Book Review

Infections in Immunocompromised Infants and Children

N Engl J Med 1993; 328:976-977April 1, 1993

Article

Infections in Immunocompromised Infants and Children
Edited by Christian C. Patrick. 977 pp., illustrated. New York, Churchill Livingstone, 1992. $225. ISBN: 0-443-08857-8

The consultative practice of the specialist in pediatric infectious diseases has changed dramatically within the past decade. Currently, as many as 50 percent of all infectious-disease consultations are sought because of an infection in an immunocompromised infant or child. Thus, a book devoted to an in-depth presentation of this topic is most welcome.

Dr. Patrick has coordinated the efforts of 71 contributors who have participated in addressing this important area of infectious diseases. The book is divided into nine sections. The ontogeny of the immune system, the subject of section 1, is followed by sections devoted to disorders of host defense, epidemiology of infections in the immunocompromised host, and infections of the host who has been compromised by virtue of prematurity, acquired immunodeficiency disease, liver transplantation, kidney transplantation, or other conditions. These sections are followed by an extensive discussion of the specific organisms most commonly implicated in infections of immunocompromised patients. The last four sections of the book discuss the prevention of infection in the compromised pediatric patient (by active immunization, passive immunoprophylaxis, or antibiotic therapy) and review the diagnostic procedures available for establishing the etiologic diagnosis of infection.

Physicians and others who use this textbook are most likely to attempt to assess a particular problem by looking up the subject in the index. If they wish to truly appreciate the book, I would suggest that they read it cover to cover. Having done so, I can attest to its easy readability; although the text is multiauthored, it reads as if it had been written by a single person. Liberal and appropriate use has been made of tables and illustrations. The reader will particularly enjoy the algorithms that are found in many chapters and that provide a useful approach to the evaluation of specific problems. The chapter on central nervous system infections in the immunocompromised host and the discussions of infections due to the large DNA viruses (cytomegalovirus, Epstein-Barr virus, herpes simplex virus, and varicella-zoster virus) are outstanding. The inclusion of copies of information sheets explaining the meaning of white-cell counts to parents and patients, as well as guidelines for educating parents and patients about their infections and about the use of vaccines in the immunocompromised host, is particularly valuable.

No textbook of this size is without some shortcomings, particularly a first edition. The discussion of septic shock is adequate, but the recommendations for therapy are not particularly explicit. Specific recommendations for the appropriate dosages of antibiotics and the frequency of administration are not presented consistently from chapter to chapter. When several approaches to therapy are possible, the authors frequently do not indicate their preference. In the chapter devoted to a critical analysis of reported empirical antibiotic regimens for patients with fever and neutropenia, moxalactam is listed as a specific recommendation. This drug is no longer available for distribution. The copy editor has not ensured consistency, permitting DTP and DPT to be used interchangeably. Haemophilus influenzae is frequently misspelled. These minor problems will be almost invisible to the general reader, who will find a wealth of information important to the care of the immunocompromised infant or child presented in an enjoyable manner.

Dr. Patrick and his colleagues are to be congratulated on their accomplishments. They have prepared a book that is strongly recommended to anyone charged with the care of infants and children, but that is particularly valuable for subspecialists in pediatric infectious diseases.

Ralph D. Feigin, M.D.
Baylor College of Medicine, Houston, TX 77030