Book Review

Emerging Neurological Infections

N Engl J Med 2005; 353:2092-2093November 10, 2005

Article

Emerging Neurological Infections
(Neurological Disease and Therapy. Vol. 67.) Edited by Christopher Power and Richard T. Johnson. 505 pp., illustrated. Boca Raton, Fla., Taylor & Francis, 2005. $199.95. ISBN: 0-8247-5423-9

There are only two books that I consider to be required reading for practitioners in infectious diseases: Rats, Lice and History by Hans Zinsser (Boston: Little, Brown, 1984) and Emerging Infections: Microbial Threats to Health in the United States by Joshua Lederberg et al. (Washington, D.C.: National Academies Press, 1992). Both of these books are beautifully written perspectives on the interacting factors that underlie most, if not all, epidemics: human behavior (and often, misbehavior), animal reservoirs, vectors, and microbial evolution. And both provide excellent background reading to the more tightly focused Emerging Neurological Infections, edited by Christopher Power and Richard T. Johnson.

Lederberg and colleagues' report for the Institute of Medicine articulated a still useful definition of emerging infections as “new, reemerging or drug-resistant infections whose incidence has increased within the past two decades [since 1972] or threatens to increase in the future.” Although conventional wisdom held that infections no longer posed a major challenge in the United States, the resurgence of infections as a cause of death and illness in the last quarter of the 20th century should not have come as a surprise to those familiar with Zinsser's historical perspective.

By my count, well over 50 infectious agents (viruses, bacteria, fungi, parasites, and prions) have a predilection or tropism for the nervous system. But of these, only a handful can be regarded as “emerging” pathogens, and all of these agents are covered in detail or mentioned in Emerging Neurological Infections. The editors intended this book for practitioners working or training in neurology, neurosurgery, infectious diseases, public health, pediatrics, and related basic-science disciplines. Their aim was to cover the basics of emergence, disease recognition, pathogenesis, therapy, and public health considerations. Although some topics are not as comprehensively covered as others, overall these goals are admirably met.

Individual chapters that make this book worthy of purchase include those on cerebral malaria (the cause of more than 1 million deaths of children annually), Lyme disease, and the Flaviviridae family (including West Nile virus, an agent that was introduced in the United States in 1999 and was responsible for more than 16,000 cases of encephalitis by the end of 2004). Also outstanding are the chapters on neurocysticercosis, enterovirus 71, Nipah encephalitis, Guillain–Barré syndrome, prion diseases and dementia, human African trypanosomiasis, and HIV-related neurologic disease in the era of highly active antiretroviral therapy (HAART). HIV is arguably the most important emerging pathogen of the nervous system, since a large majority of the more than 40 million people who are infected with HIV worldwide do not have access to HAART. Immunosuppression caused by HIV underlies the dramatic increase in neurologic infections caused by opportunists such as Mycobacterium tuberculosis, Toxoplasma gondii, and Cryptococcus neoformans.

Since the 1992 publication of the Institute of Medicine report, new biologic threats have appeared, and a much deeper appreciation of the global nature of these infections has developed. In addition to the important role played by travel (including immigration), violations of basic human rights have become recognized as a central factor in the emergence of many infections. These topics are well discussed in the chapter on ecologic disturbances and emerging infections. Also, in the concluding chapters, the authors provide a framework for prioritizing emerging infections and for the public health response to these illnesses. Although the challenges seem daunting, the good news is that the pace of scientific advancement in understanding and dealing with these infections has also been astonishing. Both of these facets have been captured in this book, which has been added to my list of highlyfor practitioners in the field of infectious diseases.

Phillip K. Peterson, M.D.
University of Minnesota Medical School, Minneapolis, MN 55455