Emerging Infections 8

DICTIONARIES DEFINE THAT FOR SOMETHING TO “EMERGE” IT has to rise from an obscure or inferior position. One could say that humans, by vanquishing the threats of infectious diseases, have emerged as one of the dominant species on the planet. But an ominous foreshadowing of the history of infectious diseases is contained in another dictionary definition of “emerge,” in which emergence refers to coming into being through evolution. While the human species has developed an armamentarium to ward off the known infectious threats to health, the microbial world has not been idle. One only has to peruse newspaper headlines to realize that reports of emerging infections are increasing at an alarming rate. Humans around the world are continually battling viruses, bacteria, prions, and parasites. Sorting through the plethora of new infectious threats to human health and biosecurity can be daunting, even for infectious disease specialists. The rapid-fire pace with which new discoveries of unknown pathogens are announced makes most textbooks irrelevant when it comes to this topic, and one is left to use Internet search engines when colleagues or patients inquire about some exotic new infection creating havoc on the other side of the globe. A recent review on this topic begins with a fitting 19th-century quote from Rudolf Virchow: “Not a single year passes without [which] . . . we can tell the world: here is a new disease!” Emerging Infections 8, edited by a renowned team of clinicians, should be on the bookshelf of anyone desiring to keep abreast of these developments. It is the product of various symposia from the Intersciences Conference on Antimicrobial Agents and Chemotherapy. Spanning diseases caused not only by exotic or newly described pathogens, the book features chapters on microbes as disparate as Clostridium difficile and arenaviruses. Each chapter provides summaries that are both comprehensive and concise. Chapters that bring rarely discussed concepts to light include an insightful piece on norovirus infection susceptibility and the relationship to blood group antigens, an encouraging overview of the Japanese encephalitis virus vaccine pipeline, as well as a discussion of Streptococcus suis infection. I found the discussion of bats as disease reservoirs, addressed in the chapter on Nipah and Hendra viruses, thoroughly illuminating and informative. Integrating the facts that bats can cover large distances via their ability to fly, are long-lived, roost in numbers, and have unique immune features, the authors of that chapter explain what makes these organisms attractive hosts for viruses such as the severe acute respiratory syndrome virus, coronavirus, Marburg, and possibly the elusive Ebola. Chapters likewise contain information that would be useful to a clinician. For example, treatment suggestions for adenovirus infections in immunocompromised hosts are presented, providing clinicians with guidance for what is often an exceedingly complex decision. Other topics of high clinical relevance include comparisons of C difficile–associated diarrhea with the newly described entity of Klebsiella oxytoca hemorrhagic colitis, a detailed look at human immunodeficiency virus–associated immune reconstitution inflammatory syndromes, and pertussis. The closing chapter is, fittingly, devoted to the topic of new diagnostic techniques that have aided the discovery of new pathogens. The major strength of this book is that it is premised that a disease does not have to be new or flashy to be subsumed in the definition of “emerging.” Finding deficiencies was a hard task; however, in the chapter on Lyssaviruses, one notable deficiency was the detailed discussion of a rabies case successfully treated using a novel regimen. In an era when the power of medicine has dramatically shifted to unveiling the cryptic causes of new diseases, a book like this one will become as necessary and ubiquitous as the Sanford Guide to Antimicrobial Therapy. It is in this vein that I recommend Emerging Infections 8 to provide a foundation for what will likely be an exciting and frightening era of infectious disease.