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Histoplasmosis
VOL. 74, NO. 6
BOOK REVIEWS
As is fitting in any new movement, con tributors to this symposium were concerned with the state of the art, color vision test methods and analysis of approach, and case and experimental reports directed towards clarification and classification of color defi ciencies in various pathologies of the retina and visual pathways. There is a section on the examination of peripheral color vision. This is most important because we need im proved peripheral retinal reference data in cases of impairment of macula function. Similarly, we need improved specification of stimuli if color perimetric techniques are to be advanced. This book is to be recommended to those interested in the development of diagnostic techniques, with emphasis on color. It will be interesting to compare the state of the art several years hence. Jay M. Enoch Edited by Libero Ajello, Ernest W. Chick, and Michael L. Furcolow. Springfield, Charles C Thomas, 1971. Clothbound, 516 pages, table of contents, index, 63 black and white figures. $34.00 This book includes the material presented at the second National Conference on Histo plasmosis held in October, 1969, at the Cen ter for Disease Control in Atlanta, Georgia. Attending the conference were scientists and physicians from countries throughout the Western hemisphere where in some in stances more than 30% of the population is affected by this disease. The presentations covered every aspect of histoplasmosis and included two presentations on presumed histoplasmin choroiditis.
HISTOPLASMOSIS.
The disease is most prevalent in the val leys of the Mississippi and Ohio Rivers where more than 80% of the population in many localities becomes infected by the time they reach adulthood. The disease is also en demic throughout most of Central and South America. Soil, especially when enriched with chicken, bat, or starling droppings appears to
1225
be the reservoir of infection. Skin test surveys are the major epidemiologic tool presently available. Positive reac tions to histoplasmin indicate that the fungus is present in the local environment and that the people are being exposed to the point sources of infection. Conversely, negative reactions indicate that either sources of in fection are absent, or that pople are not con tacting them. Blastomyces and coccidioides should be considered as the most common causes of cross reaction" to histoplasmin in skin testing, but indeed there are a whole host of less common fungi which may also produce cross reactions, the point being that it is important to know which other type of fungus is prev alent in a particular area when doing skin testing for histoplasmosis. According to the results of skin test sur veys, millions of people become infected with the organism, but only a small propor tion of those infected developed clinical dis ease. Those who develop clinical disease are particularly prone to acute or chronic pulmo nary involvement. Presumably, this orga nism is the etiologic agent of many forms of pneumonia and other respiratory tract infec tions. The disease may mimic other fungal diseases, sarcoidosis, carcinoma, pneumonia, occupational diseases, and particularly tu berculosis. Indeed, the matter may even be more complicated when histoplasmosis coex ists with tuberculosis. The most severe form of involvement occurs in a progressive dis seminated form in which there may be in volvement of the oral cavity, gastrointestinal tract, liver, spleen, genitourinary tract, heart and great vessels, blood and bone marrow, adrenal glands, lymph nodes and skin, as well as the lungs. Death my occur in patients with severe systemic histoplasmosis. Indeed about 800 deaths are reported each year from histoplasma infections. The treatment of choice for severe pulmonary or dissemi nated cases is amphotericin B. A puzzling observation is the much greater resistance that blacks have to both
1226
AMERICAN JOURNAL OF OPHTHALMOLOGY
systemic histoplasmosis and presumed histoplasmin choroiditis. Although there is very little new material on presumed histoplasmin choroiditis, this book is recommended to anyone interested in the general subject of histoplasmosis and probably represents the best general refer ence published to date. Alex E. Krill By Magda Radnot and Agnes Kemyeres. Budapest, Hungarian Academy of Sciences, 1971. Clothbound, 70 pages. $2.40 This elegantly printed and bound, small book is a personalized biographical interpre tation through the affectionate eyes of a stu dent, later a colleague, a disciple, and ulti mately, the first woman to hold a Hungarian chair of ophthalmology. Unfortunately, lan guage barriers in the early decades of this century particularly separated United States physicians from appreciation of the technical excellence and sometimes, the cultural charm of central European ophthalmic leaders. Jo seph Imre, Jr. (1884-1945) is painted in broad strokes of Dr. Radnot's brush as a cul tured Hungarian scholar from a family with a tradition of several generations of similar accomplishment. Professor Imre was precise, highly energetic, self critical, and at times, just a bit vain. From a limited perspective, many American ophthalmologists associate him only with surgical reconstruction of the eyelids. Actually, he was a broad-gauged scholar, active in ophthalmology and in uni versity affairs. He even served as rector of the University of Pecs. Though brilliant, Imre's life and work advanced through a JOSEPH IMRE, JR.
DECEMBER, 1972
troubled period of Hungary's relationships to other Central European nations. Similar professional difficulties also attended his progress, and he developed somewhat out side of the major university system. Such conflicts plagued the life of Javal in Paris, as well as von Graefe in Berlin, but the author of this volume makes only fleeting reference to these troubles which were indeed of high magnitude. Parallel difficulties in his first marriage (to an American woman) do not emerge in this biography. Details of the strong support in his second marrige, this time to a Swiss woman, and the fate of his two children are also omitted from this rec ord. Imre made strong contributions to medical control of trachoma, rehabilitation of the blind and partially sighted, cataract tech nique, principles of education, teaching tech niques, and medical ethics. His bibliography of 85 references is included, but more impor tantly, the author points out that four of the present five chairs of ophthalmology in Hun gary are held by his disciples. This volume, described as "a debt of honor" by the author, is also an affectionate tribute rather than an intensive critique of the struggles of a world leader in ophthal mology through many areas of difficulty. Both the historian and the romanticist will ask for more. The book, however, is a gra cious tribute which rekindles warmth of un derstanding among dissimilar cultures and dissimilar institutions, all plagued by similar self-erected problems of man himself. It is well worth the moments required for reading by the thorough ophthalmologist. Arthur H. Keeney
BOOK REVIEWS
As is fitting in any new movement, con tributors to this symposium were concerned with the state of the art, color vision test methods and analysis of approach, and case and experimental reports directed towards clarification and classification of color defi ciencies in various pathologies of the retina and visual pathways. There is a section on the examination of peripheral color vision. This is most important because we need im proved peripheral retinal reference data in cases of impairment of macula function. Similarly, we need improved specification of stimuli if color perimetric techniques are to be advanced. This book is to be recommended to those interested in the development of diagnostic techniques, with emphasis on color. It will be interesting to compare the state of the art several years hence. Jay M. Enoch Edited by Libero Ajello, Ernest W. Chick, and Michael L. Furcolow. Springfield, Charles C Thomas, 1971. Clothbound, 516 pages, table of contents, index, 63 black and white figures. $34.00 This book includes the material presented at the second National Conference on Histo plasmosis held in October, 1969, at the Cen ter for Disease Control in Atlanta, Georgia. Attending the conference were scientists and physicians from countries throughout the Western hemisphere where in some in stances more than 30% of the population is affected by this disease. The presentations covered every aspect of histoplasmosis and included two presentations on presumed histoplasmin choroiditis.
HISTOPLASMOSIS.
The disease is most prevalent in the val leys of the Mississippi and Ohio Rivers where more than 80% of the population in many localities becomes infected by the time they reach adulthood. The disease is also en demic throughout most of Central and South America. Soil, especially when enriched with chicken, bat, or starling droppings appears to
1225
be the reservoir of infection. Skin test surveys are the major epidemiologic tool presently available. Positive reac tions to histoplasmin indicate that the fungus is present in the local environment and that the people are being exposed to the point sources of infection. Conversely, negative reactions indicate that either sources of in fection are absent, or that pople are not con tacting them. Blastomyces and coccidioides should be considered as the most common causes of cross reaction" to histoplasmin in skin testing, but indeed there are a whole host of less common fungi which may also produce cross reactions, the point being that it is important to know which other type of fungus is prev alent in a particular area when doing skin testing for histoplasmosis. According to the results of skin test sur veys, millions of people become infected with the organism, but only a small propor tion of those infected developed clinical dis ease. Those who develop clinical disease are particularly prone to acute or chronic pulmo nary involvement. Presumably, this orga nism is the etiologic agent of many forms of pneumonia and other respiratory tract infec tions. The disease may mimic other fungal diseases, sarcoidosis, carcinoma, pneumonia, occupational diseases, and particularly tu berculosis. Indeed, the matter may even be more complicated when histoplasmosis coex ists with tuberculosis. The most severe form of involvement occurs in a progressive dis seminated form in which there may be in volvement of the oral cavity, gastrointestinal tract, liver, spleen, genitourinary tract, heart and great vessels, blood and bone marrow, adrenal glands, lymph nodes and skin, as well as the lungs. Death my occur in patients with severe systemic histoplasmosis. Indeed about 800 deaths are reported each year from histoplasma infections. The treatment of choice for severe pulmonary or dissemi nated cases is amphotericin B. A puzzling observation is the much greater resistance that blacks have to both
1226
AMERICAN JOURNAL OF OPHTHALMOLOGY
systemic histoplasmosis and presumed histoplasmin choroiditis. Although there is very little new material on presumed histoplasmin choroiditis, this book is recommended to anyone interested in the general subject of histoplasmosis and probably represents the best general refer ence published to date. Alex E. Krill By Magda Radnot and Agnes Kemyeres. Budapest, Hungarian Academy of Sciences, 1971. Clothbound, 70 pages. $2.40 This elegantly printed and bound, small book is a personalized biographical interpre tation through the affectionate eyes of a stu dent, later a colleague, a disciple, and ulti mately, the first woman to hold a Hungarian chair of ophthalmology. Unfortunately, lan guage barriers in the early decades of this century particularly separated United States physicians from appreciation of the technical excellence and sometimes, the cultural charm of central European ophthalmic leaders. Jo seph Imre, Jr. (1884-1945) is painted in broad strokes of Dr. Radnot's brush as a cul tured Hungarian scholar from a family with a tradition of several generations of similar accomplishment. Professor Imre was precise, highly energetic, self critical, and at times, just a bit vain. From a limited perspective, many American ophthalmologists associate him only with surgical reconstruction of the eyelids. Actually, he was a broad-gauged scholar, active in ophthalmology and in uni versity affairs. He even served as rector of the University of Pecs. Though brilliant, Imre's life and work advanced through a JOSEPH IMRE, JR.
DECEMBER, 1972
troubled period of Hungary's relationships to other Central European nations. Similar professional difficulties also attended his progress, and he developed somewhat out side of the major university system. Such conflicts plagued the life of Javal in Paris, as well as von Graefe in Berlin, but the author of this volume makes only fleeting reference to these troubles which were indeed of high magnitude. Parallel difficulties in his first marriage (to an American woman) do not emerge in this biography. Details of the strong support in his second marrige, this time to a Swiss woman, and the fate of his two children are also omitted from this rec ord. Imre made strong contributions to medical control of trachoma, rehabilitation of the blind and partially sighted, cataract tech nique, principles of education, teaching tech niques, and medical ethics. His bibliography of 85 references is included, but more impor tantly, the author points out that four of the present five chairs of ophthalmology in Hun gary are held by his disciples. This volume, described as "a debt of honor" by the author, is also an affectionate tribute rather than an intensive critique of the struggles of a world leader in ophthal mology through many areas of difficulty. Both the historian and the romanticist will ask for more. The book, however, is a gra cious tribute which rekindles warmth of un derstanding among dissimilar cultures and dissimilar institutions, all plagued by similar self-erected problems of man himself. It is well worth the moments required for reading by the thorough ophthalmologist. Arthur H. Keeney