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Tuberculosis, 2nd Edition FREE TO VIEW

Ashok Shah, MD
Chest. 2004;126(5):1714. doi:10.1378/chest.126.5.1714-a
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By William N. Rom, MD, MPH, and Stuart M. Garay, MD, eds. Philadelphia, PA: Lippincott Williams & Wilkins, 2004; 790 pp; $159.95

“Whilst meagre Pthisis gives a silent bow Her strokes are sure, but her advances slow. No loud alarms nor fierce assaults are shown She starves the fortress first, then takes the town.”

Samuel Garth, 1699

Three centuries have elapsed since Garth penned his graphic description of tuberculosis, but the world today is still burdened with this ancient scourge of mankind. More than 120 years after Robert Koch’s epoch-making discovery of the tubercle bacillus, and a half-century since the advent of effective chemotherapy, one third of the world’s population is estimated to be latently infected with tuberculosis. As a consequence, the World Health Organization has been constrained to declare tuberculosis as a “global emergency.” This resurgence of tuberculosis, with a little help from the HIV and combined with the growing menace of multidrug-resistant disease, has ensured that tuberculosis today still rules as, in John Bunyan’s memorable words, the “Captain of all these Men of Death.”

Keeping this in view, Drs. William Rom and Stuart Garay must be commended for bringing out this new edition in a timely manner. The second edition of this comprehensive book on tuberculosis takes into account the tremendous advances in research in the field, including the unraveling of the genome of Mycobacterium tuberculosis. The change from the first edition is distinctly visible. While the first edition contained seven sections with 82 chapters, the new edition comprises 60 chapters in six sections, and although the number of chapters has been reduced, the book is meticulously organized. History and epidemiology have now been combined in the first section, beginning with a literate essay on “The Writer’s Voice: Tuberculosis in the Arts” that makes very interesting reading. However, the absence of “Tuberculosis Through the Ages” in this edition, especially the discovery of the tubercle bacillus by Robert Koch, left me a little discontented. I do hope that this chapter, along with the “Geographic and Evolutionary Epidemiology of Tuberculosis,” might be restored in future editions.

The next two sections are where the strength of this book truly lies. These deal in depth with the basic aspects of tuberculosis, including host response. State-of-the-art information on the Mycobacterium genome project is the highlight of the section on “Genomics and Microbiology.” The microbiology of tuberculosis and the host response are well worth perusal by practicing physicians, who often tend to skip these chapters. I found the fourth and fifth sections, “Clinical Aspects” and “Therapy,” to be of particular interest, given my focus as a clinician, with all aspects of tuberculosis having been updated exhaustively. The chapters on “Pulmonary Tuberculosis” and “Imaging of Thoracic Tuberculous Infections” also deserve special mention. Although the chapter on “Tuberculosis and Silicosis” has been deleted, an abbreviated version has been incorporated into the chapter on “Pulmonary Tuberculosis.” However, the chapter “Hematologic Abnormalities and Mycobacterial Infections” has not found a place in this edition. With the change of name from “Pott’s Disease” to “Spinal Tuberculosis” in the second edition, this chapter, now bereft of the photographs that embellished it previously, appears less picturesque. However, the compendious chapters on extrapulmonary tuberculosis are laudable for their brilliant layout.

The section on “Therapy” has been strengthened with two innovative chapters on pharmacokinetic considerations and pharmacogenomics. “Principles of Tuberculosis Management” has been brilliantly elucidated, and key principles, such as the effects of HIV, directly observed therapy, and public health programs, have been dealt with lucidly and succinctly. Current knowledge about the mechanisms of resistance to isoniazid has been included. Although there is an excellent chapter on “Management of Multidrug-Resistant Tuberculosis,” keeping in view the ever-increasing threat of the disease, I would have preferred that the chapter on “Second-Line Agents” be retained and updated. The last section on “Prevention and Control,” while retaining the flavor of that section from the previous edition, has been reduced from 11 chapters to 6. In particular, a more global approach would have further enhanced the value that this scholarly book already enjoys.

Tuberculosis has carved a niche for itself, emerging as the standard textbook on tuberculosis in the 21st century. I will most certainly continue to look forward to subsequent editions.




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