- Email: [email protected]
Infection, Oxford General Practice Series 40
Book Reviews of Th2-dominated immunological responses in vertebrates, and that the increase in allergies in the western world may be due to a decrease in helminth infection in western populations, and a consequent malfunction of the Th2 responses. He points out the lack of knowledge about blood-living digeneans other than the schistosomes, and as described above, studies on the spirorchids may help in understanding mechanisms by which the schistosomes evade the immune response of the mammalian host. He emphasizes the importance of studying the biology of these parasites, and feels
passionately that basic information on the physiology and functional morphology of this fascinating group of organisms (especially the less well-known genera) will illuminate the field of parasitology. This book indicates how classical zoological studies can be combined with biochemical, immunological and molecular approaches to lead to a fascinating synthesis. It has been a privilege and a pleasure to review this book, and I hope many others will be able to experience the world of the platyhelminthes by immersing themselves in these pages.
Infection, Oxford General Practice Series 40 edited by L. Southgate, C. Lockie, S. Heard and M. Wood, Oxford University Press, 1997. £27.50 (476 pages) ISBN 0 919 262092 4 The last half of this century has been marked by the changing perception of the role and importance of infectious diseases in World health, and (more specifically) in developed countries. The advent of large-scale use of antibiotics, coupled with the development and use of a number of vaccines, gave the impression that the war against infectious diseases had been won. This view was strengthened by the epidemiological transition that relates to the changing patterns of disease and mortality from one in which communicable diseases predominate to one in which chronic diseases are the major cause of morbidity and mortality. The AIDS pandemia came as an abrupt reminder that the human species lives in an unstable dialectic with other organisms. In a very short period, health personnel had to learn and be aware of the diagnosis and management of Pneumocystis carinii pneumonia, cryptococcal meningitis, or cryptosporidium diarrhoea, among other infections with low community-based incidence rates. The pathology associated with these microorganisms is an increasing problem in the management of hospital AIDS patients. The increasing importance of these infections has been due not only to the ascending prevalence of AIDS, but also to the increasing number of patients therapeutically immunosuppressed as a result of organ transplantation or cancer. Tuberculosis (TB) is probably the best example of how fragile the balance of surveillance and control of infectious diseases is. Over the past 20 years, the incidence of TB was lower than ever before in most industrialized countries, indicating that the disease was under control. This led to reconsideration of control strategies, which resulted in the termination of prevention programmes in many countries. Coupled with this, low investment in TB research has led to few changes in treatment and control of the disease. However, industrialized countries are observing a steady increase in the incidence of TB Parasitology Today, vol. 14, no. 12, 1998
associated with the AIDS epidemic (which was never reduced in developing regions), affecting not only AIDS patients, but also the general population, with the additional problem of the increased number of resistant Mycobacterium strains in the community. The small input to TB research contrasts strikingly with the enormous effort made to find specific drugs to treat AIDS, and which continues with the search for a vaccine. A simple but realistic explanation for the marked difference in research input between these two diseases is the population they mainly affect. Thus, whereas TB became a disease of the poor countries (and was therefore forgotten), AIDS affects the wealthiest regions and all socio-economic groups. The improvement and development in communication and travel facilities have been enormous in recent years. This has stimulated population movements between countries and continents, for vacation, business or migration. Microorganisms have travelled with people from one region to another. Climatic changes may also facilitate the emergence or reappearance of some infectious diseases. Thus, diseases that were hitherto limited to certain areas may appear elsewhere, where they never existed or were eradicated years ago. The potential to spread malaria infection, for example, may become a reality in the near future, at least in southern Europe, where it disappeared not so long ago. In fact, apart from the occasional reports of malaria cases close to airports, in which it is assumed that the infection is acquired from an infected mosquito transported from an endemic area, there has already been a recent report of a case of malaria caused by Plasmodium vivax transmitted by an autologous mosquito in an area that is non-endemic for malaria. Spread of dengue from endemic areas has also been mentioned as the vector (Aedes aegypti) is rapidly progressing and the virus may be harboured by some individuals coming from endemic areas.
References 1 Hamilton, W.D. and Zuk, M. (1982) Science 218, 384–387 2 Armstrong, E.P. et al. (1997) J. Comp. Neurol. 377, 41–48 3 Gallien, L. (1935) Travaux de la Station Zoologique de Wimereux 12, 1–181 4 Fournier, A. and Combes, C. (1978) Zoomorphologie 91, 147–155 John Kusel Division of Biochemistry and Molecular Biology University of Glasgow Davidson Building Glasgow, UK G12 8QQ
In this context, a book on infection that stresses the relevance of the subject is timely, especially if presented from a general perspective and with a practical view. All but one of the Editors have wide expertise on primary health care in the UK, and this is reflected in the practical suggestions given on the management of situations by the primary care team. Although these recommendations may appear too obvious sometimes, they are nevertheless useful. The chapter on prevention is complete and covers the main aspects, with a good discussion on the reasons for poor immunization compliance and ways to improve it. There are, however, some inaccuracies, such as the level of BCG efficacy, which is actually lower than the 70% mentioned as it has been shown in several studies of BCG efficacy in different geographical settings. In the same chapter, the table on mechanisms of transmission of certain infections would be more complete if it included HIV, Hepatitis B and malaria as potentially transmitted congenitally. Similarly, malaria may also be transmitted through blood transfusion. As the number of HIV-positive people who travel abroad is increasing, the inclusion of a specific sub-section for HIV-positive travellers (within the chapter on prevention of infection during travel abroad) would have been useful. Indications and contraindications of certain vaccines, as well as behavioural advice on different potential risk situations in this context, would also have been helpful. The main criticism is that the general title is somewhat misleading, and should make reference to the specific group of health workers and the country the book is actually addressed to. Indeed, some of the recommendations (for example, those regarding contraindications for immunizations if the child is febrile or has diarrhoea) cannot be applied in developing countries. Finally, the intended audience of the book is not clear, ie. whether it is mainly a book for the library or for the physician’s pocket, in which case more illustrations would have been useful in each of these sections. Clara Menendez Unidad de Epidemiologia y Bioestadistica Hospital Clinic, Villarroel 170 08036 Barcelona, Spain
0169-4758/98/$ – see front matter © 1998 Elsevier Science. All rights reserved.
503
passionately that basic information on the physiology and functional morphology of this fascinating group of organisms (especially the less well-known genera) will illuminate the field of parasitology. This book indicates how classical zoological studies can be combined with biochemical, immunological and molecular approaches to lead to a fascinating synthesis. It has been a privilege and a pleasure to review this book, and I hope many others will be able to experience the world of the platyhelminthes by immersing themselves in these pages.
Infection, Oxford General Practice Series 40 edited by L. Southgate, C. Lockie, S. Heard and M. Wood, Oxford University Press, 1997. £27.50 (476 pages) ISBN 0 919 262092 4 The last half of this century has been marked by the changing perception of the role and importance of infectious diseases in World health, and (more specifically) in developed countries. The advent of large-scale use of antibiotics, coupled with the development and use of a number of vaccines, gave the impression that the war against infectious diseases had been won. This view was strengthened by the epidemiological transition that relates to the changing patterns of disease and mortality from one in which communicable diseases predominate to one in which chronic diseases are the major cause of morbidity and mortality. The AIDS pandemia came as an abrupt reminder that the human species lives in an unstable dialectic with other organisms. In a very short period, health personnel had to learn and be aware of the diagnosis and management of Pneumocystis carinii pneumonia, cryptococcal meningitis, or cryptosporidium diarrhoea, among other infections with low community-based incidence rates. The pathology associated with these microorganisms is an increasing problem in the management of hospital AIDS patients. The increasing importance of these infections has been due not only to the ascending prevalence of AIDS, but also to the increasing number of patients therapeutically immunosuppressed as a result of organ transplantation or cancer. Tuberculosis (TB) is probably the best example of how fragile the balance of surveillance and control of infectious diseases is. Over the past 20 years, the incidence of TB was lower than ever before in most industrialized countries, indicating that the disease was under control. This led to reconsideration of control strategies, which resulted in the termination of prevention programmes in many countries. Coupled with this, low investment in TB research has led to few changes in treatment and control of the disease. However, industrialized countries are observing a steady increase in the incidence of TB Parasitology Today, vol. 14, no. 12, 1998
associated with the AIDS epidemic (which was never reduced in developing regions), affecting not only AIDS patients, but also the general population, with the additional problem of the increased number of resistant Mycobacterium strains in the community. The small input to TB research contrasts strikingly with the enormous effort made to find specific drugs to treat AIDS, and which continues with the search for a vaccine. A simple but realistic explanation for the marked difference in research input between these two diseases is the population they mainly affect. Thus, whereas TB became a disease of the poor countries (and was therefore forgotten), AIDS affects the wealthiest regions and all socio-economic groups. The improvement and development in communication and travel facilities have been enormous in recent years. This has stimulated population movements between countries and continents, for vacation, business or migration. Microorganisms have travelled with people from one region to another. Climatic changes may also facilitate the emergence or reappearance of some infectious diseases. Thus, diseases that were hitherto limited to certain areas may appear elsewhere, where they never existed or were eradicated years ago. The potential to spread malaria infection, for example, may become a reality in the near future, at least in southern Europe, where it disappeared not so long ago. In fact, apart from the occasional reports of malaria cases close to airports, in which it is assumed that the infection is acquired from an infected mosquito transported from an endemic area, there has already been a recent report of a case of malaria caused by Plasmodium vivax transmitted by an autologous mosquito in an area that is non-endemic for malaria. Spread of dengue from endemic areas has also been mentioned as the vector (Aedes aegypti) is rapidly progressing and the virus may be harboured by some individuals coming from endemic areas.
References 1 Hamilton, W.D. and Zuk, M. (1982) Science 218, 384–387 2 Armstrong, E.P. et al. (1997) J. Comp. Neurol. 377, 41–48 3 Gallien, L. (1935) Travaux de la Station Zoologique de Wimereux 12, 1–181 4 Fournier, A. and Combes, C. (1978) Zoomorphologie 91, 147–155 John Kusel Division of Biochemistry and Molecular Biology University of Glasgow Davidson Building Glasgow, UK G12 8QQ
In this context, a book on infection that stresses the relevance of the subject is timely, especially if presented from a general perspective and with a practical view. All but one of the Editors have wide expertise on primary health care in the UK, and this is reflected in the practical suggestions given on the management of situations by the primary care team. Although these recommendations may appear too obvious sometimes, they are nevertheless useful. The chapter on prevention is complete and covers the main aspects, with a good discussion on the reasons for poor immunization compliance and ways to improve it. There are, however, some inaccuracies, such as the level of BCG efficacy, which is actually lower than the 70% mentioned as it has been shown in several studies of BCG efficacy in different geographical settings. In the same chapter, the table on mechanisms of transmission of certain infections would be more complete if it included HIV, Hepatitis B and malaria as potentially transmitted congenitally. Similarly, malaria may also be transmitted through blood transfusion. As the number of HIV-positive people who travel abroad is increasing, the inclusion of a specific sub-section for HIV-positive travellers (within the chapter on prevention of infection during travel abroad) would have been useful. Indications and contraindications of certain vaccines, as well as behavioural advice on different potential risk situations in this context, would also have been helpful. The main criticism is that the general title is somewhat misleading, and should make reference to the specific group of health workers and the country the book is actually addressed to. Indeed, some of the recommendations (for example, those regarding contraindications for immunizations if the child is febrile or has diarrhoea) cannot be applied in developing countries. Finally, the intended audience of the book is not clear, ie. whether it is mainly a book for the library or for the physician’s pocket, in which case more illustrations would have been useful in each of these sections. Clara Menendez Unidad de Epidemiologia y Bioestadistica Hospital Clinic, Villarroel 170 08036 Barcelona, Spain
0169-4758/98/$ – see front matter © 1998 Elsevier Science. All rights reserved.
503