VISAVET Library

The biology of the mycobacteria.Clinical aspects of mycobacterial disease.

Author/s: Lucas, S. B.; Naafs, B.; Waters, M. F. R.; Stanford, J. L.; Grange, J. M.

Mycobacterial infection is the Cinderella speciality of medicine in the UK. No longer are the protean manifestations of Mycobacterium tuberculosis infection diagnosed by tuberculosis physicians; they have been replaced by chest physicians more conversant with carcinoma than tuberculosis and infectious disease physicians who see only a small number of unusual mycobacterial infections, usually in immunocompromised hosts. This book, the third in a series devoted to mycobacteria, firmly emphasizes the global importance and the clinical context of mycobacterial infections.
Five sections cover general aspects of mycobacterial disease, tuberculosis, leprosy, other mycobacterial infections, and immunotherapy. In an introductory overview J.M. Grange (p. 3) considers the history of mycobacterial disease and the current infectivity, mortality and morbidity of mycobacterial diseases as well as the particular social problems caused by leprosy.
S.B. Lucas (p. 107) reviews extensively the histopathology of mycobacterial infections, focusing on possible underlying mechanisms producing pathology rather than merely detailing involvement in each organ. He judiciously uses case-reports and experimental evidence and synthesizes sometimes disparate information in order to present a unified view of the histology of mycobacterial infection.
Tuberculosis is thoroughly discussed in chapters on pulmonary tuberculosis, extra-pulmonary tuberculosis and chemotherapy, the latter being a clear guide through the confusing detail of the many chemotherapeutic regimens.
Leprosy has immunological consequences including Type IV hypersensitivity reactions resulting in reversal reactions (Type I reactions) and antigen-antibody complex disease (erythema nodosum leprosum, Type II reactions). B. Naafs's outstanding chapter on reactions (p. 359) emphasizes pathological mechanisms as well as a practical approach to clinical management. Chemotherapy in leprosy is covered well by M.F.R. Waters (p. 405) with appropriate emphasis on the current WHO regimens for multi- and paucibacillary disease. His clear historical background details the initial enthusiasm for dapsone in 1943 followed by the emergence some 20 years later of dapsone-resistant strains, and the recent spectre of resistance to both rifampicin and dapsone. The rationale for the current WHO multidrug treatment is clear.
The final chapter, on immunotherapy (J.L. Stanford, p. 567), raises the exciting possibilities of reducing treatment time even further in both leprosy and tuberculosis.
This is an authoritative book with each chapter being well referenced and the authors highlighting current areas of interest. In view of the increasing interest in mycobacterial infections it is therefore disappointing that there is no chapter on AIDS and mycobacterial infections.
Mycobacterial disease, however, occurs principally in developing countries, where this volume should be widely read. Although the editors clearly understand and sympathize with the needs and problems of those treating and trying to control mycobacterial disease their publishers have no such philanthropic sentiments-at #65 a volume few in the developed world will buy this volume never mind the Third World market it should serve.