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Tuberculosis: Clinical Management and New Challenges
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MD Rossman and RR MacGregor. 426 pages. New York: McGraw-Hill; 1995. $60.00. ISBN 0-07-053-9502. Order phone 800-262-4729.
There has long been a need for a succinct but thorough overview of tuberculosis that would touch on the organism, the disease, the epidemiology, and inpatient and outpatient approaches to therapy. The authors of Tuberculosis: Clinical Management and New Challenges have succeeded in providing just such a book.
This text is small enough to be portable and, as medical texts go, is relatively inexpensive. The breadth of the topics is amazing for the book's size. In this single source, the reader can find current information (most chapters have references from 1992 or 1993) on all aspects of science and medicine relevant to dealing with patients with tuberculosis. Each chapter is written by an authority on the subject. The authors do not hesitate to express opinions that differ from established "guidelines," but they clearly label such opinions as their own. Moulding's chapter on preventive therapy is an excellent example. He cites the established recommendations and generously annotates them with explanatory comments, mentioning areas in which his views are different. Many other chapters provide, in one convenient location, information that has taken a bit of work to find. The science of air disinfection, reviewed by Nardell and Riley, can be contrasted with the regulatory burden imposed by the Occupational Safety and Health Administration (OSHA) on hospitals, as reviewed by Brennan and MacGregor. Each chapter is short enough to attract the nonspecialist and detailed and well referenced enough to be useful to the specialist.
The complex interaction of human immunodeficiency virus (HIV) infection and tuberculosis is addressed in many chapters; taken together, these discussions give the reader a good overview of the subject. But this reviewer remains astounded at the lack of integration by phthisiologists of multidrug-resistant tuberculosis and tuberculosis in patients with HIV infection into the vast literature on other drug-resistant organisms and on the behavior of other infections in profoundly immunocompromised persons. For other bacteria, the use of antibiotics is generally admitted to predispose patients to the development of resistance. The prevalence of resistance is not decreased by more intense or widespread use of the antibiotic. Authorities on tuberculosis do not even address the diametric opposition of their suggested approach for reduction in multidrug-resistant tuberculosis. They also do not address the apparent contradiction of assuming that an aggressive pathogen such as Mycobacterium tuberculosis can be easily eliminated in a population that is not even able to control Pneumocystis carinii, Cryptococcus neoformans, and Salmonella species.
The typography is good and could easily be read by this presbyopic reviewer. As is usual in texts, the radiographs are less than satisfactory, but they are intelligible.
Rossman and MacGregor have integrated disciplines as varied as epidemiology, molecular biology, immunology, pharmacology, and air disinfection into a smooth, flowing whole directed toward a better understanding of the care of patients with tuberculosis.
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