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Candida and candidosis
Journal
of Hospital Infection (1989) 13, 103-105
Book reviews Candidu
and Candidosis.
pp. 468,
E35.00.
F. C. Odds.;
Bailliere
Tindall,
London
(1988).
2nd Ed.
Clinical problems relating to candida infection have become increasingly prominent in hospital practice in recent years as treatment has become more aggressive in our intensive care units and the population of patients with immunosuppressive conditions has increased. It is against this background that the new edition of Dr Odd’s monograph is a most welcome edition to the bookshelves. The first edition was published in 1979. The accelerating pace of research in this field is indicated by the need to completely revise the original text, to expand the book to approximately twice its length, and to increase the number of papers quoted in the bibliography from 2265 to 5796. The book first deals with microbiological aspects of the nature of candida species, covering their toxonomy, physiology, genetics, biochemistry, ultrastructure, isolation and identification. There is then an extensive review of their role in disease and the diagnosis and management of infections they cause. The evidence supporting many commonly held tenets is critically examined. These include the value of identifying hyphal forms as an indicator of clinical disease, the place of antibiotics, steroids and oral contraceptives as predisposing factors in the causeation of candidosis and the roles of low pH and lactobacilli in preventing vaginal infection. For each of these examples, the author argues that traditional views may be either oversimplifications or incorrect. Two of the principal problems concerning systemic candidosis relate to the difficulty in distinguishing clinically yeast colonization from invasive infection and the problems surrounding anti-fungal chemotherapy. The latter includes high risk of host toxicity (amphotericin), high probability of drug resistance (flucytosine) or low or uncertain therapeutic efficacy (azoles). As the author points out this provides the conundrum that most physicians are unwilling to institute anti-fungal treatment unless diagnosis is certain and yet diagnostic tests are inherently unreliable. These particular issues are examined in depth. Whilst not providing a definitive solution to these problems, the detailed clinical descriptions of candida infections and discussions regarding the predictive value of diagnostic tests and the place of different anti-fungal agents in therapy will certainly assist in evaluation. The literature reviewed is encyclopaedic (where else could one find a reference to candidosis of the inner ear?) and deals not only with mainstream issues but other fringe items such as ‘chronic candidosis’ and the ‘yeast connection’ and the colourful ‘auto brewery’ syndrome. This is a book that can be thoroughly recommended to all who have either a scientific or clinical interest in this field, A. J. Howard
District
103
Pathology Laboratory, Ysbyty Gwynedd, Penrhosgarnedd, Bangor, Gwynedd, LL57 ZPW, UK
of Hospital Infection (1989) 13, 103-105
Book reviews Candidu
and Candidosis.
pp. 468,
E35.00.
F. C. Odds.;
Bailliere
Tindall,
London
(1988).
2nd Ed.
Clinical problems relating to candida infection have become increasingly prominent in hospital practice in recent years as treatment has become more aggressive in our intensive care units and the population of patients with immunosuppressive conditions has increased. It is against this background that the new edition of Dr Odd’s monograph is a most welcome edition to the bookshelves. The first edition was published in 1979. The accelerating pace of research in this field is indicated by the need to completely revise the original text, to expand the book to approximately twice its length, and to increase the number of papers quoted in the bibliography from 2265 to 5796. The book first deals with microbiological aspects of the nature of candida species, covering their toxonomy, physiology, genetics, biochemistry, ultrastructure, isolation and identification. There is then an extensive review of their role in disease and the diagnosis and management of infections they cause. The evidence supporting many commonly held tenets is critically examined. These include the value of identifying hyphal forms as an indicator of clinical disease, the place of antibiotics, steroids and oral contraceptives as predisposing factors in the causeation of candidosis and the roles of low pH and lactobacilli in preventing vaginal infection. For each of these examples, the author argues that traditional views may be either oversimplifications or incorrect. Two of the principal problems concerning systemic candidosis relate to the difficulty in distinguishing clinically yeast colonization from invasive infection and the problems surrounding anti-fungal chemotherapy. The latter includes high risk of host toxicity (amphotericin), high probability of drug resistance (flucytosine) or low or uncertain therapeutic efficacy (azoles). As the author points out this provides the conundrum that most physicians are unwilling to institute anti-fungal treatment unless diagnosis is certain and yet diagnostic tests are inherently unreliable. These particular issues are examined in depth. Whilst not providing a definitive solution to these problems, the detailed clinical descriptions of candida infections and discussions regarding the predictive value of diagnostic tests and the place of different anti-fungal agents in therapy will certainly assist in evaluation. The literature reviewed is encyclopaedic (where else could one find a reference to candidosis of the inner ear?) and deals not only with mainstream issues but other fringe items such as ‘chronic candidosis’ and the ‘yeast connection’ and the colourful ‘auto brewery’ syndrome. This is a book that can be thoroughly recommended to all who have either a scientific or clinical interest in this field, A. J. Howard
District
103
Pathology Laboratory, Ysbyty Gwynedd, Penrhosgarnedd, Bangor, Gwynedd, LL57 ZPW, UK