Book Review

Meningococcal Disease

N Engl J Med 1995; 333:1016-1017October 12, 1995

Article

Meningococcal Disease
Edited by Keith Cartwright. 316 pp. New York, John Wiley, 1995. $99.95. ISBN: 0-471-95259-1

Fear is a great motivator, as exemplified by the reactions to the Ebola virus and the human immunodeficiency virus. Among the most dreaded bacteria, the foremost is the meningococcus, which can kill a healthy adolescent in a matter of hours. In today's climate of alarm about emerging pathogens, it is appropriate to recall the virulence of this ancient pathogen.

This book is aimed at clinical and research-oriented infectious-disease specialists. But it is not a compilation of the latest in molecular basic science, as evidenced by the lack of detailed discussions of the molecular lessons to be learned from study of the meningococcus or the mechanisms of antigenic variation, natural DNA transformation, microbial adherence, and penicillin resistance. Indeed, the friendly and entertaining style of this multiauthored monograph can serve as an example of how to fill the gaps between the terse summaries offered by medical textbooks and the hard-core data-based articles appearing in many primary journals.

The discussion of the epidemiology of the disease covers historical and current global and regional trends. The exemplary chapter on global epidemiology not only presents data but also relates fluctuations in the incidence of meningococcal disease to biologic properties of the meningococcus. Three chapters on the broad spectrum of meningococcal disease amplify this discussion. Why does one person remain a carrier, whereas another dies within hours? Why are there chronic and acute forms of sepsis with this pathogen? A superb dissection of the pathophysiology of sepsis, focusing on the biologic responses to meningococcal endotoxin, brings the discussion to the molecular level. These chapters covering the “when” and “how” of meningococcemia complement each other effectively. Surprising by its absence is any reference to the wealth of recent work on the microbe's adhesive appendages, a topic that the chapter on the meningococcal surface dismisses in a paragraph.

This book contains extremely helpful guidelines for handling an outbreak and recommendations for treating an index case. A section on the emergence of penicillin resistance would have been very helpful. The presentations of issues concerning vaccine design and mechanisms of host immunity are thorough, although these topics are treated separately, requiring integration by the reader. Particularly readable and informative is the extensive chapter on host immunity.

The infectious-disease specialist is often handed recommendations without being given ready access to the reasoning behind them. This book presents that reasoning with a flair for describing real-life situations. If I should have a question on epidemiology, pathophysiology, or the handling of an outbreak of meningococcal disease, this is the textbook that I would consult.

Elaine Tuomanen, M.D.
Rockefeller University, New York, NY 10021