Cutaneous Manifestations of Infection in the Immunocompromised Host

This textbook, an update to the first edition published in 1995, attempts to provide physicians a concentrated and comprehensive appreciation of the skin as a critical organ to be inspected during the evaluation of the immunocompromised host. Indeed, the spectrum of such patients in modern medicine is expanding, not only from the increasing numbers of patients, but also from the diverse armamentarium of immunosuppressants. The management of infections in the patient with abnormal host defense can be daunting, in part because of the array of potential pathogens; the variability in clinical presentation and course; and the necessity for rapid implementation of appropriate antimicrobial therapy to optimize chances for survival. This book contributes to the care of such patients by focusing exclusively on, and thus raising awareness of, the skin manifestations of infectious diseases in these patients. Although infectious disease physicians may be attracted to the book's topic, it should be noted that its organization is distinctly different from that habitually found in other books geared to the clinician dealing with infections. Rather than using a microbial approach organized into familiar taxons (eg bacteria, mycobacteria, fungi, parasites) and/or a syndromic approach (eg macules/papules, nodules, etc.), followed by a top-down strategy, the book is organized into an intertwined mixture of such chapters, which I found a little awkward at times. For example, the first chapter, on “Subcutaneous and Deep Mycoses” is divided into sections on specific organisms (eg Aspergillosis; Candidiasis; Scedosporium and Pseudallescheria). This is then followed by the chapter on “Hyalohyphomycosis”, potentially providing the impression to those less familiar with medical mycology that this is a separate entity caused by fungal pathogens distinct from the preceding chapter. This chapter is then followed by one on “Superficial Mycoses”, but in which mucosal candidiasis is noticeably absent. The chapters on bacteria (which, in my experience, are one of the more common causes of skin infections in immunocompromised hosts) are preceded by several chapters on arguably less common pathogens (eg Algae; Rickettsiae; Protozoa). Thus, the infectious disease clinician may need to adapt to this book's distinct didactic style. This book is intended to be a clinical dermatological manual. In this regard, the various sections are extremely and amply well illustrated. The photographs are in color, well illuminated, and focused beautifully for the characteristic lesion discussed to be easily identified. In those cases attempting to demonstrate progression of the lesion, fantastic sequential photographs are provided. The captions accompanying each image are clear and concise. The images are strategically well-placed, in the relevant section on the discussed pathogen, preventing the reader from flipping through pages to find the figures, as sometimes occurs for other dermatological books. For the occasional histological figure, however, instructional arrows supporting the caption may be considered in future editions. For the non-infectious disease physician, the text on each pathogen is simple, concise and sufficiently informative, summarizing material from the standard textbooks of infectious diseases. However, it is certainly not meant to be comprehensive: the sections do not delve into microbiology, pathogenesis from the immunocompromised host's perspective, and only occasionally are treatment options mentioned. The authors performed a monumental task of reviewing published literature on the various skin manifestations reported with each pathogen. What I would have preferred is to structure the text in a way that first focuses on the “classic” skin lesion by the respective pathogen, and then to proceed to a table format listing the plethora of other “atypical” skin manifestations identified from the case reports. Organizing it as such would have been less distracting, at least for this reader. For those seeking further information, the sources in the reference lists are well chosen. What I particularly enjoy when reading infectious disease textbooks (or even better, discussing these books with their respective authors/editors) are clinical pearls, reflecting wisdom from lessons learned under years of experience. This aspect reflects the beautiful apprenticeship that is clinical medicine. In this regard, this book provides such golden nuggets of dermatological information, particularly in the Introduction and in the chapter, “Clues to the Diagnosis of Skin Lesions in the Immunocompromised Host.” I applaud the authors for this herculean endeavour of putting together a text that attempts to concisely describe skin presentations of infectious diseases in immunocompromised hosts. For physicians and allied care personnel involved in managing such patients, this book will visually complement standard textbooks of infectious diseases. Potential conflicts of interest. Board member: CSL Behring (Canada) and Sunovion, Consultant: Pfizer, Grants: CSL Behring (Canada), Speakers' Bureau: CSL Behring (Canada) and Sunovion. The author has submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

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