Book Review

A World Guide to Infections: Diseases, Distribution, Diagnosis

N Engl J Med 1993; 328:1794-1795June 17, 1993

Article

A World Guide to Infections: Diseases, Distribution, Diagnosis
By Mary E. Wilson. 769 pp., illustrated. New York, Oxford University Press, 1991. $95. ISBN: 0-19-504385-5

In writing this book, Wilson took on a major challenge: to describe the global geography of infectious diseases. As she points out in the preface, “This is the book I sought ten years ago and could not find.” In fact, Professor Brian Maegraith of the Liverpool School of Tropical Medicine produced an earlier attempt (Exotic Diseases in Practice. London: Heinemann, 1965). Wilson's book results from a remarkable attempt to deal with a difficult task. Its subject -- the geographic distribution of disease -- may be fundamentally impossible to approach scientifically, not only because information is nonexistent in many cases, but also because the epidemiologic basis for what we do know is suspect. Developing countries are not currently equipped to engage in extensive surveillance of infection and disease, not simply because of unwillingness but because of the absence of infrastructure. Furthermore, the geographic distribution of infections is constantly changing, thus making a textbook approach less than optimal. A regularly updated computer-based information system might be more suitable.

The book is arranged in three main parts, covering the patient, the place, and the diseases. I decided to sample several chapters from each section to determine how practical and helpful the information is. Part 1 (“The Patient”) contains several useful chapters on gathering history and on immigrants and travelers, as well as four chapters addressing important disease presentations. In the chapter on fever, infectious agents are divided into groups according to class of organisms (viruses, protozoa, and so on) and presented in tables along with regions where they are acquired. The information summarized in the tables includes nearly every possible organism, but it will not necessarily be useful to the clinician practicing in a developed country. Unfortunately, the text and the tables do not provide guidance in approaching the individual febrile patient. Furthermore, one can argue with the accuracy of some entries in the tables. The evidence for most of the helminthic infections included as causing fever and skin lesions may not be acceptable to physicians familiar with these infections, for example. The same can be said about other tables in this chapter. The exhaustive information included in the chapter on eosinophilia is helpful in cataloguing this group of diseases, but it probably would have been useful to distinguish common causes of eosinophilia from rare organisms that are infrequently associated with eosinophilia.

Part 2 (“The Place“) is an encyclopedic summary of the worldwide distribution of infections. It lists over 200 infections, arranged alphabetically by disease name and geographic area of prevalence. This list is followed by a chapter dealing with diseases endemic in defined geographic areas such as North, sub-Saharan, and southern Africa. Again, diseases are included in alphabetical order. The list is exhaustive, but the prevalence and the geographic distribution within each broad region are not included. The author has attempted to gather up-to-date information, and the relevant references often include recent publications. If what one is looking for is not included, it is probably because of the simple fact that the information does not exist.

In part 3, the author provides brief but informative descriptions of the infectious diseases included in the previous chapters. Diseases are arranged alphabetically with no distinctions according to the class of the etiologic organism.

Wilson is to be congratulated on the well-designed, well-referenced, and informative chapters on the global spectrum of infectious agents. Each chapter is organized in a logical way. One may argue that some updating (for example, mention of the oral typhoid vaccine) or some adjustment of statements that sound categorical (that surgical resection is the preferred treatment for hydatid disease, for example) is already needed. This attempt to produce a single-authored textbook of infectious diseases succeeds in many ways, but it also demonstrates that the complexity of the field may necessitate expertise in specific areas.

The book ends with several appendixes that are of practical value. This is a useful book for the busy practicing physician. It makes seeking further help a lot easier. Its shortcomings are related to the quality of the available information rather than to its design and content.

Adel A.F. Mahmoud, M.D., Ph.D.
Case Western Reserve University School of Medicine, Cleveland, OH 44106