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Book Review
Polymicrobial Diseases
K.A. Brogden and J.M. Guthmiller, editors
ASM Press, Washington, D.C., 2002, ISBN: 1-55581-244-9, Pages: 446, Price:
$115.95
Suggested citation for this article: Haverkos
HW . Polymicrobial diseases (book review). Emerg Infect Dis [serial
online] 2003 Jan [date cited]. Available from: URL: http://www.cdc.gov/ncidod/EID/vol9no1/02-0487.htm
Polymicrobial diseases involve multiple infectious agents and are referred
to as complex, complicated, mixed, dual, secondary, synergistic, concurrent,
polymicrobial, coinfections. This new book, a collection of 21 chapters
written by a variety of authors, reviews mixed infections in animals and
humans. The chapters are gathered into sections on polyviral diseases,
polybacterial diseases, viral and bacterial infections, fungal infections,
infections resulting from microbe-induced immunosuppression, and a concluding
perspective. Polymicrobial diseases described include abscesses, AIDS-related
opportunistic infections, conjunctivitis, gastroenteritis, hepatitis,
multiple sclerosis, otitis media, periodontal diseases, respiratory diseases,
and genital infections. Approximately two-thirds of the chapters deal
with human diseases; the others discuss infections in cattle, goats, and
pigs.
The chapters are generally well written with a focus on microbiology,
pathogenesis, and to a lesser degree, treatment. The chapters on abscesses,
multiple sclerosis, and mixed mycotic infections are especially informative.
The chapter on abscesses provides a comprehensive review of the microbiology
processes involved, the role of anaerobes in mixed infections, and animal
models. The section on viruses and multiple sclerosis is provocative in
its proposal that several viruses might coexist and interact to promote
multiple sclerosis and other neurologic diseases. The list of candidate
etiologic agents includes Human herpesvirus-6, human T-lymphotropic
virus type 1, measles viruses, JC virus, Epstein-Barr virus, and herpes
simplex virus-1. The chapter on mixed mycotic infections adequately discusses
how fungi interact by mechanisms such as commensalism, opportunism, mixed
colonization, co-isolation, and dual and polymicrobial infection.
Growing two or more microbes in the laboratory in a clinical situation
does not prove that a polymicrobial infection is the cause of the disease.
The editors and authors do not provide a framework similar to that of
Robert Koch or Bradford Hill, which one can use to decipher the role(s)
of each candidate agent in a polymicrobial disease. A limited discussion
is provided on the role of noninfectious factors, such as genetics of
the host, retained “hardware,” alcohol in hepatitis, or tobacco
use in respiratory diseases. How each of the chapters was selected for
inclusion and what other topics were considered is not clear.
The reference lists are one of the book’s strengths but also a weakness.
The lists are extensive, occupying about 30% of the book’s pages.
Prioritizing the outside readings on each topic would have been useful.
Several of the chapters might have been combined, such as the two on periodontal
diseases, those on retroviruses, and those on respiratory diseases in
humans, cattle, and pigs. In the next edition, the authors might explore
the polymicrobial etiology of Reye syndrome, autoimmune disorders, atherosclerosis,
and cancers, such as Kaposi sarcoma, hepatocellular sarcoma, and cervical
cancer. I recommend the book to those who think beyond the “single
agent, single disease” framework and imagine multifactorial causes
for those diseases currently listed as “etiology unknown.”
Harry W. Haverkos
Food And Drug Administration, Rockville, Maryland
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