Book Review

Tuberculosis

N Engl J Med 1996; 334:1752June 27, 1996

Article

Tuberculosis
Edited by William N. Rom and Stuart M. Garay. 1002 pp., illustrated. Boston, Little, Brown, 1996. $179.95. ISBN: 0-316-75574-5

After a progressive decline that began in the 19th century, the incidence of tuberculosis in the United States began to climb again in the mid-1980s. This resurgence of tuberculosis was due to a number of factors, including the epidemic of HIV infection, homelessness in urban areas, and immigration from countries with a high prevalence of the disease. Unfortunately, the public health infrastructure needed to deal with this resurgence had deteriorated badly. To complicate matters further, there was now a whole generation of physicians with little training or experience in the diagnosis and treatment of tuberculosis. Biomedical research on the disease was at a low ebb, and research into new antituberculous drugs was virtually nonexistent. Fortunately, there has been a subsequent resurgence of basic, epidemiologic, and clinical research on tuberculosis.

Against this background, the publication of Tuberculosis is most timely and most welcome. Drs. Rom and Garay, with the assistance of many experts, have assembled a book that comprehensively discusses virtually every aspect of tuberculosis. Somewhat unusually, the first three chapters have little to do with the current state of tuberculosis; I found them fascinating. The first begins with the history of Mycobacterium tuberculosis, presenting evidence of its evolution from M. bovis several millennia ago and concluding with the identification of the bacillus by Koch in 1882. The second details the impact of tuberculosis on the lives of famous people, particularly those in the arts, and the third presents a history of the sanatorium movement.

From there, the book is divided into sections dealing with epidemiology, microbiology, host response, clinical disease, therapy, and prevention. The treatment of each area is detailed and current. The section on epidemiology, for example, does an excellent job of covering the recent changes in the epidemiology of tuberculosis and the spread of multidrug-resistant strains. There is extensive discussion of the insights into the transmission of tuberculosis brought by the new molecular techniques. The section on prevention includes a thoughtful discussion of tuberculosis control in hospitals in the light of recent changes in the regulations of the Occupational Safety and Health Administration, as well as the ethical and legal issues in tuberculosis control.

The clinical chapters cover every conceivable aspect of the disease. Two of them deserve special comment. “Pulmonary Tuberculosis” by Dr. Rom is a superb description of the most common clinical form of M. tuberculosis infection. Although his stated aim is to educate physicians who have neither diagnosed nor treated patients with tuberculosis, the chapter also contains much information of value to experienced clinicians. The authors of “Radiology of Tuberculosis” present a splendid collection of images ranging from plain radiographs to high-resolution computed tomographic scans. Inexperienced clinicians often fail to recognize the radiographic manifestations of tuberculosis; this chapter should help to correct that problem.

The principles of treatment, drug resistance, and the special problems posed by the coexistence of HIV and mycobacterial infection are well covered. Clinicians who may not find the sections on microbiology and the host response directly relevant to their practice are encouraged to read these chapters. They document a dramatic upsurge in basic research, particularly in the past five years. These chapters are well written, and most are accessible to readers who are not basic scientists.

This impressive textbook will be of great value to any clinician who encounters patients with tuberculosis and to public health officials concerned with the control of tuberculosis. It deserves a place in every medical school and hospital library; physicians in training should be directed to it at every suitable opportunity.

Robert R. Muder, M.D.
Pittsburgh Veterans Affairs Medical Center, Pittsburgh, PA 15240