Book Review

Medical Mycology

N Engl J Med 1993; 328:1792-1793June 17, 1993

Article

Medical Mycology
By K.J. Kwon-Chung and John E. Bennett. 866 pp., illustrated. Philadelphia, Lea and Febiger, 1992. $69.50. ISBN: 0-8121-1463-9

The authors of Medical Mycology, authorities in clinical mycology, state that their book is directed toward a broad audience. It encompasses a vast amount of information about increasingly important fungal infections in normal and immunocompromised hosts.

The introductory chapters, including that on laboratory aspects (in particular the descriptive mycology), might at first glance be of more interest to laboratory workers than to clinicians, but the definitions of terms are lucid and useful, and the examples given of medically important fungi are apt. The chapter on laboratory diagnosis contains useful tables on identification.

The chapter on antifungal agents contains appropriate admonitions about the limitations of susceptibility testing. Throughout the book, the authors' experience and critical approach are noteworthy, as exemplified by their useful advice on the actual use of antifungal agents, by their comments on the collection and examination of specimens, and by their incisive comments on the literature.

The division of the chapters on infections into sections permits readers with interests in epidemiologic features, clinical manifestations, laboratory diagnosis, or other aspects to focus on a particular area and seek specific information. Description of mycology generally takes precedence over the usually briefer descriptions of clinical and therapeutic aspects. Nonetheless, the latter are useful and reflect an appropriately conservative perspective. The authors give an excellent discussion of the art of treating coccidioidomycosis, but they could be more specific about the total dose of amphotericin B in severe acute coccidioidal pneumonia and could cite the higher off-label doses of fluconazole used around 1991 for the suppression of meningitis.

Chapters on the other major deep mycoses, such as aspergillosis, blastomycosis, cryptococcosis, and histoplasmosis, are likewise detailed; those on less commonly encountered fungi are excellent. The chapter on phaeohyphomycosis and those on infections due to miscellaneous fungi make sense of a lot of material that in other hands would be confusing. The discussion of differential diagnosis is a particularly strong point for all entities. The appendixes are directed to laboratory workers, but the glossary is useful to all. Appropriate black-and-white illustrations and references abound.

Minor faults include occasional discrepancies, such as the statement that Pseudallescheria boydii is important and belongs to the order of Microascales, when the figure in the same chapter omits this order within the phylum Ascomycota. Similarly, in chapter 2, on epidemiology, the authors seem to be more skeptical about the potential for the nosocomial spread of candida than they are in the later chapter on candidiasis. Occasional grammatical and typographic errors (“septa . . . is,” the use of protozoa, substrata, and criteria as singular nouns, “teliomorph” instead of teleomorph, and so on) mar an otherwise readable reference source.

As compared with what is currently available in standard infectious-disease textbooks, this book has more detailed therapeutic recommendations and discussions of infections in patients with AIDS. A clinician interested in the diagnosis and treatment of fungal infections or one with a specific question will find more useful information about those aspects of both common and relatively obscure entities in this welcome book than can be found in other books on medical mycology.

Richard D. Meyer, M.D.
Cedars-Sinai Medical Center, Los Angeles, CA 90048