Book Review

Congenital, Perinatal and Neonatal Infections

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

Article

Congenital, Perinatal and Neonatal Infections
Edited by Anne Greenough, John Osborne, and Sheena Sutherland. 245 pp., illustrated. New York, Churchill Livingstone, 1992. $59. ISBN: 0-443-04508-9

The idea for this book grew out of a report, TORCH Screening Reassessed, by a Public Health Laboratory Working Party in England. The report concluded that simply sending a blood sample with a request for screening for toxoplasma, rubella, cytomegalovirus, and herpes simplex (TORCH) was an inadequate way of investigating many congenital infections. In addition, the authors recognized growing public concern over the risk presented to the fetus by maternal infection. The book is therefore aimed at a broad audience including medical, nursing, and paramedical staff members, as well as laypersons.

The book is divided into two sections. The first provides general information on clinical aspects of congenital infections and their diagnosis, prevention, and treatment. The second section is a catalogue of microorganisms that cause congenital infections, presented in alphabetical order, from Chlamydia trachomatis to varicella-zoster virus. This approach is very similar to the layout of the Red Book (Report of the Committee on Infectious Diseases, 22nd edition, Elk Grove Village, Ill.: American Academy of Pediatrics, 1991).

Each chapter in the catalogue provides in-depth information on a specific microorganism, the associated incidence of disease in pregnant women and neonates, clinical presentation, laboratory diagnosis, management, prevention, counseling, and future developments. In addition, each chapter provides information on the incidence and presentation of the disease in children and non-pregnant adults. With regard to some microorganisms, nosocomial infections are also discussed. It can be argued that such information is not essential in a book focusing on congenital infections. If nosocomial infections are to be considered, a more general discussion would have been useful that included the most common microorganisms causing such infections. To a large extent, the information provided in the introductory chapters is repeated in the chapters on the separate microorganisms, where it becomes redundant. The color plates do not provide any essential information, and their exclusion would have reduced publication costs and made room for a glossary so that the text would have been easier for laypersons to understand.

The strength of this book is that it provides well-organized, in-depth, up-to-date information (including references published up to 1990) on most known congenital infections. Because the authors include congenital infections only, there is room to discuss the individual infectious agents in more detail than is found in the Red Book. The catalogue includes only two of the bacteria commonly isolated in early-onset (congenital) neonatal sepsis, Escherichia coli and Streptococcus agalactiae. Other frequently encountered organisms are excluded. Because the clinical presentation of congenital sepsis is similar regardless of cause, it would have been preferable to present more general information. The book contains no information on a number of microorganisms known to cause congenital infections, including fungi, trypanosomes, mycobacteria, and Ureaplasma urealyticum. Health professionals working in the tropics will find no information on perinatal infections caused by agents prevalent in those areas.

The exclusion of some microorganisms from the book is probably based on the authors' clinical experience in the United Kingdom. Similarly, some of the specific information on incidence, handling of laboratory specimens, and recommendations for the isolation of the mother, the infant, or both also apply only to the United Kingdom. The authors provide a good rationale for discontinuing the use of the acronym TORCH, because it has no place in clinical diagnosis and may result in the performance of unnecessary or inappropriate tests.

In summary, this book provides well-organized, easy-to-read, current information on the most common congenital infections. It should be readily available for use as a reference textbook in prenatal and postnatal consulting by obstetrical and neonatal perinatologists. It is a valuable complement to the Red Book for members of the perinatal team in training. The inclusion of a glossary would make the book more accessible to the lay public. For the next edition, an international approach is recommended so that the information will be more applicable to the global setting.

Arne Ohlsson, M.D., M.Sc., F.R.C.P.C.
University of Toronto, Toronto, ON M5S 1B2, Canada