: Cases in Medical Microbiology and Infectious Diseases: 2nd edn Peter H. Gilligan, M. Lynn Smiley and Daniel S. Shapiro

American Society for Microbiology (ASM) Press, 1997. £25.95 (xii + 336 pages)ISBN 1 55581 106 XA recent and effective change in medical education has been the introduction of discussion-based learning. In this approach, students are presented with unknown cases and led through a discussion that illustrates important points in the diagnosis, pathogenesis, epidemiology and management. Cases in Medical Microbiology and Infectious Diseases is designed to accompany courses in medical microbiology and infectious diseases taught in the first two years of medical school. It can also be used as a stand-alone review for medical students preparing for the Part I examination of the National Board of Medical Examiners. The book consists of 70 discussion cases organized by system (genitourinary tract, respiratory tract, gastrointestinal, skin and soft tissue, central nervous system, systemic, and emerging infections). Each case has a one- to two-paragraph description of the symptoms of the illness, accompanied by color photographs illustrating the microbiologic findings, and 5–7 questions that are answered on the following page.The text is very interesting and readable, and the topics covered are inclusive of the major bacterial, viral and parasitic infections of humans in developed countries. Diagnosis of infectious diseases is current, including for example: the new recommendations for western blot to confirm the diagnosis of Lyme disease; antigen detection tests for enteric infections, such as rotavirus, giardiasis and cryptosporidiosis, use of E-tests to determine antibiotic susceptibility of the pneumococcus; and urinary antigen test for legionellosis. Perhaps the strongest part of the book is the discussion of pathogenesis, where one can find interesting discussions of the role of P-fimbriae in the pathogenesis of E. coli pyelonephritis, bacterial polysaccharide capsules as targets of protective antibody responses, and antigenic drift and shift in influenza virus epidemics.One problem with the book is that the clinical microbiology data are not presented in enough detail for the student to make the diagnosis. The Gram stains are occasionally of poor quality, and explanation of what culture media the illustrated bacterial colonies are growing on is sometimes left out. The poor quality of the images on the CD-ROM version of the book is especially disappointing. The lack of enough information to make the diagnosis in a few of the cases could frustrate students who are working through the problems, or lead them to skip ahead to the answers prematurely. In addition, as in any test that covers such an enormous area, there are minor problems or areas not completely up-to-date, such as a misplaced emphasis on serologic tests (which are negative during acute infection) to diagnose Rocky Mountain spotted fever, no discussion that Cyclospora will resemble Cryptosporidium on modified acid-fast stains of stools (with the size of the oocyst the differentiating factor), and a lack of any discussion of the nonpathogenic parasite Entamoeba dispar (which is identical in appearance to E. histolytica) in the section on amebiasis.However, these are small criticisms of an excellent collection of discussion cases. I found it to be an enjoyable book to work through, and an outstanding and compact review of microbiology and infectious diseases.