviral syndrome) Acquired immune deficiency syndrome (AIDS) |
AIDS-related opportunistic infection |
Frequent if untreated |
Yes (years to decades) |
HIV-related malignancies |
Common |
Yes (years to decades) |
||
Human papillomavirus infection |
Asymptomatic |
Cervical neoplasia |
Rare |
Yes (months to years) |
Genital warts |
Genital squamous cell cancers (penis, anus) |
Rare |
Yes (years) |
|
Tracheal infection in newborns of infected mothers |
Very rare |
Yes (months to years) |
||
Human T-cell lymphotropic virus infection (I) (HTLV-I) |
Asymptomatic Chronic persistent oligoarthritis |
Adult T-cell leukemia or lymphoma |
Rare |
Yes (years) |
HTLV-I-associated myelopathy |
Rare |
Yes (years) |
|
|
Potential Long-Term Outcomes in Adults with Clinical Disease |
||
Disease or Syndrome |
Acute Syndrome(s) in Adults |
Disease(s), Syndrome(s), or Clinical Features |
Frequency of Occurrence of Outcomesa |
Delay Between Acute Infection and Onset of Outcomesb |
Trichomoniasis (Trichomonas vaginalis) |
Asymptomatic |
Preterm delivery |
Rare |
No |
Vaginitis |
|
|
|
|
Urethritis |
|
|
|
|
NOTE: The term infection refers to a primary infection that leads to disease. aProbability calculated as percentage of acute cases. Frequent, >50% of cases; common, >5- 50% of cases; rare, 1-5% of cases; very rare, <1% of cases. bDelay defined as health outcomes not evident at time of acute illness. SOURCE: Baum 2005; Holmes et al. 1999. |
REFERENCES
Baum S. 2005. Introduction to Mycoplasma diseases. Mycoplasma Diseases. In: Mandell G, Bennett J, Dolin R, Editors. Principles and Practice of Infectious Diseases. 6th ed. Philadelphia, PA: Churchill Livingstone. Pp. 2269-2271.
GIDEON. 2006. Global Infectious Disease and Epidemiology Network. [Online]. Available: http://www.gideononline.com [accessed April 12, 2006].
Heymann DL. 2004. Control of Communicable Diseases Manual. Washington, DC: American Public Health Association.
Holmes KK, Sparling PF, Mardh P, Lemon SM, Stamm WE, Piot P, Wasserheit JN. 1999. Sexually Transmitted Diseases. 3rd ed. New York: McGraw-Hill.
Mandell GL, Bennett JE, Dolin R. 2005. Principles and Practice of Infectious Diseases. 6th ed. Philadelphia, PA: Elsevier Churchill Livingstone.
Nester EW, Anderson DG, Roberts JCE, Pearsall NN, Nester MT. 2004. Microbiology: A Human Perspective. 4th ed. New York: McGraw-Hill.
Wilson ME. 1991. A World Guide to Infections: Diseases, Distribution, Diagnosis. New York: Oxford University Press.