Journal of Antimicrobial Chemotherapy (1999) 43, 849–852
JAC
Book reviews
Probiotics: a Critical Review
G. W. Tannock, Ed.
Horizon Scientific Press, Wymondham, UK, 1999.
ISBN 1-898486-15-8.
£59.99.
Do you buy bioyoghurt because (to quote a 1970s’ TV
advertisement for an alcoholic beverage) “it looks good,
it tastes good and by golly it does you good”? Wrong!
According to the Introduction of this book you buy it
because its “organoleptic and rheological characteristics”
are preferable to regular yoghurts, and you have a vague
idea that “consumption of the product will contribute to . . .
well-being”.
Probiotics is, however, a serious subject that involves
much more than bioyoghurts. The concept that the body
flora can be modulated in a way beneficial to health is as old
as the century, but is only just emerging from the shadows of
‘alternative medicine’. One only has to observe the pro-
liferation of health food outlets and articles on ‘healthy
living’ in the Sunday supplements to realize the importance
of the topic. Think about it: the public is, in large numbers,
seeking out viable bacteria in order to consume them on a
regular basis. Surely this practice must be the concern of all
microbiologists: is it safe, helpful, well regulated, desirable?
Some of the answers, or at least clues, will be found from
reading this book. There are 10 chapters, written by
acknowledged experts—food scientists, animal scientists,
microbiologists and one representative from industry—
from seven countries. Topics covered include several
aspects of intestinal flora, probiotics in farm animals (a hot
subject now that antibiotics as growth promoters appear to
be being phased out), immunology, clinical trials and pre-
biotics (specific feeding of one’s own ‘friendly’ bacteria).
I missed comments on the usefulness of API kits for iden-
tifying lactobacilli and bifidobacteria; if one has to use
molecular methods for all identifications, only specialist
laboratories will be able to participate. This would be a
pity, as if ever there was a field where the gifted amateur
can still contribute, probiotics is it.
There is a lot to absorb in this book, but it is worth the
effort. For beginners, I recommend reading it as a main
course after you have experienced the aperitif of the con-
tents of Supplement 2 to the British Journal of Nutrition,
volume 80 (1998).
J. M. T. Hamilton-Miller
Department of Medical Microbiology,
Royal Free and University College Medical School,
London NW3 2PF, UK
849
© 1999 The British Society for Antimicrobial Chemotherapy
Slide Atlas of Infectious Diseases, Volume I, AIDS,
2nd edition
G. L. Mandell, Ed.
Harcourt Brace, 1998.
ISBN 0443-07554-9.
£500.00.
Volume I of the Slide Atlas of Infectious Diseases addresses
one of the major global health issues of the current age,
namely HIV infection. The Atlas’s approach to HIV infec-
tion is encyclopaedic in scope and magisterial in style.
There are 33 contributors, all renowned experts in their
field of HIV medicine, 20 chapters, each referenced and
supplemented by a selected bibliography and 500 high
quality transparency slides. The subjects included within
this volume include the epidemiology, natural history and
prevention of HIV infection, basic virology and immuno-
pathology, 14 chapters dealing with clinical manifestations
and two ultimate chapters describing the principles and
practice of highly active antiretroviral therapy (HAART).
Every slide in this volume has a corresponding written
vignette which expands and explains the data or clinical
appearances projected.
This physically large and slightly clumsy volume will be
used primarily by clinical teachers as a resource centre and
in libraries as a self-directed learning tool. Given its high
cost, this volume is not aimed at the individual clinician as
a purchase for their personal library. The material is ideal
as a framework or core for teaching programmes, for
example, the didactic teaching of specialist registrars in
GU medicine and will be used to provide supplementary
material for undergraduate lecture courses. In addition, it
will be of especial value to younger and less experienced
HIV physicians, in particular those who have not experi-
enced at first hand the ravages of this disease in the pre-
antiretroviral therapy era. Such colleagues will be afforded
a very accurate and cogent retrospective on this disease as
it was, and, I hope and trust, will never be again.
My criticisms are few. It is inevitable that, given the
speed of scientific development and the depth of under-
standing of HIV disease in all its virological and immuno-
pathological dimensions, this volume and its references will
quickly become passé. The most current references are
1996 and bring one up to date at the time of the 11th Inter-
national Conference on AIDS held in Vancouver in 1996.
Users seeking up-to-date information and guidance on
HAART will be better served by accessing one of the many
quality HIV oriented Web sites.
There is little, if any, material in this volume pertaining
 Book reviews
to HIV disease in the under-developed world where 90%
of HIV disease exists. The principles of HIV medicine may
be the same, but the clinical expressions can be very differ-
ent in the tropical context. Some of the slides have triple
and quadruple elements which appear crowded and thus
indistinct. The pages within the ring binder folder do not
turn easily and access to the centre and latter chapters can
be clumsy and awkward.
These minor criticisms apart I regard this volume as an
excellent contribution to the resources of busy clinical
teachers. I propose to use my copy as the framework on
which the teaching of specialist registrars in GU medicine
will be based. I accept fully that additional information, in
particular data pertaining to antiretroviral therapy, will be
required from more up-to-date sources. In the meantime I
cannot wait to access and use the electronic version of this
useful volume.
S. C. Glover
Consultant Physician,
Southmead Hospital,
Department of Medicine,
Westbury-on-Trym,
Bristol BS10 5NB, UK
Cases in Medical Microbiology and Infectious
Diseases (book), 2nd edition
P. H. Gilligan, M. L. Smiley and D. S. Shapiro
MICRO II Cases in Medical Microbiology (CD-ROM)
R. Twarog, P. H. Gilligan, M. L. Smiley and D. S. Shapiro
Blackwell Science, Oxford, 1997.
ISBN 1-55581-106-X.
£62.50.
Cases in Medical Microbiology comprises a soft-backed
textbook and accompanying CD-ROM and attempts to
‘challenge students to develop a working knowledge of the
variety of microorganisms that cause infection in humans’
through a problem-based approach. The book contains
details on 70 cases (said to be from actual patients) and asks
questions in four areas: the organisms’ characteristics and
laboratory diagnosis, pathogenesis and clinical characteris-
tics, epidemiology, and prevention; drug treatment is, quite
correctly, only addressed when there is a clear consensus
on therapy. Forty cases are new to the 2nd edition and
many of the remainder are revised; cases are arranged in
the six major organ systems and in new and re-emerging
infectious diseases. Each section has a useful introductory
overview and tables of commonly encountered organisms.
There is a table of normal laboratory values and a glossary
broadens the audience of the text beyond the medically
850
qualified. The text is lavishly illustrated with 101 colour
plates in 336 pages and addresses the whole gamut of infec-
tious agents including bacteria, fungi, parasites, viruses and
prions. This is an enjoyable approach to self-learning,
encouraging the student to develop a differential diagnosis
and is a useful adjunct to any medical course with a
dwindling hands-on approach to microbiology.
The CD-ROM is a multimedia version of 34 selected
cases that can be run (entirely from the CD-ROM) on most
PC-compatible computers with any Windows platform and
8 megabytes of RAM: installation on a hard-drive or server
requires 50 megabytes of free disk space. As in the hard
copy version, one is provided with a scenario, patient
history and significant findings (often the most appropriate
details in reaching a diagnosis). One may then ‘visit’
chemistry, haematology or microbiology laboratories or
the radiology department to request any tests one deems
necessary to make a diagnosis. If an appropriate test is
requested, results are given: in the case of the microbiology
laboratory (which, I feel, will be used the most), these may
be in the form of an image or images. Upon collation of
results, a series of MCQs ensures that the correct diagnosis
has been made.
Again, this approach encourages the development of a
differential diagnosis and intelligent use of laboratory facil-
ities as the price of each test is added to the bill! The temp-
tation is to make a diagnosis as cheaply as possible;
however, hundreds of dollars (this is an American product)
saved in attempting to make a diagnosis must be weighed
against the thousands of dollars at stake in any litigation
case. Further, the introduction of a price per test does not
make the product inflation proof. Interestingly, I did not
find the CD-ROM as enjoyable as the book, which is excel-
lent and amply meets its goal. However, there does not
appear to be a user fee and the disk would be an inexpen-
sive acquisition for a medical school network, for example.
T. Winstanley
Department of Microbiology,
Royal Hallamshire Hospital,
Sheffield, UK
Sexually Transmitted Diseases: Methods and
Protocols
Rosanna W. Peeling and P. Frederick Sparling
Humana Press, Totowa, New Jersey, 1999.
ISBN 0-89603-535-2.
$89.50 pp. 244.
This is a well written, comprehensive summary of molecu-
lar methods that are used for the diagnosis of sexually
transmitted diseases and for typing of the causative agents.
It is designed to be dipped into, with each chapter being
 Book reviews
complete in itself. However, the general opening and sum-
mary chapters are particularly good and should not be
overlooked. The introductory chapter gives an excellent
brief overview of the diagnosis of STDs over the past 30
years and puts into context the enormous impact that
molecular methods have had and the current breath-taking
pace of new developments. The main body of the book is
divided into two sections ‘Molecular techniques for the
detection of sexually transmitted diseases’ (seven chapters)
and ‘Research techniques for epidemiology and the
management of STDs’ (five chapters). Contributions by
international experts cover the major bacterial (Chlamydia
trachomatis, Haemophilus ducreyi, Neisseria gonorrhoeae,
Treponema pallidum and Mycoplasma spp.) and viral
(HIV, HPV and hepatitis B) sexually transmitted
pathogens.
Although this is a multi-author book, there is very little
repetition of information, and the editors have been careful
not to over emphasize the importance of any one STD. It
was nice to find a positive emphasis on methodologies
pertinent to field studies in under-developed countries. For
example, one chapter details the use of dried plasma speci-
mens for HIV viral load monitoring. Also of interest was
a multiplex PCR for genital ulcer diseases caused by T.
pallidum, herpes simplex virus and H. ducreyi, which are
clinically difficult to differentiate. Each chapter reviews the
literature first and then gives practical details of two or
three selected methods. The literature reviews are particu-
larly useful as a starting point for anyone new to the field,
making sense of what can seem a bewildering array of
papers each advocating a different method to be of
superior sensitivity and specificity. The protocols that are
chosen for detailed description are broken up and dis-
cussed section by section under the headings of equipment,
sampling, materials and methods. Whilst this allows easy
cross-referencing between the particular requirements of
different protocols, it does make individual protocols a
little disjointed and difficult to follow. Also, in an attempt
to provide practical step-by-step protocols, the contribut-
ing authors have had to relegate important explanatory
commentary and useful tips to what can be rather unwieldy
‘notes’ sections at the end of each chapter (some are up to
10 pages long).
The final chapter of this book looks towards the uses of
molecular techniques for the research and control of STDs
in the new millennium and airs some of the more thorny
issues such as the cost implications of moving towards non-
culture based methods of diagnosis, and of screening pro-
grammes. It also highlights the likely impact of molecular
methodology on the management of STDs in developed
and under-developed countries. In summary, I was
impressed with this book and found it very helpful in bring-
ing my own knowledge up to speed on the typing and diag-
nosis of those diseases which are peripheral to my main
areas of interest. It will be a valuable text for anyone
directly involved in, or simply wishing to be well informed
851
about current molecular methodologies used in the diag-
nosis of STDs.
Helen M. Palmer
Genitourinary Infections Reference Laboratory (GUIRL),
Public Health Laboratory,
Bristol BS2 8HW, UK
Clinical Virology
Douglas D. Richman, Richard J. Whitley and Frederick G.
Hayden, Eds.
Churchill Livingstone, London, 1999.
ISBN 0-443076-537.
£126.00.
This new textbook of virology is a testament to the growing
importance of clinical virology in medicine. This is a multi-
author book with many of the authors international experts
in their respective field. The contributors are mostly from
the USA with a handful from Europe and Australia and the
book has a North American slant. The book is divided into
two sections. Section I describes system-based infections
and general principles, and Section II, specific viral agents.
This book is full of information and a great effort has
been made to keep it up to date; with a rapidly growing
subject such as virology this is quite an achievement. The
chapter on antivirals describes the new non-nucleoside
reverse transcriptase and protease inhibitors and that on
Hantavirus includes recently described hantavirus pul-
monary syndrome. HHV6, HHV7, Kaposi sarcoma
associated herpes virus (HHV8) and hepatitis G viruses are
all included in the book. The introduction has a very useful
chart of taxonomy of human viruses. All the chapters are
well referenced with a range of one hundred to more than
six hundred references.
I enjoyed Section I immensely. This section would be of
particular use to clinicians as it succinctly described virus
infections under clinical rather than virological headings.
Besides the expected chapters on infections of central
nervous, respiratory and gastrointestinal systems there are
also chapters on heart and muscle, skin and eye infections.
Chapters on chronic fatigue syndrome and infections in
organ transplant recipients are very timely. It is, therefore,
surprising that there is nothing on congenital or vertically
transmitted infections in this section, although this area is
covered under individual viruses in Section II. This is some-
thing that the editors might want to correct in later editions.
Coverage of general topics such as viral vaccines and labo-
ratory diagnosis is, out of necessity, limited in scope.
Disappointingly the chapter on vaccines does not discuss
the principles of vaccine production or immunization
strategies but describes the current vaccines and vaccina-
tion schedules in the USA. This deficit is more than made
 Book reviews
up for by the interesting read provided by the chapter on
gene therapy and viruses.
Readers need not worry that individual viruses have
been neglected; there are still more than a thousand pages
devoted to these. They are conveniently divided into RNA
and DNA viruses and the editors have done well to main-
tain a standard style throughout the chapters, although the
length of each is variable. They are divided into sections
dealing with virology, epidemiology, pathogenesis, clinical
manifestations, laboratory diagnosis and treatment/
prevention. The expertise of the authors is reflected in the
detail of the chapters.
Besides the text, the strength of book lies in its charts,
tables and algorithms that give, at a glance, diagnostic and
management protocols. The uninitiated will find this very
useful, as the text is at times hard going, especially for non-
virologists. There is also an excellent colour plate section.
This book will be of interest to virologists (clinical and
scientific), microbiologists, infectious disease physicians
and any one else interested in clinical virology. At £126 it
is not too expensive compared with other textbooks of
similar nature. It should be a serious contender for depart-
mental and hospital libraries and serious students of
virology would benefit from a personal copy. If I was to
have only one textbook of clinical virology, this is the one
I would choose to have on my personal bookshelf.
G. Kudesia
Public Health Laboratory,
Northern General Hospital,
Herries Road,
Sheffield S5 7AU, UK
Managing Infections
C. A. Bartzkas and G. W. Smith, Eds
Bios Scientific Publishers,
Oxford, 1998.
ISBN 1-859961-711.
£24.95.
This book is intended to provide a framework for the
evidence-based management of infections. It contains
852
entries for 90 or so conditions which are grouped by organ
system. Rather than present model plans of management
or algorithms as in traditional texts, it gives a range of
possible management options. Each of these is accom-
panied by comments marked with a tick (good) or a cross
(bad). The approach is non-directional; there is no recom-
mended management. The options are followed by history
and examination checklists and sections devoted to ‘rituals
and myths’, pitfalls and useful hints. A list of further read-
ing follows the entry for each condition.
The layout of the book is logical and easy to follow. The
checklists are sensible and the hints helpful. The rituals and
myths sections are full of common-sense debunking and
mirror my own prejudices. My quibbles are with the
management options which are the guts of the book.
First, the format is not consistent; some entries take the
form of case histories, some are just lists of options.
Secondly, the non-directional approach does not rank the
management options (and some options are better than
others); adding up the ticks and crosses is no substitute.
Finally and most seriously, there are no references at all in
this book, only lists of recommended reading. Doubtless,
providing references would have doubled the size of the
book and rendered it out of date very quickly, but without
them the book cannot really be described as evidence-
based.
Overall, this book is a stimulating read and full of prac-
tical advice. Practising microbiologists will recognize the
clinical scenarios which are presented and the lists of
management options are like those which emerge during
discussions with clinicians. The authors have deliberately
avoided ranking the options. This encourages readers to
think through the possibilities, but does not provide guid-
ance. The book does not provide the evidence base for its
many assertions but it is doubtful whether a book of this
size could. The book is probably best used as a basis for
tutorials or as a spur to clear thinking in clinical practice. It
is not a practice guide as the publishers suggest.
R. Bendall
Consultant Medical Microbiologist,
Public Health Laboratory Service,
Truro, UK