Book Review

Infections of the Central Nervous System

N Engl J Med 1993; 328:143-144January 14, 1993

Article

Infections of the Central Nervous System
Edited by W. Michael Sheld, Richard J. Whitley, and David T. Durack. 937 pp., illustrated. New York, Raven Press, 1991. $159. ISBN: 0-88167-766-3

This is a thoughtfully organized, comprehensive multiauthored textbook devoted to all aspects of central nervous system infections. It was the editors' intention that their book occupy a position between large general textbooks and single-subject treatises. The book meets their goals with outstanding success.

The editors have addressed their book to the “advanced reader,” emphasizing the syndrome-oriented clinical approach while maintaining the primary organization of the book according to microorganism. Additional chapters address diagnostic methods, examination of the cerebrospinal fluid, and neurodiagnostic imaging. The contributors represent a variety of disciplines, each of which adds substantially to our understanding of infections of the central nervous system.

At a time in the evolution of medical education when more and more emphasis is directed to “focus” in history taking, procedural expertise, and general care, it is enormously satisfying to encounter a book devoted to the historical, pathophysiologic, clinical, and preventive aspects of disease. This well-written book not only provides the practical information necessary to manage illness but also identifies areas of uncertainty or ignorance.

Some of these poorly understood phenomena include the mechanisms by which bacterial pathogens gain entry into the central nervous system; the inadequacy of immune defenses for the control of infection established in the brain; the finding of sterile cultures in 95 percent of newborns suspected of having sepsis and meningitis; and the rarity of serious listeria infections (including meningitis) in patients with AIDS despite the fact that Listeria monocytogenes is the most common cause of bacterial meningitis in patients with defective cell-mediated immunity.

I join the editors in their view that “advances in diagnosis, therapy, prognosis, and prevention require better understanding of the pathogenesis and pathophysiology” of infections of the central nervous system. Their book makes a major contribution to the promotion of those advances at the same time that it provides the rationale and the steps necessary to approach diagnosis and carry out treatment.

I recommend this book with enthusiasm, not only to the advanced reader but also to medical students, who, after all, will be the ones to carry us beyond the understanding of today. In addition to the excellent organization and the quality of the material presented, the book is a pleasure to read.

Lawrence R. Freedman, M.D.
UCLA School of Medicine, Los Angeles, CA 90024