Division of Bacterial and Mycotic Diseases --------------------------------------------------------------------------- The Division of Bacterial and Mycotic Diseases (DBMD), National Center for Infectious Diseases (NCID), Centers for Disease Control and Prevention (CDC), is dedicated to preventing and controlling the many emerging, re-emerging, drug-resistant, and other important bacterial and mycotic diseases in the United States and around the world. DBMD and Emerging Infectious Diseases Changes in society, technology, our environment, and microorganisms themselves are affecting the occurrence of bacterial and mycotic diseases. For example, increased use of out-of-home child care is contributing to the problem of otitis media, which is reaching epidemic proportions among U.S. children. The widespread use of antibiotics has coincided with increased antimicrobial resistance, which is of special concern in pneumonia, now among the top 10 causes of death in the United States. Recent changes in food processing and transport methods provide opportunities for the development and spread of foodborne bacterial agents. Microbial adaptation is leading to new or previously unrecognized pathogens. Past division investigations have identified the causes of Legionnaires' disease, hemorrhagic colitis, hemolytic uremic syndrome (HUS), Brazilian purpuric fever, and toxic shock syndrome. Now the division continues to meet the challenges presented by a changing spectrum of diseases. The Branches The division's four branches are responsible for investigation, surveillance, and control of specific groups of diseases. In three of the branches, epidemiology and laboratory sections collaborate to provide clinical and epidemiologic information on disease outbreaks and identification, diagnostic-test development, virulence determination, and antimicrobial susceptibility testing of the pathogens involved; the fourth branch provides statistical and information systems support to the division. Childhood and Respiratory Diseases The Childhood and Respiratory Diseases Branch focuses on bacterial infections in children, such as those caused by Haemophilus influenzae type b, Neisseria meningitidis, group B streptococci, Streptococcus pyogenes, and S. pneumoniae; and respiratory pathogens in adults, including pneumococcal disease, chlamydial infections, legionellosis, and mycoplasma infections. This branch is the focus of the division's child care-related activities and works closely with CDC's Child Day Care Health and Safety Program to develop programs focused on prevention and control of infections in child care centers, especially otitis media. A major branch effort is development and evaluation of vaccines, a key factor in preventing many diseases of both children and adults. The branch works with CDC's National Immunization Program and other federal and state agencies to study vaccine-preventable diseases and to evaluate the effectiveness of newly developed vaccines. Genetic and immunologic studies have helped branch researchers evaluate specific disease-causing factors in organisms such as those causing Brazilian purpuric fever and bacterial meningitis and have paved the way for the development of vaccines to prevent these and other diseases. Pneumococcal Disease As the most common bacterial cause of otitis media in children and a major cause of bacterial pneumonia, sepsis, and meningitis in adults, Streptococcus pneumoniae is responsible each year for at least one-third of the 24 million outpatient visits for otitis media and for 500,000 cases of pneumonia and meningitis in the United States. Approximately 40,000 deaths are caused each year by pneumococcal infections. Recently, pneumococcus has shown increasing resistance to penicillin, the preferred drug for treating infection with this organism. Many strains are now resistant to several common oral antibiotics, and resistance to advanced generation cephalosporins has been documented. --------------------------------------------------------------------------- Emerging Bacterial and Mycotic Diseases Newly identified bacterial, mycobacterial, mycotic, and actinomycotic pathogens and known pathogens with unusual patterns of drug resistance constitute the focus of the Emerging Bacterial and Mycotic Diseases Branch. Laboratory sections serve as international resources to identify and characterize bacterial and fungal pathogens. Research programs focus on new methods to diagnose these diseases and to develop effective prevention and control strategies. A major focus is on diseases that impact immunocompromised persons. The branch coordinates the division's efforts to control and prevent opportunistic infections in such immunocompromised persons. Candidiasis Candidiasis is an important emerging fungal disease. The incidence of hospital-acquired, invasive candidiasis increased 10-fold over the decade of the 1980s. Candidemia accounted for 8% of all hospital-acquired bloodstream infections, and Candida species were the fourth most common cause of septicemia. This type of illness occurs most often in immunocompromised patients, but it can also occur in patients who require long hospital stays or prolonged therapy with multiple antibiotics, or in those who need indwelling catheters for nutritional support. Candida species also cause localized disease of mucosal surfaces, such as the mouth, esophagus, or vagina. Some mucosal infections, such as thrush or vulvovaginal candidiasis, are common in patients with underlying conditions, but these infections can also occur in healthy persons. --------------------------------------------------------------------------- Foodborne and Diarrheal Diseases The Foodborne and Diarrheal Diseases Branch focuses on the surveillance, outbreak investigation, and control and prevention of both foodborne and diarrheal diseases (e.g., cholera, shigellosis). Collaborators in the control and prevention of foodborne diseases are state health departments and federal risk management agencies. The branch serves as a consultative resource for food safety regulatory agencies and the food industry; it works with other federal agencies, state health departments, the Indian Health Service, the Pan American Health Organization, and foreign governments to control and prevent diarrheal diseases in underserved populations, in travelers, and overseas. Its investigations have identified major new foodborne pathogens (e.g., Escherichia coli O157:H7, Salmonella enteritidis in eggs) and have been essential to meeting the challenge of the recent Latin American cholera epidemic. As a result of these investigations, new prevention efforts are being implemented to improve the safety of food and water both in the United States and overseas. Laboratory sections provide reference, surveillance, and educational materials for cholera, shigellosis, and infections caused by Salmonella, Listeria monocytogenes, Campylobacter, and E. coli. In addition, the laboratories evaluate immunologic, biochemical, and newer DNA- and RNA-based molecular methods for rapid diagnosis of enteric diseases, characterization of epidemic strains, and identification of virulence factors and toxins. Escherichia coli O157:H7 In 1992, the Foodborne and Diarrheal Diseases Branch investigated a major outbreak in the western United States caused by hamburgers contaminated with Escherichia coli O157:H7. Over 500 cases were identified, four persons died, and 53 others contracted HUS, a severe illness that leads to kidney failure. E. coli O157:H7, an emerging cause of foodborne illness, can cause bloody diarrhea, kidney failure, and central nervous system disease, with the most severe illness occurring in the very young and the very old. About 20,000 cases occur each year in the United States; many are severe enough to require hospitalization. The infection is often misdiagnosed, and patients may receive inappropriate, sometimes life-threatening treatments. E. coli O157:H7 is responsible for most cases of HUS; 3%-5% of persons with HUS die, and others experience long-term kidney damage. --------------------------------------------------------------------------- Biostatistics and Information Management The Biostatistics and Information Management Branch provides statistical expertise for the division's investigations into disease outbreaks, research studies, and surveillance data analyses. The branch has designed and implemented software for laboratory reporting and specimen tracking: the Public Health Laboratory Information System allows state public health laboratories and laboratories in other agencies and other countries to report information on isolates of Salmonella, Shigella, Campylobacter, and mycobacteria; and the Laboratory Information Tracking System provides computerized tracking of the thousands of laboratory specimens submitted to DBMD each year. The branch also coordinates dissemination of information to public health officials and researchers, offers training in statistical methods, and maintains systems for collecting and processing the surveillance data gathered by the division's other branches. --------------------------------------------------------------------------- DBMD and the National Center for Infectious Diseases are committed to the principles of Equal Employment Opportunity and Affirmative Action. --------------------------------------------------------------------------- For further information on the Division of Bacterial and Mycotic Diseases contact The Office of the Director, DBMD, MS C-09 National Center for Infectious Diseases Centers for Disease Control and Prevention 1600 Clifton Road Atlanta, GA 30333 --------------------------------------------------------------------------- Updated: Wednesday, July 3, 1996