Clinical Infectious Diseases: A Practical Approach
As the owner of several major texts on infectious disease, I was quite interested in reviewing another entry in the field. My initial impression was that Root's first edition of Clinical Infectious Diseases: A Practical Approach, was being published as a potential competitor to Mandell or Gorbach's books, the two authoritative infectious disease texts that have been around for about 20 and 10 years, respectively. However, this is not the apparent motivation of Root or the book's publisher, Oxford University Press.
Where this new work attempts to create a niche for itself is stated in the preface by Dr. Root and his three associate editors, who note that they attempted to create a book that presents material “somewhere between the general medical texts and the more encyclopedic infectious diseases texts.” Therefore, the intended audience includes both infectious disease specialists and generalists.
On a positive note, the editors have put together an array of well-known physician authors from the United States, Canada, Europe and Australia. This eclectic approach to authorship is a definite strength of the book. In addition, the editors themselves are either specialists or generalists, which serves to remove bias and create a balance to the material. This last statement is based on studies showing that the more a clinician-writer knows about the subject (i.e., the more an “expert” he or she is), the more biased and, often, less evidence-based is the presentation of information.
Clinical Infectious Diseases is divided into seven sections. The first four introductory sections include: Pathophysiology of Infectious Diseases; Diagnostic Methods in Infectious Disease; Antimicrobial Drugs: Principles and Usage; and Vaccines/Immunomodulatory Agents. Of these four sections, the one on antimicrobial drugs is undoubtedly the most useful to the practicing clinician. An individual chapter entitled “Selection of Antimicrobials for Treatment” is written by the recently deceased icon of antibiotics, Jay Sanford, M.D. Our residents often invoke his name when defending their choice of a particular antibiotic. This chapter contains excellent information on host and microbial factors, bacteriostatic versus bactericidal agents, and indications for combination therapy. These are topics rarely covered in clinical review articles.
The fifth section of the text, “Infectious Disease Syndromes,” is organized by location of a disease manifestation. Areas covered include “Fever of Unknown Origin” (written by Robert Petersdorf),“Cellulitis and Abscesses,” “Infections with Rash” and “Urinary Tract Infections” (written by Walter Stamm). Last on the list of 35 topics in this section is a chapter on “Chronic Fatigue Syndrome.” I specifically read this chapter and, despite my own bias toward doubting the existence of the condition, I found the material to be interesting and balanced
A nice touch to the chapters in Section V is the consistent organization that follows a format of etiology, epidemiology, host factors, pathophysiology, clinical manifestations, laboratory studies, diagnosis, treatment and prevention. This sequence allows readers to quickly identify what they are looking for without having to muddle through an array of semi-interesting but clinically useless information. Cross-referenced citations to other chapters in the book are another nice editing touch. Tables are frequently employed to simplify the presentation of specific materials.
Section VI is entitled “Infections in Special Patients/Risk Groups.” The majority of the 15 topics in this section, such as postsurgical wound infections, burn infections and infections in organ transplant recipients, fall outside of the realm of most family physicians. Two exceptions are included in interesting chapters entitled “Alcohol Abuse, Host Defenses and Infection” and “Endemic and Travelers Diarrhea.”
The text ends with a section on human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome. This section, although well intended, was probably not worth the effort. The section on treatment is already about two years out of date. The rapid release of HIV-related information online will rarely allow a physician who is caring for HIV-infected patients to use a textbook as a primary reference source. Moreover, there are at least three very good, more current textbooks available that deal specifically with HIV disease.
Although I am happy to own a copy of Clinical Infectious Diseases as part of my medical library, I would not recommend it for either of the libraries at the two clinical sites in our residency program. My preference for a teaching setting would be Mandell's two-volume Principles and Practices of Infectious Diseases, 5th ed., which was recently updated. In a private practice setting, Clinical Infectious Diseases may be useful to a family physician who is comfortable treating more complicated infections in adults. Otherwise, one would do just as well to spend considerably less money on a user-friendly primary care text such as Rakel's Current Therapy or one of my favorites, Primary Care Medicine by Goroll and May.
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