Book Review

In Defense of the Brain: Current concepts in the immunopathogenesis and clinical aspects of CNS infections

N Engl J Med 1998; 338:628-629February 26, 1998

Article

In Defense of the Brain: Current concepts in the immunopathogenesis and clinical aspects of CNS infections
Edited by Phillip K. Peterson and Jack S. Remington. 355 pp., illustrated. Boston, Blackwell Science, 1997. $95. ISBN: 0-86542-555-8

The purpose of In Defense of the Brain is clearly defined by the editors in their preface: “We asked the contributors to provide the reader a current understanding, at the molecular level, of the strategies used by the host to defend the brain.” There is clearly a need for a book that summarizes the many recent advances in knowledge of the pathogenesis of infections of the central nervous system. The editors, however, were only partially successful in achieving their objective.

Unfortunately, for the infections in which understanding of immunopathogenesis is limited, the editors gave the chapter authors the option of stressing new concepts of treatment and prevention. This option allowed the editors to include discussions of toxoplasmosis, cystocercosis, cryptococcal meningitis, rabies, and prion diseases, but these provide little or no information about host defenses at the molecular level. By including such topics, the editors created a more complete “mini-textbook” on infections of the central nervous system at the expense of obscuring their primary objective. These chapters could have been omitted, because the information included in them is available in any recent infectious-disease textbook.

As in many multiauthored books, repetition is a problem: the anatomy of the blood–brain barrier is discussed in chapters 1, 2, and 6; the cytokines released during infections of the central nervous system are described in chapters 4, 5, and 7. The first eight chapters also do not seem to be in the most appropriate sequence. Chapters 1, 2, 6, 7, and 8 discuss the pathogenesis of bacterial meningitis. Interpolated between chapters 2 and 6 are chapters on microglia, defenses against viral and parasitic infections, and glia-mediated neurotoxicity. The reader interested in bacterial meningitis would do well to read the chapters in the sequence 1, 6, 7, 8, 2, 3, and 5.

The initial eight chapters on bacterial meningitis and on the role of microglia in defending the brain clearly succeed in providing the reader with an up-to-date review of the strategies used by the host to defend the brain against infection. Each of the remaining 12 chapters is devoted to a specific pathogen. Unfortunately, because so little is known about pathogenesis at the molecular level for some of the pathogens discussed in the book, almost half the chapters cannot meet the primary objective of the editors. In the remainder, there is considerable repetition of the earlier descriptions of cytokines and cellular elements involved in host defenses.

Given the high quality of the writing overall, it is unfortunate that the index is so unhelpful. Important topics missing from the index include outer membrane protein, pili, fimbria, adhesins, and bacterial polysaccharide capsules. Some authors cited in the text are indexed, but others are not, without any obvious reason. Thus, the index fails to function either as a topical index or as an authors' index.

This book will be of interest to specialists, whether in infectious diseases, microbiology, or neurology. A major attraction for such readers will be the excellent bibliographies. All the articles are up to date through early 1996. The book is much too detailed and too expensive for the general medical reader.

Ronald Gold, M.D., M.P.H.
Hospital for Sick Children, Toronto, ON M5G 1X8, Canada

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