Book Review

Cutaneous Manifestations of Infections in the Immunocompromised Host

N Engl J Med 1995; 333:1015-1016October 12, 1995

Article

Cutaneous Manifestations of Infections in the Immunocompromised Host
By Marc E. Grossman. 196 pp., illustrated. Baltimore, Williams & Wilkins, 1995. $99. ISBN: 0-683-03642-4

Infections are a major problem for immunosuppressed patients, a group whose numbers are increasing dramatically as a result of chemotherapy, organ transplantation, autoimmune diseases, and the spread of AIDS. Skin lesions may be the first clue that an infection is present and, when recognized and examined by biopsy, may lead to lifesaving intervention. However, cutaneous manifestations of infection range from subtle to morbid, as shown by the outstanding photographs included in this book. Breathtaking in clarity, these photographs are not for readers with queasy stomachs.

This well-organized book contains chapters dealing with such topics as subcutaneous and deep mycoses, algae, mycobacteria, viruses, rickettsia, arthropods, protozoa, helminths, and spirochetes. Each chapter is then divided into sections on conditions caused by specific organisms (aspergillosis, blastomycosis, and so on). References are grouped at the end of each chapter to prevent the reader from being distracted by footnotes.

The photographs are all in color, well lit, and large enough for the characteristic lesions of each entity to be easily identified. In cases in which the manifestation of the infectious process changes dramatically as it progresses, several sequential photographs show this change. Microscopical photographs are included only when they provide a particularly striking image of the identifying characteristic of the pathogen, as in the case of the delicately branching filaments of the gram-positive nocardia. The captions accompanying each photograph are clear and illuminating, expanding on the text as needed.

The text itself is clear, elegantly simple, and filled with helpful information. Information on the epidemiologic features of each organism adds depth and dimension to the work. Each section begins with an explanation of what the pathogen actually is, in what geographic areas it is generally found, and its most likely sources. This is followed by an overview of routes of transmission and entry into the body and a description of the types of patients most likely to be susceptible to the organism. A straightforward account of the manifestations and course concludes each section. Occasionally, the author also includes a discussion of treatment options, most often in the captions to the photographs.

For the clinician who is uncertain about exactly what the patient may have, chapter 14 is a helpful and well-thought-out summary of “clues” to diagnosis. The book's introduction, used together with the differential diagnoses listed in chapter 15, makes ferreting out the offending pathogen a relatively simple process. The guidelines laid out in chapter 14 provide useful advice for any young clinician in a patient care setting. Dr. Grossman is a highly experienced clinical expert in this area, and his outstanding teaching skills come across in this book.

As generalists increasingly take on the care of patients with highly complicated conditions, they will appreciate an atlas of this quality and breadth. The text, totally lacking in discipline-specific jargon, is a welcome and friendly reference for all physicians and even nonmedical readers — a quality unfortunately in short supply in most textbooks. The book is comprehensive and yet astonishingly compact (just under 200 pages), making it simple to use and therefore highly likely to be consulted.

Donna R. Clanton, B.A.
Madeleine Duvic, M.D.
University of Texas Medical School, Houston, TX 77030