Am. J. Trop. Med. Hyg., 68(6), 2003, pp. 753
Copyright © 2003 by The American Society of Tropical Medicine and Hygiene
CD-ROM REVIEW
CABI PUBLISHING'S TOPICS IN INTERNATIONAL HEALTH: Diarrhoeal Diseases
Dr. Herbert L. DuPont
University of Texas
School of Public Health/Medical School and Baylor College of Medicine
6720 Bertner Avenue, MC1-164
Room P153
Houston, TX 77030
hdupont{at}sleh.com
This, CD containsvoluminous information, illustrations, exercises and recommendations dealing with diarrheal diseases. The material is divided into eleven tutorials: 1. Overview; 2. Organisms and Pathophysology; 3. Defense Mechanisms; 4. Epidemiology; 5. Prevention and Control; 6. Acute Watery Diarrhea; 7. Acute Bloody Diarrhea; 8. Persistent Diarrhea; 9. Clinical Assessment; 10. Rehydration and Early Feeding; 11. The Role of Diet and Drugs.
The Tutorials have a variety of screens to graphically present the material. Approximately 50 screens are provided per tutorial. As an example of how a tutorial is developed, Chapter 2. Organisms and Pathophysiology is divided into 49 screens and includes sections dealing with Objectives, Introduction, Physiology, Fluid and Electrolyte Flux at the Cellular Level, Pathophysiological Mechanisms of Diarrhea and Mechanisms of Diarrhea Caused by Pathogens.
This is a wonderful review of diarrheal diseases, particularly, pediatric diarrhea in the developing world. The title might have been changed to more accurately reflect this population. Many other settings such as diarrhea of travelers, military, expatriates, immigrants, and adults and children in industrialized countries are not well developed. The view reflects the views on the topic as of the mid 1990s and many parts are out-dated, failing to include important data developed in the last five to eight years. While the reviewers are leaders in the field, the balance of the material might have been improved by including persons outside the United Kingdom in the review. In the section dealing with mechanisms of diarrhea only certain agents are discussed, including Shigella, rotavirus and Vibrio cholerae. A great deal is known about other agents and this material could have been included. Under infective dose of organisms it is stated that the lowest dose of organisms for diarrhea pathogens is for enteric viruses, followed by E. histolytica, followed by Giardia, at about 102, followed by Shigella at 104, Salmonella, 104 to 106 and E. coli and V. cholerae, 104 to 106. Enteric viruses are infective at a low dose, but not lower than Shigella and the infective dose of Shigella is far lower than that listed in this material. No infective dose material is given for Campylobacter or Cryptosporidium in the CD although this information is available. The document lists in multiple places the antimicrobials to use for treatment of shigellosis with ampicillin and trimethoprim/sulfamethoxazole being their first two choices. I know of nowhere in the world where these drugs remain active against prevalent Shigella strains. They remain of historical interest and should be removed from such a list. Fluoroquinolones are mentioned but said to be expensive and to have possible side effects. Other appropriate choices are included with no perspective on how to select an agent. Antimotility drugs are said in the document to have a limited role in the symptomatic management in adults which reflects current views for diarrhea treatment in the developing, not the industrialized world. In review of many of the sections, the most recent reference was 1997 and most references were in the time frame of 1985–1995.
The material is well organized. It is presented in an interesting, graphic, comprehensive and useful format. The perspective offered and material presented would be of value for persons attempting to learn accepted general principles of diarrheal disease pathogenesis, prevention and management. The most important limitation of the CD as mentioned before is the dated material. This reviewer hopes that the Wellcome Trust elects to undertake regular revisions to this otherwise marvelous document. While not up-to-date, it could be made so by regular review and up dating and this is strongly recommended.
The material was reviewed by nine persons from the United Kingdom: Professors A Ashworth, London School of Hygiene and Tropical Medicine; WAM Cutting, the University of Edinburgh; RH Behrens, Hospital for Tropical Diseases; RJD Moy, Institute of Child Health, The University of Birmingham; BS Drasar, London School of Hygiene and Tropical Medicine; SRA Huttly, London School of Hygiene and Tropical Medicine; MS Murphy, The University of Birmingham; G. Dougan, Imperial College of Science and Technology, London; and, IW Booth, The University of Birmingham.
