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Ecological and Epidemiological Factors

David H. Walker, MD; Alan G. Barbour, MD; James H. Oliver, PhD; Robert S. Lane, PhD; J. Stephen Dumler, MD; David T. Dennis, MD; David H. Persing, MD, PhD; Abdu F. Azad, PhD; Edward McSweegan, PhD

JAMA. 1996;275(6):463-469.

Abstract
Among the etiologic agents of emerging infectious diseases are several bacterial organisms that naturally reside in animal and arthropod hosts. The most compelling emerging bacterial zoonotic and vector-borne diseases in the United States are Lyme disease; a Southern erythema migrans—like illness; human monocytic ehrlichiosis; human granulocytic ehrlichiosis; a novel cat flea—associated typhus group rickettsiosis; bartonelloses of immunocompetent and immunocompromised persons, particularly with AIDS; and sylvatic plague. Some of these antimicrobial-treatable infections are life threatening. During the acute stage of illness when antimicrobial agents are most effective, the flulike clinical signs and symptoms and available laboratory tests frequently do not point to a particular diagnosis. Epidemiological factors determined by the ecology of the bacteria are often the most useful diagnostic clues. The recognition of these evolving problems emphasizes the need for development of better laboratory diagnostic methods, for surveillance for and tracking of disease, and for continued research into factors contributing to transmission of the organisms. The continual appearance of previously unidentified bacterial infections requires prospective national strategies for timely recognition of the syndrome, identification of the agent, establishment of criteria and methods for diagnosis, optimization of the treatment regimen, and determination of successful approaches to prevention and control.

(JAMA. 1996;275:463-469)

Author Affiliations
From the Department of Pathology, University of Texas Medical Branch at Galveston (Dr Walker); the Departments of Microbiology and Medicine, University of Texas Health Science Center at San Antonio (Dr Barbour); the Department of Biology, Georgia Southern University, Statesboro (Dr Oliver); the Department of Environmental Science, Policy, and Management, University of California at Berkeley (Dr Lane); the Departments of Pathology (Dr Dumler) and Microbiology and Immunology (Dr Azad), University of Maryland School of Medicine, Baltimore; the Division of Vector-Borne Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, Colo (Dr Dennis); the Department of Laboratory Medicine Pathology, Mayo Foundation, Rochester, Minn (Dr Persing); and the National Institute for Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md (Dr McSweegan).

Footnotes
This article is one of a series addressing emerging and reemerging global microbial threats.

This article evolved from discussions at the Scientific Workshop on Emerging Bacterial Zoonotic and Vector-Borne Diseases, May 8-9, 1995, Galveston, Tex.

Reprint requests to the Department of Pathology, University of Texas Medical Branch at Galveston, 301 University Blvd, Galveston, TX 77555-0609 (Dr Walker).

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