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Microbial skin disease: its epidemiology
Book reviews wide range management
of readers-to of patients
229
all, that is, who are concerned with these diseases.
C. J. Ellis
with
the diagnosis
and
East Birmingham Hospital, Bordesley Green East, Birmingham B9 5ST
Microbial Skin Disease: &l.s.OO pp. 135.
its Epidemiology.
By W. C. Noble.
Edward
Arnold
(1983).
Within the modest confines of slightly more than 100 pages of text, Professor Noble’s monograph succinctly reviews most of the varied infections and infestations to which the skin is heir. Despite the book’s confident title, however, many of these diseases are sporadic and have either a low degree of communicability or are principally endogenous. Where infectivity is relatively high, as in impetigo, transmission is mainly in the general population and epidemiological data remain scanty. Nevertheless, there are compelling reasons for hospital epidemiologists to consider microbial skin disease in detail. Micro-organisms colonize and infect the skin with relative ease under the conditions prevailing in hospital. The skin in its turn constitutes an important source of infection throughout the hospital. The best known example is, of course, Staphylococcus aureus; and the author usefully summarizes the epidemiology of infection in the newborn and in surgical patients. Outside hospital an interesting outbreak of staphylococcal sepsis is described which started when clothing was contaminated in a cold-wash cycle and where a subsequent cluster of seven cases was ascribed to ‘a sexual encounter’. Streptococcus pyogenes, which was the supreme hospital pathogen until the 194Os, has fallen indeed, the three-page section devoted to it contains only a single sentence on a hospital outbreak-of erysipelas in a psychiatric unit. Considerably more space is given to herpesvirus infections in hospital; in particular, herpetic whitlow in members of staff acquired by cross-infection from patients is contrasted with neonatal infection mainly transmitted from the mother during birth. DNA ‘finger printing’ has proved valuable in studying these infections. Pathogens at the other extreme of size are dealt with in connection with infestation of patients by mites from nearby nests of pigeons. Also some of the enigmas of hospital-acquired scabies are discussed-its unpredictably high communicability at times, as when one patient caused an outbreak involving 30 members of staff and eight other contacts. Such events may be due to dispersal from crusted or Norwegian scabies, which is typically seen in the mentally subnormal or in elderly or immunosuppressed patients. The latter category has a separate chapter devoted to it; but high risk patients show few specific predispositions to skin infection, except for mycobacterial and herpesvirus infections, and warts in patients with defects of cellmediated immunity, and, of course, recurrent pyogenic infections in cases where there are polymorph abnormalities. This small but relatively expensive book will usefully fill a gap in the hospital epidemiologist’s library. Sydney
Selwyn
Department
of Medical Microbiology, Westminster Medical School, London SWIP 2AR
of readers-to of patients
229
all, that is, who are concerned with these diseases.
C. J. Ellis
with
the diagnosis
and
East Birmingham Hospital, Bordesley Green East, Birmingham B9 5ST
Microbial Skin Disease: &l.s.OO pp. 135.
its Epidemiology.
By W. C. Noble.
Edward
Arnold
(1983).
Within the modest confines of slightly more than 100 pages of text, Professor Noble’s monograph succinctly reviews most of the varied infections and infestations to which the skin is heir. Despite the book’s confident title, however, many of these diseases are sporadic and have either a low degree of communicability or are principally endogenous. Where infectivity is relatively high, as in impetigo, transmission is mainly in the general population and epidemiological data remain scanty. Nevertheless, there are compelling reasons for hospital epidemiologists to consider microbial skin disease in detail. Micro-organisms colonize and infect the skin with relative ease under the conditions prevailing in hospital. The skin in its turn constitutes an important source of infection throughout the hospital. The best known example is, of course, Staphylococcus aureus; and the author usefully summarizes the epidemiology of infection in the newborn and in surgical patients. Outside hospital an interesting outbreak of staphylococcal sepsis is described which started when clothing was contaminated in a cold-wash cycle and where a subsequent cluster of seven cases was ascribed to ‘a sexual encounter’. Streptococcus pyogenes, which was the supreme hospital pathogen until the 194Os, has fallen indeed, the three-page section devoted to it contains only a single sentence on a hospital outbreak-of erysipelas in a psychiatric unit. Considerably more space is given to herpesvirus infections in hospital; in particular, herpetic whitlow in members of staff acquired by cross-infection from patients is contrasted with neonatal infection mainly transmitted from the mother during birth. DNA ‘finger printing’ has proved valuable in studying these infections. Pathogens at the other extreme of size are dealt with in connection with infestation of patients by mites from nearby nests of pigeons. Also some of the enigmas of hospital-acquired scabies are discussed-its unpredictably high communicability at times, as when one patient caused an outbreak involving 30 members of staff and eight other contacts. Such events may be due to dispersal from crusted or Norwegian scabies, which is typically seen in the mentally subnormal or in elderly or immunosuppressed patients. The latter category has a separate chapter devoted to it; but high risk patients show few specific predispositions to skin infection, except for mycobacterial and herpesvirus infections, and warts in patients with defects of cellmediated immunity, and, of course, recurrent pyogenic infections in cases where there are polymorph abnormalities. This small but relatively expensive book will usefully fill a gap in the hospital epidemiologist’s library. Sydney
Selwyn
Department
of Medical Microbiology, Westminster Medical School, London SWIP 2AR