Out of Africa: daunting data and dazzling discussion on TB

John Wiley & Sons, 1998. £57.50 hbk (ix + 269 pages)ISBN 0 471 98261 XGenetics and Tuberculosis is a monograph based upon a symposium held in Capetown, South Africa from 18–20 November 1997. Upon discovering that the book is a compilation of invited articles by meeting participants, my initial enthusiasm for a book on genetics and tuberculosis turned to gloom. However, I was happily surprised to discover that, rather than being a collection of old tunes by the old favorites, this book remains rather fresh and insightful. Perhaps this is because the conference organizers restricted the attendance and provided ample time for discussion following each formal presentation. These discussions are chronicled in a well-edited addendum to each chapter, in which serious questions are explored and nagging controversies are vetted. The result is an interesting and readable volume.The connection between genetics and tuberculosis ranges from intimate to tenuous throughout the book. The chapters by Bellamy and Hill on host genetic susceptibility to tuberculosis, by Kramnik, Demant and Bloom on susceptibility of congenic mice to tuberculosis and by Cole and Barrell on the genome of Mycobacterium tuberculosis H37Rv fit the title squarely, whereas other presentations, such as the use of cytokines to treat multidrug-resistant tuberculosis and a discussion on endocytic trafficking within macrophages, although enlightening, have less to do with genetics. A significant strength of this book is its ability to capture the small-meeting atmosphere. Many of the chapters retain a free-flowing, conversational style, and the question and answer sections give the reader a sense of virtual participation. These discussions are broad-ranging and free-spirited and, in some cases, they are as long as the formal presentations themselves. Another attribute is the historical approach taken by several authors; the chapter by Hopewell on epidemiologic analyses to target tuberculosis control in the developed world and that by Fine on vaccines, genes and trials are both noteworthy for their breadth of perspective.However, Genetics and Tuberculosis is not without a few disappointments. One is a lack of discussion on several key topics such as pharmacologic preventive approaches for tuberculosis and the genetics of bacterial virulence mechanisms. For reasons that are unclear, several important presentations (endocytic trafficking by Russell and mycobacterial cell wall biosynthesis by Brennan) were relegated to discussion sessions and are, therefore, foreshortened in comparison with other topics. Finally, there are clear-cut reminders of the fact that the conference took place nearly two years ago. For example, the presentation by Cole and Barrell is overshadowed by their Nature paper actually reporting the complete genome1xCole, S.T. et al. Nature. 1998; 393: 537–544Crossref | PubMed | Scopus (4907)See all References1 and the discussion by Rook on Mycobacterium vaccae in immunotherapy is altered by the recent clinical trial published in the Lancet showing a lack of protective efficacy2xDurban Immunotherapy Trial Group. Lancet. 1999; 354: 116–119Abstract | Full Text | Full Text PDF | PubMed | Scopus (77)See all References2.Genetics and Tuberculosis is, without doubt, a specialized publication. It will be a welcome addition to the library of any serious tuberculosis researcher. Many students are also likely to find it of value for its richness of ideas and fresh discussions interwoven with controversy and historical perspective. The organizers and the editors have done an applaudable job in compiling a relevant and readable transcript of this 1997 meeting.