Book Review

Diagnostic Microbiology of the Immunocompromised Host

N Engl J Med 2009; 361:101-102July 2, 2009

Article

Diagnostic Microbiology of the Immunocompromised Host
Edited by Randall T. Hayden, Karen C. Carroll, Yi-Wei Tang, and Donna M. Wolk. 479 pp., illustrated. Washington, DC, ASM Press, 2009. $139.95. ISBN: 978-1-55581-397-0

Laboratory medicine has no more urgent role than in the diagnosis and management of infections in immunocompromised patients. For this vulnerable population, clinical algorithms are logically rooted in the need for timely identification, quantification, and genotyping of pathogens. The need to explain the roles, limitations, and evidence for the clinical utility of laboratory testing for these purposes is critical and is compounded by the rapid development of next-generation tests. This book is the first standard reference to focus specifically on issues that are unique to immunocompromised patients. It serves as a comprehensive overview of traditional and molecular methods of diagnosis that are used in testing for infectious disease. Unlike other books on infectious-disease diagnostics, it contains both detailed chapters on specific pathogens and a large integrative section that considers diagnostics in relation to organ systems.

The authors of the introductory section concisely organize the landscape of primary and secondary host immunodeficiency. A careful selection of the immunology one needs to know is included, along with a more detailed introduction to specific chemotherapeutic and immunosuppressive drugs and regimens. Several figures illustrate timelines for infection after transplantation, and a useful table clearly summarizes the linkage of pathogens to immunosuppressive agents. The need for clinicians and laboratory professionals to focus on the uniquely different biologic settings of patients with immunodeficiency is emphasized as a prelude to other chapters. Beyond laying the groundwork for subsequent sections, this very clear, practical, and exhaustively referenced overview is a valuable stand-alone resource for specialists and nonspecialists alike.

Thirteen chapters address diagnostics for specific pathogens, including common and esoteric agents. The potential for minimally pathogenic agents to cause disease in patients with compromised immunity invites a long menu of tests. These chapters guide readers through old and new methods of testing with a scope and utility that go beyond the book's central theme. Recommendations for test utilization and for interpretation of results are included for many of the clinical scenarios for which data are available. The extensive use of flow charts to explain these diagnostic pathways is extremely helpful. Seven chapters on organ systems emphasize the everyday challenges of diagnosis and management that are posed by this complex patient population. The authors of the last section of the book forecast trends for the field, highlighting approaches that could simplify operations, increase the speed with which results are obtained, or contribute new types of clinically relevant information.

The editors' intention of creating a book with widespread utility and appeal to a broad spectrum of clinicians and laboratory professionals is realized in this unique and important book. One of its effects should be the facilitation of cross-competencies between clinicians and laboratory professionals. A welcome trend in the diagnosis of infectious diseases in patients with immunodeficiency would be greater inclusion of laboratory experts in clinical consultation and the participation of clinicians in the conception and selection of diagnostic forms of technology. This book helps both parties to proceed in that direction.

David R. Hillyard, M.D.
University of Utah School of Medicine, Salt Lake City, UT 84124
hillyadr@aruplab.com