Infectious Diseases Of The Respiratory Tract

Infectious Diseases of the Respiratory Tract

From The New England Journal of Medicine The most serious of all infections of the respiratory tract in terms of morbidity, mortality, and cost is pneumonia. It is the sixth leading cause of death in the United States, accounting for 600,000 hospital admissions and 64 million days of restricted activity each year. Pneumonia, Sir William Osler's "captain of the men of death," is an illness that is subject to great variation in all aspects of its management: hospital admission rates for pneumonia differ by a factor of four to five from one county to the next; the length of stay, even in this era of managed care, varies from institution to institution (in Canada in 1997, the length of stay varied by a factor of two in a 20-center study of pneumonia); and the type and duration of antibiotic therapy are subject to the same degree of variation. Although there are more than 100 known microbial causes of pneumonia, the cause of up to 50 percent of all cases of community-acquired pneumonia requiring admission to the hospital is unknown. This may be because there are pathogens still waiting to be discovered or because of inadequate diagnostic techniques. Pneumonia is an ever-changing disease -- the worldwide spread of penicillin-resistant and, indeed, multidrug-resistant Streptococcus pneumoniae has necessitated a change in our therapeutic approach to pneumonia. Infectious Diseases of the Respiratory Tract mixes a traditional and a novel approach to this subject. The traditional approach is reflected in the discussion of diagnostic methods, major respiratory tract pathogens, and respiratory tract syndromes. The novel approach is to include a variety of topics such as respiratory tract infections associated with foreign travel, miscellaneous agents of pneumonia and lower respiratory tract infections, and pulmonary infections in patients with cystic fibrosis. The discussion of pneumonia due to the major respiratory tract pathogens is generally good. The quality of the radiographs is excellent. Some of the chapters, such as those on pulmonary infections in cystic fibrosis, cytomegalovirus pneumonia, legionellosis, and miscellaneous agents of pneumonia and lower respiratory tract infections, make the textbook a worthwhile purchase for the respirologist or infectious-diseases consultant with an interest in pneumonia. There is, however, no discussion of general issues that challenge the physician who deals with patients with pneumonia: Are there criteria that I can use to decide whom to admit and whom to send home? What is the best empirical therapy for patients who can be treated on an ambulatory basis, especially if I am practicing in an area in which there is penicillin-resistant S. pneumoniae? When do I switch to oral antibiotics? What are the discharge criteria for patients who are admitted with pneumonia? There are also some unavoidable gaps in the textbook, such as the absence of a discussion of the newer "respiratory tract quinolones," and some avoidable lapses, such as the lack of a chapter dealing with nursing home-acquired pneumonia. Reviewed by Thomas Marrie, M.D. Copyright ? 1998 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS. From the common cold to many life-threatening conditions such as tuberculosis, infectious disease of the respiratory tract is a widespread problem. This text provides a complete and highly illustrated dossier of information and practical advice on both pathogens and major syndromes. It also includes coverage of key support and highly specialized areas such as pediatrics, foreign travel, and intensive care management. Care of patients with major respiratory infections ideally involves coordinated multidisciplinary teamwork. Such teams are managed by physicians with a breadth of knowledge spanning numerous specialties that include infectious disease, radiology, microbiology, surgery, intensive c