Book Review

Respiratory Infections: A Scientific Basis for Management

N Engl J Med 1994; 331:1534-1535December 1, 1994

Article

Respiratory Infections: A Scientific Basis for Management
Edited by Michael S. Niederman, George A. Sarosi, and Jeffrey Glassroth. 657 pp., illustrated. Philadelphia, W.B. Saunders, 1994. $125. ISBN: 0-7216-4347-7

Acute respiratory problems are among the most common of all diseases seen by physicians. Most of these illnesses are caused by infectious organisms. They can lead to substantial disability, serious morbidity, and even death. Medical knowledge of respiratory infections continues to evolve with the recognition of new pathogens and host defects, epidemics of community-acquired and nosocomial disease, drug resistance, and new antimicrobial agents. This book attempts to summarize the large and complex field of respiratory infections in both children and adults. It succeeds very well. Its six sections cover the pathogenesis of these infections, the clinical approach to patients, specific disease-causing organisms, diagnosis, treatment, and prevention.

The first part of the book gives the reader a theoretical basis for understanding the immunologic and nonspecific mechanical defenses that enable the respiratory tract to avoid injury despite exposure to an environment containing numerous pathogens. This section is up to date, scholarly, and readable, and it provides useful information to scientists and clinicians. The next section, on the clinical approach, reflects an unusual point of view. Its chapters address the differential diagnosis of respiratory infections in specific groups of patients in a variety of clinical settings. The discussion touches not only on community-acquired and nosocomial pneumonia but also on elderly nursing home residents, patients in intensive care units who are receiving mechanical ventilation, patients with postoperative pneumonia, and various types of immunocompromised patients, including those with cancer, transplant recipients, and those infected with the human immunodeficiency virus. When appropriate, the book covers children and adults separately. One interesting chapter discusses infections in immigrants and refugees. The approach in this section is based on the recognition that most physicians are unable to pinpoint a specific infecting organism initially; instead, they adopt a strategy that considers many factors related to the host and the clinical setting in order to arrive at a diagnosis.

The book next covers the most frequent specific infectious causes of pulmonary disease. It gives detailed information on epidemiologic factors, microbiology, clinical presentation, management, and prevention. These chapters are very well written and illustrated. The somewhat limited section on diagnosis stresses bacterial infections. These are well reviewed, but information on the diagnosis of other types of infection is scattered throughout the book. The excellent discussion of therapy summarizes data on the use of antibiotics (including inhaled antibiotics), chest physiotherapy, mucolytics, expectorants, and other adjunctive measures for the treatment of infection. New experimental agents, such as cytokine antagonists, are also discussed. The last part of the book covers prevention, including vaccines and antibiotics, as well as infection-control methods. It includes a nice discussion of the role of antibiotics in chronic bronchitis.

This book, by experts in the fields of both pulmonary medicine and infectious diseases, was edited by three physicians with extensive clinical experience. It should be invaluable, as both a book for reading and review and a reference book, to all physicians in training or in practice in these fields. Medical students, internists, pediatricians, and family practitioners will also find this a helpful and well-written reference. There is some variation in the quality of the chapters and some overlap (some is intentional); a few topics, such as the care of patients with bronchiectasis and the long-term sequelae of infections, are dealt with in a limited way. Overall, however, this excellent, up-to-date review of respiratory infections contains a wealth of clinical information.

Dorothy A. White, M.D.
Memorial Sloan-Kettering Cancer Center, New York, NY 10021

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