Book Review

Tuberculosis: A Comprehensive International Approach

N Engl J Med 1994; 330:72-73January 6, 1994

Article

Tuberculosis: A Comprehensive International Approach
(Lung Biology in Health and Disease. Vol. 66.) Edited by Lee B. Reichman and Earl S. Hershfield. 752 pp., illustrated. New York, Marcel Dekker, 1993. $195. ISBN: 0-8247-8852-4

Future medical historians examining tuberculosis in the 20th century will describe a bimodal incidence in many of the industrialized nations. After a long period of steady decline, in the final 15 years of the century the pathogen confounded all predictions and made a dramatic resurgence. A similar trend, albeit delayed by a number of years, will be seen in public health expenditures for the control of tuberculosis in these countries. Although it will be more difficult to discern, historians may also describe a parallel decline in medical expertise in all aspects of tuberculosis and a considerable delay before the trend was reversed. An entire generation of physicians who are currently responsible for the clinical and public health aspects of tuberculosis have received little formal undergraduate or postgraduate training in the nature and treatment of tuberculosis; this textbook will be of immense help to these physicians. Further complicating matters is the fact that this disease is now more difficult to diagnose and treat than it was 25 years ago.

The book is organized in five major sections. The first covers microbiology, immunology, pathogenesis, and epidemiology. Each chapter is written by a noted authority and provides an excellent and succinct review that would be of use to students, clinicians, public health authorities, and research scientists trying to increase their understanding of this complex disease. The second section deals with diagnosis and treatment and is less even than the first section, with excellent chapters on vaccination with bacille Calmette-Guerin and case finding, but disappointingly brief chapters on diagnosis and therapy. For practitioners, particularly in the AIDS era, who are faced with immediate and practical problems in the diagnosis and management of tuberculosis, this section lacks the kind of detail that might be expected in a textbook written by our foremost authorities. The provision of details regarding diagnosis and therapy may render a textbook outdated more rapidly, but there is at present a dearth of books on the clinical aspects of tuberculosis. In the third section, which describes special clinical problems, the chapters dealing with tuberculosis related to the human immunodeficiency virus and tuberculosis among children, the homeless, aboriginal North Americans, and the urban poor are particularly useful. The fourth section reviews tuberculosis control throughout the world, whereas the last section summarizes future research priorities.

A major strength of this textbook is the international stature and experience of the 50 contributors, the list of whom constitutes a veritable Who's Who in tuberculosis research and control. Contributors include experts whose career began over 40 years ago as well as those who have become preeminent in the field in the past 5 to 10 years. As with all multiauthored textbooks, the perspective, content, and clarity of the chapters are somewhat uneven, and they are occasionally repetitious. However, the editors are to be commended for integrating the very different focuses of and priorities for the control of tuberculosis in different regions of the world. Readers cannot fail to appreciate that controlling tuberculosis must be a global effort, since this disease will never be eliminated in any one country if there continues to be transmigration of populations from high-incidence to low-incidence areas. Although less useful as a reference for clinicians requiring help with complex diagnostic and management problems, this book should provide a global perspective on tuberculosis and a wealth of basic and epidemiologic information that should be useful to all those struggling to fill the gap between formal medical education and the challenges posed by tuberculosis throughout the world.

Richard Menzies, M.D.
Montreal Chest Hospital, Montreal, QC H2X 2P4, Canada