Principles and Practice of Clinical Virology

Principles and Practice of Clinical Virology, 6th ed.

ISBN: 9780470517994

$450

968 pages

In this expensive one-volume book, there are 39 chapters devoted to clinically-relevant virus infections: epidemiology, transmission routes, their clinical features and diagnosis, vaccine development, treatment and management of disease, and prevention. Some of the leading clinicians from around the world were recruited to contribute chapters, although there is a distinct concentration of U.K.-based investigators among the authors.

It is not readily apparent which audience this book is intended for. The title indicates that it is geared toward clinicians, but it is stronger on basic science and pathogenesis than on clinical instruction. This book does not have the terse style of many clinical texts; It is more like my own Neurotropic Viral Infections (Cambridge University Press, 2008), which is intended for a wide range of medical professionals.

The organization of the chapters is somewhat unusual, in that the pathogens are not arranged by the categories of DNA, RNA, and retrovirus; by complexity of the viruses; or by target organ, but are apparently randomly ordered, though the herpesviruses are clustered in Chapters 6–11, and all of the diverse hepatitis viruses are covered in only one chapter (Chapter 12). One chapter is devoted to all the enteroviruses (Chapter 25, including polio, echovirus, and coxsackievirus), one for rotaviruses (Chapter 14), and another combines a few of the viruses that cause acute gastroenteritis (Chapter 15, including adenovirus, norovirus, and astrovirus). The majority of chapters (17) are devoted to RNA viruses. The length of individual chapters of this 968-page volume ranges widely, from 7–8 pages (mumps and retroviruses) to 37–38 pages (varicella zoster virus and vaccines). However, all of the most important human pathogens are included in the book.

The illustrations are appropriate, but are exclusively reproduced in black and white; the use of color could have enhanced many of the figures. Other textbook publishers provide images in black and white, but will supplement this with the essential color images in a cluster insert, or alternatively as web-based files. It is much less expensive to publish in black and white, and it is even less expensive to publish books on websites for subscribers.

The authors are all authorities in their areas, although I might have selected different contributors. This book is not intended to be cutting-edge, and for instance, the chapter on diagnostics utilizes approaches that are tried and true (and available in most community hospitals in developed countries), not the powerful new research tools that can identify unknown agents that have recently been developed by many individuals, including Ian Lipkin. I do not have the prior edition to compare the content, and for the sake of brevity I will focus on three chapters in this critique of the 6th edition.

Brian W.H. Mahy (Centers for Disease Control and Prevention, Atlanta, GA) contributed the very short chapter on Emerging Virus Infections (Chapter 4). Among the most confounding problems of viral pathogenesis are the causes of aseptic pneumonias, or more serious unidentified severe central nervous system infections. In addition, new infections such as severe acute respiratory syndrome (SARS) and Hendravirus have recently appeared in humans without warning. Viruses thought to be eliminated by aggressive vaccination programs (e.g., polio and smallpox) have the potential to reappear, either in developing countries or as bioterrorism agents. Related viruses such as monkeypox or camelpox can jump species and be inadvertently transferred by wild animals or unquarantined pets. These events occur because (1) the viruses themselves evolve and are able to infect new hosts, (2) people may invade endemic areas where humans have not lived in large numbers, (3) we now have better diagnostic techniques and can detect and identify pathogens that were previously missed, or (4) people are now exposed to insect or animal vectors and thus to the viruses they transmit. This chapter briefly surveys all of these mechanisms for the emergence of infections. It ends with an anecdote, that in some prostate cancers in individuals with an underlying immune deficiency, there may be a gammaretroviral infection. We do not yet know if this indicates cause and effect, or whether this virus in any way contributes to the disease's prognosis, but it is an intriguing idea.

The chapter on Influenza (Chapter 16) was written by Maria Zambon and Chris W. Potter (Center for Infection, Colindale, U.K.) before the new swine-origin H1N1 pandemic strain began circulating. The chapter begins with a standard introduction to influenza virus, and the diversity and host range of the different influenza A subtypes. It also describes the life cycle and receptor discrimination of the sialic acid 2,3- versus 2,6-linkage to glycoproteins, which determines host cell binding by viral hemagglutinin, and these are covered in sufficient detail that a clinician can understand why avian-origin viruses may not infect humans. Antigenic shift and drift, and their role in seasonal epidemics and pandemic disease, are also described. The clinical features of infection are described, as are the complications. Diagnosis and treatment, including the few antivirals available and their mechanisms of action, are also discussed. Finally, there is a discussion of prevention of infection by vaccines, listing the different formulations of vaccine ranging from subunit to live attenuated cold-adapted virus vaccines. This chapter does not go into any more depth than many others I have read, including those that can be found in any textbook such as Fields' Virology (Knipe, Lippincott Williams and Wilkins, 5th ed., 2007).

Caroline Breese Hall (University of Rochester, Rochester, NY) wrote Chapter 18 on Respiratory Syncytial Virus (RSV). This virus is an important cause of severe bronchiolitis of infants and the elderly; in others it causes only mild respiratory disease. Like the influenza chapter, the virology, transmission, pathogenesis, and epidemiology are described. Unlike influenza, for RSV immunity is less clear-cut or easily established. Diagnosis and management of infections in infants are also discussed. Prevention is a problem, as there are no effective vaccines at present, and there was a disastrous vaccine trial using formalin-inactivated virus.

In summary, this is a comprehensive and very expensive book that surveys human viral pathogens. It is idiosyncratic in many ways. If I were asked if I would spend $450 for this book, my answer would likely be no. However, if it were available in a departmental book collection in a conference room, or in a university or hospital library, I would consult it.