Microbes and Infections of the gut

Abstract

The ambitious objective in the decision to produce this book was, the editor points out in his preface, to include in a single volume "a discussion of bacterial, viral, protozoal and helminthic gut infections, bacteria overgrowth syndromes, and the role of gut bacteria in carcinoma of the colon and abdominal wound infection". Furthermore, the team of contributors intended to "provide for the physician and the microbiologist and immunologist, a synthesis of the old with recent developments in microbial gut disease, and also to bring together subjects that usually appear in different specialist textbooks on infectious diseases, gastroenterology, surgery, microbiology and immunology". These are formidable targets, indeed. The dust cover summarizes the purpose of the book more briefly: "to provide the graduate gastroenterologist, microbiologist and infectious disease physician with a synthesis of current knowledge and recent developments in gut microbial disease". The 12 contributors thus set themselves a very difficult task; most are working in Australia, but with some notable exceptions such as T.H. Flewett, R.J. Gross and B. Rowe. The book opens with a competent account of the development of the infant gut flora (S.P. Borriello and S. Stephens, p. 1); necrotizing enterocolitis is well covered. Immunological aspects of the intestinal lymphoid system are dealt with by G.N. Cooper (p. 27). There then follow 5 chapters on infections of the human gut by salmonella, campylobacter and shigella (B. Rowe and R.J. Gross, p. 47), Escherichia coli (R.J. Gross and B. Rowe, p. 79), cholera and other vibrios, Aeromonas and Plesiomonas (C.S. Goodwin, p. 103), enteric fever (J. Schneider, p. 129) and food poisoning due to Staphylococcus aureus, Clostridium perfringens and Bacillus cereus (J. Schneider, p. 149); these are all competent accounts. The next chapter is an excellent up-to-date review of the virology of acute diarrhoea by T.H. Flewett (p. 159). M. Gracey (p. 187) contributes an essay on "the challenge of childhood gastroenterologists"; that includes some Third World data including some from his own work in Indonesia. Oral rehydration techniques are summarized. Chapter 10 deals with intestinal protozoal and helminthic infections (D. Grove, p. 209); there are certain gaps here-cryptosporidium and other coccidia are for example not mentioned, and we are told that "a new agent, praziquantel, is currently under investigation" for the treatment of schistosomiasis! The account of gastrointestinal tuberculosis (and Yersinia infections) (C.S. Goodwin, p. 241) is inadequate. Abdominal tuberculosis is a very common and grossly underdiagnosed entity in the Third World and should have received far more intensive coverage than this. G.N. Cooper (p. 253) reviews immunization procedures including cholera and typhoid vaccinations, and some of the public health aspects of gastroenteritis-which includes "travellers' diarrhoea"-are dealt with by C.S. Goodwin (p. 269); ways in which the mortality from gastrointestinal disease in the Third World can be reduced are discussed. Regulation of normal gut bacteria, and bacterial overgrowth syndromes are reviewed by P.J. McDonald (p. 289) and the management of gut-derived sepsis (following surgery and cancer chemotherapy) by P.J. McDonald, J.McK. Watts and J.J. Finlay-Jones (p. 307). The book concludes with two chapters by S.P. Borriello (pp. 327 and 347) on the role of Clostridium difficile in intestinal disease, including pseudomembranous colitis, and gut bacteria in relation to chronic carcinoma. All chapters are followed by a reference list; whereas some are up-to-date, others definitely are not; one wonders about the gestation time for this book. The index (13 pages) is just adequate. Have the contributors achieved what they set out to do? There can be no doubt that they have brought together a vast amount of information, much of it recently acquired knowledge, on gastrointestinal infections. Clearly much of this information is available in other texts, but this team of contribu