Worldwide, tuberculosis is the leading cause of death associated with infectious diseases. The incidence of tuberculosis is expected to increase substantially during the next 10 years because of the interaction between tuberculosis and human immunodeficiency virus (HIV) epidemics. An estimated 1.7 billion persons, one third of the world's population, are currently infected with Mycobacterium tuberculosis.

Is there a need for another textbook on tuberculosis? Five publications on this topic are listed in Medical and Health Care Books in Print (1995). Rom and Garay's is the most comprehensive, with 1002 pages and 131 authors. Who would be a more appropriate editor of a major treatise on tuberculosis than Dr. Rom, who is the director of Bellevue Hospital's chest service?

Overall, this book is an excellent reference work: well-organized, well-written, uniformly readable, and of consistent quality and style despite being a multiauthor text. It is highly recommended to all physicians involved in the care of patients with tuberculosis, particularly specialists in infectious diseases and pulmonary medicine.

The first section, on history, reviews some obscure and scholarly theories about the origins of M. tuberculosis and its contagiousness, relying on paleopathologic and archeological findings. One speculation is that M. tuberculosis evolved in humans from M. bovis some time after the domestication of cattle. Chapter 2, "Phthisis and the Arts," discusses famous persons who had tuberculosis and shows the effect that mycobacterial organisms have had on western culture.

Section II covers geographical and molecular epidemiology, transmission, and pathogenesis. The continuing controversy over how long a patient receiving antituberculous therapy remains infectious is reviewed. Section III, on microbiology, consists of nine chapters and discusses new developments that use the polymerase chain reaction and firefly luciferase in the diagnosis of tuberculosis. Section IV is on host response and covers pathogenesis, immune response, and the formation of granulomas. Clinical aspects of tuberculosis are described in section V, which consists of 27 chapters and is comprehensive and encyclopedic. Section VI is on therapy and appropriately includes a chapter on the treatment of multidrug-resistant tuberculosis.

The book has a few flaws. The chapter titled "Diagnosis of Tuberculosis by Microbiologic Technique" suggests that saliva would not be a useful specimen, even though using saliva for acid-fast smears and cultures may give positive results. No mention is made of the observation that the mycobacterium killed with isoniazid lose their ability to stain with carbon-fuchsin but continue to stain with flurochrome dye. In the chapter on the radiology of tuberculosis, which reviews tuberculosis and the HIV-positive patient, the observation that patients who have advanced HIV disease and positive sputum cultures for M. tuberculosis may also have normal chest radiographs is omitted. The discussion of initial therapy in the era of multidrug resistance does not include the regimen options recommended in 1993 by the Centers for Disease Control and Prevention and the American Thoracic Society.

Despite these shortcomings, the length, scope, and price of this book will appeal to an audience of specialists and mycobacterial researchers. Primary care physicians and nonsubspecialists should consider less exhaustive and more succinct books, such as Tuberculosis (Schlossberg; ed. Springer-Verlag; 1994; $110.00) or Tuberculosis Current Concepts and Treatment (Freidman; ed. CRC Pr; 1994; $105.00), which are relatively inexpensive as medical texts go.