From The New England Journal of Medicine
--Anonymous, TB Controllers Songbook, 2000
The recent dramatic resurgence of tuberculosis in the United States and many other industrialized countries has sparked an equally dramatic resurgence in scientific interest in this disease. This interest has stimulated the publication of several new textbooks on tuberculosis and has resulted in substantially increased funding for the control of tuberculosis and for research on the disorder, particularly in the United States. The increased funding has yielded a wealth of new knowledge, as well as declining case rates in the United States and many other industrialized countries (although the rates are still increasing in Britain). In the United States, the steady reductions in numbers of cases over the past five years have resulted in prophecies of doom rather than celebrations. The naysayers predict that complacency will return and that funding for tuberculosis will fall much faster than the rates themselves, setting the stage for yet another cycle of neglect and resurgence.
The naysayers have obviously not been to a bookstore or library recently. Even with the declining rates of tuberculosis, interest has not faded, as demonstrated by the recent publication of several second editions of textbooks, including Tuberculosis: Current Concepts and Treatment, edited by Lloyd Friedman. This book incorporates much of the new knowledge, as well as recommendations by authoritative agencies, and should therefore provide a useful update for clinicians caring for patients with tuberculosis.
To lay the groundwork for an understanding of the disorder, the book begins with a review of the basics -- epidemiology, pathogenesis, and transmission. This is followed by chapters on diagnosis, including bacteriologic approaches, new rapid diagnostic tests, and radiography, and on the clinical and management aspects of pulmonary and extrapulmonary tuberculosis in children, pregnant women, and other adults. Treatment of drug-resistant forms is reviewed, as is treatment of latent infection. The book ends with an international perspective.
As with many books written by multiple authors, this one is somewhat uneven. The discussions of the pathogenesis of tuberculosis, new rapid diagnostic tests, extrapulmonary tuberculosis, nontuberculosis mycobacteria, and the currently available first-line and second-line antituberculosis drugs are excellent. These well-written, concise, and informative sections should prove useful to any clinician confronted with challenging aspects of the diagnosis and treatment of tuberculosis. The chapter on radiographic diagnosis has excellent examples of x-ray films and computed tomographic scans from patients with almost every conceivable form and complication of pulmonary and extrapulmonary tuberculosis.
However, there are some omissions and weaknesses. Particularly disappointing is the lack of a chapter that summarizes the clinical diagnosis of tuberculosis and the relative advantages and disadvantages of the various diagnostic approaches. The chapters on bacteriologic and radiographic methods do not include any discussion of their sensitivity, specificity, or reproducibility, and therefore do not provide guidance on preferred approaches for patients with various presentations. Surprisingly, there is no chapter on tuberculosis in patients with human immunodeficiency virus infection. Information on this topic must be gleaned from reading several chapters. The information on treatment is also divided into several chapters, and there is little guidance on dealing with practical problems in treatment, such as renal or hepatic insufficiency.
Tuberculosis is a global disease. As the editor points out, 99.8 percent of all cases of tuberculosis occur outside the United States. In these countries, the medical communities dealing with a vast population of affected patients must confront many challenging clinical problems every day. For this group of physicians, an up-to-date, clinically oriented book should be most welcome. This book, however, has a North American focus in its approach to diagnosis, treatment, and control. The chapter on epidemiology provides information only on the situation in the United States, and the chapter on international aspects is too brief. Almost all the authors are based in the United States, a fact that reflects the scientific excellence of the community of physicians dealing with tuberculosis in the United States, but nevertheless limits the global applicability of the book. Of course, this does not pose a problem for practitioners in the United States.
Tuberculosis is once again on the decline in the United States and many other industrialized countries. However, in eastern Europe, Africa, and Asia, the epidemic rages unabated. This second edition of Tuberculosis is a welcome compendium of new clinical knowledge that can assist in the day-to-day fight to eliminate tuberculosis in the United States. This book is also a welcome sign that the medical community "ain't gonna make the same mistake again."
Dick Menzies, M.D.
Copyright © 2000 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
Review
- Booknews, Inc.
About the first edition: An account on the disease, its manifestations, and prevention in children, adults and HIV-infected patients, for general practitioners and internists. Covers epidemiology, microbiology, and the historical perspective, and discusses skin testing, infection control, and ethical legal aspects. Includes material on both Tuberculosis and nontuberculosis mycobacteria, alternative nonclassical therapies, and recent techniques for diagnosing and assessing bacterial sensitivity to possible anti-TB medication.
- Booknews, Inc.
About the second edition: …incorporates much of the new knowledge, as well as recommendations by authoritative agencies, and should therefore provide a useful update for clinicians caring for patients with tuberculosis…a welcome compendium of new clinical knowledge that can assist in the day-to-day fight to eliminate tuberculosis in the United States. This book is a welcome sign that the medical community ain't gonna make the same mistake again.
--New England Journal Of Medicine
About the second edition: …incorporates much of the new knowledge, as well as recommendations by authoritative agencies, and should therefore provide a useful update for clinicians caring for patients with tuberculosis…a welcome compendium of new clinical knowledge that can assist in the day-to-day fight to eliminate tuberculosis in the United States. This book is a welcome sign that the medical community aint gonna make the same mistake again.
--New England Journal Of Medicine
Praise for the first edition: The book is clinically oriented, with excellent chapters on such important topics as transmission and safety issues, extrapulmonary disease, tuberculosis in childhood and pregnancy, nontuberculosis mycobacteria, chemotherapeutic agents, and the problems of drug resistance.
- The New England Journal of Medicine.
