Clinical Infectious Diseases: A Practical Approach.

This new text presents updated and valuable information to the clinician and brings to the forefront issues important for diagnosing and managing infectious diseases in an era of competing demands on resources and rapidly evolving health-care delivery systems. While other books on infectious diseases are available, the speed with which new diagnostic methods are developed and the unpredictable nature of microbial pathogens require that the clinical and health-care community be kept informed of new approaches to diagnosis. This is particularly true in today's medical environment, where international travel and world events compel the local medical community to broaden its scope beyond its former comfort zone. The editors and contributors to this book have successfully presented the diagnosis, management, and prevention of infectious diseases in a context that promotes the best of patient care and outcome.

The text has 1,013 pages of information, tables, charts, algorithms, and photographs provided by 150 contributors representing a broad array of internationally recognized expertise. The book's 103 chapters are logically divided into seven parts: Pathophysiology of Infectious Diseases, Diagnostic Methods in Infectious Diseases, Antimicrobial Drugs: Principles and Usage, Vaccines and Immunomodulary Agents, Infectious Disease Syndromes, Infections in Special Patient/Risk Groups, and Human Immunodeficiency Virus and AIDS. The first four provide sufficient background for focusing on the final three sections. The text includes 49 color plates with 54 photos that are bright, colorful, descriptive, and large enough for detail to be appreciated.

Specimen management is covered nicely in the chapters on bacteria, viruses, parasites, and fungi, although the apparent assumption is that the patient will usually be an adult. In some cases, specimens from pediatric patients may require different approaches to collection and to the amount of material to collect. In addition, the role of the swab as a collection device is not detailed enough, since there are so many types (e.g., Dacron-, rayon-, calcium alginate-, and cotton-tipped swabs), some of which are specifically recommended for use with certain agents or tests. More could have been presented regarding specimen transport, in light of the emergence of central core laboratory facilities for multihospital health systems and the use of distant facilities for microbiology analysis.

The 22 chapters on antimicrobial drugs and their appropriate use are complete and up to date. For example, a brief discussion of the recently emerged glycopeptide-intermediate Staphylococcus aureus is presented, as is information on inappropriate use of antimicrobial drags, particularly vancomycin, and the emergence of extended-spectrum beta-lactamases. Pharmacokinetics, clinical indications and use, mode of action, clinical experience, adverse reactions, mechanisms of resistance, and other useful information are described, along with a generous array of very helpful summary tables and charts.

The primary diagnostic portion of the text is presented by syndrome, not by organism or individual disease. For example, tuberculosis is covered in the chapter on "Cavitary Pulmonary Disease," while varicella is discussed in "Infections with Rash." The annotated bibliography at the end of each chapter is very helpful: recent literature references are included where possible, along with italicized notes about the content and value of each reference selected. Pathogenesis is appropriately discussed in the section for each disease or agent rather than in an introductory section. The complexity of pathogenic mechanisms and host-parasite relationships within the microbial groups makes this approach a sound one. This section of the book is nicely introduced by valuable discussions on fever that set the stage for the subsequent syndrome presentations.

The section on infections in special patient populations and in special groups at risk is appropriate and reformative and recognizes the unique needs and problems associated with these populations. Infections in immunocompromised patients, postsurgical wound infections, trauma, in-dwelling medical devices, transplantation, travelers, and alcohol and drug abuse are some of the special risks and groups presented. AIDS and HIV are considered separately in a seven-chapter section.

There are few negatives about this book. For ease of use, it might have been helpful for all information about specimen management to be summarized in a single chapter. There were some controversial recommendations for blood collection at 1-hour intervals, and some may question the proposed use of direct antigen tests in spinal fluid for pediatric patients. Today vaginosis is recognized with more accuracy in the microbiology laboratory by Gram stain evaluation rather than by culture (as recommended in the book), which can often be inconclusive.

This book, while not inexpensive, will be an important addition to the resources available to clinicians and laboratorians alike.

J. Michael Miller Centers for Disease Control and Prevention, Atlanta, Georgia, USA