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Twenty-Second Edition

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Gordon C. Cook, MD DSc FRCP(Lond) FRCP(Edin) FRACP FLS
Visiting Professor, Department of Medical Microbiology and Centre for Infectious Diseases, Royal Free and University College London Medical School, London, UK
President, The Royal Society of Tropical Medicine and Hygiene (1993–1995)
Formerly Professor of Medicine, the Universities of Zambia, Riyadh (Saudi Arabia) and Papua New Guinea
Consultant Physician at University College Hospitals Trust, Hospital for Tropical Diseases, London; St Luke's Hospital for the Clergy and Senior Lecturer at the London School of Hygiene and Tropical Medicine, London, UK
President, The Fellowship of Postgraduate Medicine, London, UK 2000–2007
President, History of Medicine Section, Royal Society of Medicine, UK

Alimuddin I. Zumla, BSc MBChB MSc PhD FRCP(Lond) FRCP(Edin)
Professor of Infectious Diseases and International Health, University College London, University College London Medical School
Director, Centre for Infectious Diseases and International Health, Windeyer Institute of Medical Sciences, University College London, London, UK
Honorary Consultant in Infectious Disease, University College London Hospitals NHS Trust and St. Luke's Hospital for Clergy, London UK
Honorary Professor, Liverpool School of Tropical Medicine, University of Liverpool, UK
Visiting Professor, Department of Medicine, University of Cape Town, South Africa
Honorary Professor, University of Zambia School of Medicine, Lusaka, Zambia
Formerly Associate Professor, Centre for Infectious Diseases, University of Texas Health Science Center at Houston, School of Medicine and Public Health, Houston, Texas, USA
Vice President, Royal Society of Tropical Medicine and Hygiene (2004–2006)
Member of the Court of Governors, London School of Hygiene and Tropical Medicine, London, UK


SAUNDERS an imprint of Elsevier Limited

2009, Elsevier Limited. All rights reserved.

Dominic Kwiatkoski— Chapter 5 text; David Yorston— Chapter 18 figures;

David Warrell— Chapter 31 and  44 figures; Suchitra Nimmannitya— Chapter 41 figures

First published 2009

First edition published in 1898

Twenty-first edition published 2003

The right of Gordon C. Cook and Alimuddin I. Zumla to be identified as authors of this work has been asserted by them in accordance with the Copyright, Designs and Patents Act 1988.

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Main Edition ISBN: 978-1-4160-4470-3

International Edition ISBN: 978-1-4160-4471-0

British Library Cataloguing in Publication Data

A catalogue record for this book is available from the British Library

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A catalog record for this book is available from the Library of Congress


Medical knowledge is constantly changing. Standard safety precautions must be followed, but as new research and clinical experience broaden our knowledge, changes in treatment and drug therapy may become necessary or appropriate. Readers are advised to check the most current product information provided by the manufacturer of each drug to be administered to verify the recommended dose, the method and duration of administration, and contraindications. It is the responsibility of the practitioner, relying on experience and knowledge of the patient, to determine dosages and the best treatment for each individual patient. Neither the Publisher nor the author assume any liability for any injury and/or damage to persons or property arising from this publication.

The Publisher

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Sir Patrick Manson (1844–1922), GCMG, FRS

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