This book, originally published in 2004, is concerned with the links between human evolution and infectious disease. It has long been recognised that an important factor in human evolution has been the struggle against infectious disease and, more recently, it was revealed that complex genetic polymorphisms are the direct result of that struggle. As molecular biological techniques become more sophisticated, a number of breakthroughs in the area of host-pathogen evolution led to an increased interest in this field. From the historical beginnings of J. B. S. Haldane's original hypothesis to more recent research, this book strives to evaluate infectious diseases from an evolutionary perspective. It provides a survey of information regarding host-pathogen evolution related to major infectious diseases and parasitic infections, including malaria, influenza and leishmaniasis. Written by leading authorities in the field, and edited by a former pupil of Haldane, Infectious Disease and Host-Pathogen Evolution will be valuable for those working in related areas of microbiology, parasitology, immunology and infectious disease medicine, as well as genetics, evolutionary biology and epidemiology.

In spite of progress in biomedical research, we know little about the causes, prevention, and treatment of the numerous mental and neurological disorders that afflict up to 15% of all individuals. In the last decade, great advances have been made in the physiopathology of mental and neurological disorders, leading to at least a partial control of Parkinson's disease, epilepsy, certain psychoses, and anxiety syndromes. Despite the fact that an underlying specific neurotransmitter deficiency has been demonstrated in Alzheimer's and Parkinson's diseases, the immune dysfunction and viral hypotheses continue to be attractive for investigators dealing with these degenerative diseases of the aging brain, which afflict 10% of senior citizens. A retrospective epidemiologic study suggests that the encephalitis lethargica and parkinsonism were almost certainly caused by the 1918 influenza virus pandemics. It must be stressed that the etiopathogenesis of many mental disorders is not known, and this ignorance has led to several untenable neurophysiological and biochemical hypotheses. Epidemiologic investigations show a high prevalence of functional psychoses and organic mental disorders. Although many of them are conceptualized as biopsychosocial disorders, recent data indicate that the biological component appears more and more as a major etiologic factor. Among the various biological hypotheses, the viral and im munologic concept has become a significant one. In view of recent discoveries in virology and immunity, it becomes clear that viral and immunologic hypotheses should be inves tigated more systematically concerning the mechanisms of numerous mental and neu rological disorders."

The recent developments in modern vaccinology are mainly based on: (i) cloning of microbial genes into recombinant vectors containing genetic information for expression of desired neutralizing immunogens; (ii) alternatives of attenuated vectors with deleted genes permitting the insertion of several foreign genes expressing antigens exposed to the host immune system during the abortive replication of such vectors; (iii) combined vaccines with the aim to protect against many diseases with a limited number of administrations; (iv) evidence demonstrating the ability of animals to respond serologically to DNA injections considered as a potential method of vaccination; (v) the possibility to manipulate the immune system with new and improved immunomodulators enhancing the immune response; and (vi) new microcarrier systems for particular immunogens or immunomodulators delivery, either in a single dose or sustained release, and presentation to the immune system for a relevant response. New vaccines being developed are mainly based on viral, bacterial or other vectors modified with genetic engineering technology, to possess and express desired antigens for vaccination against single or multiple infections. Existing combined vaccines like diphtheria, tetanus, pertussis (DTP) are also experimented with new additional components like recombinant hepatitis B virus surface antigen, inactivated poliovirus, and Haemophilus inJluenzae type b immunogens, in order to produce multivalent vaccines. Such types of vaccines permitting the reduction of multiple medical visits is of particular interest to pediatric immuni zation programs, and would benefit especially the developing countries assuring better vaccine compliance with immunization schedules.

Leading experts provide the only comprehensive book examining all aspects of immune response and immune-based treatments for HIV infection. Contributions, divided into three sections, discuss basic mechanisms, immunopathogenesis of HIV infection, and immune-based therapies. Researchers thoroughly review vaccine-including prospects of T cell vaccine-and gene therapy for HIV infection. Additional topics include organization of HIV genes, the role of co-receptors in signaling of lymphocytes, and biological response modifiers. This reference is designed for basic and clinical researchers, internists, pediatricians, infectious disease specialists, neuropathologists, oncologists, and rheumatologists.

It is now just 40 years since coxsackieviruses were first isolated by Dalldorf and Sickles in the "eponymous" town of Coxsackie, New York. Yet the overall contribution of coxsackieviruses to clinically evident dis ease of humans is still largely an open problem. Following their discov ery, coxsackieviruses were under intense clinical and laboratory scrutiny for a long time. Because of their relationship to polioviruses, the under standing of their structure, biochemistry, biology, and epidemiology ad vanced rapidly as a result of the formidable efforts that eventually led to the defeat of poliomyelitis. The ability of these viruses to infect mice permitted dissection of their pathogenicity in an experimental host and elucidation of conditions that influence its expression. Coxsackieviruses have been progressively associated with an increasing array of widely diverse human diseases. However, only some of the suggested causal correlations have been substantiated with satisfactory certainty. For others, conclusive evidence has so far resisted investigation. Most impor tant, among the latter are chronic maladies, such as dilated car diomyopathy and juvenile diabetes, that demand consideration. In recent times, there has been a partial eclipse of the subject of coxsackieviruses in the medical literature. In addition to the difficulties encountered in pinpointing their pathogenic potential, possible reasons include the general decline of interest in enteroviruses, which ensued after the conquest of poliomyelitis, and the continuous appearance in the limelight of new, more esoteric, and therefore more "appealing" viruses."

Vaccination is one of the most efficient and cost effective methods of promoting human health and has been in clinical use for at least 200 years. Nevertheless, infectious diseases continue to constitute a constant threat to the well being of humanity. Common pathogens, once believed to be under control, acquire increased virulence and resistance to drugs, while exotic microorganisms emerged from hidden reservoirs to cause yet incurable diseases in humans. These changes, together with epidemic outbreaks related to political and socio-economic instabilities, increase the needs for the development of new, advanced vaccines. In this volume, devoted to the proceedings of the 39th OHOLO Conference, we present some of the recent strategies for the design and production of novel vaccines. The advent of recombinant DNA technology has stimulated the production of several subunit vaccines. In spite of the obvious advantages to this approach, the limited immuno genicity of many subunit candidates has hindered their development. Strategies to enhance the immunogenicity of subunit vaccines is therefore critical. Several approaches toward this goal, including design of novel adjuvants and delivery systems as well as design of advantageous carriers, are presented here. Among the carriers evaluated here are polypep tides (flagellin, HBV core antigen, J3-galactosidase), attenuated virions (Vaccinia, Sindbis), and nonpathogenic licensed bacteria (Salmonella)."

This SpringerBrief on Spx reviews the investigations that led to the discovery of Spx and its orthologs and ties together the results of various studies that have explored the function and control of spx in Gram-positive organisms. Spx of "Bacillus subtilis" has been extensively studied, but very little has been published about it. This book incorporates a number of studies that have been conducted in other Gram positive bacteria, which examined the role of Spx orthologs in stress response, bacterial development and virulence.

The book contains an overview that will introduce the protein and its orthologous forms, its association with RNA polymerase, the species of Gram-positive bacteria in which it is found, and the conditions in which it is abundant and active. Spx is a member of a large group of proteins belonging to the ArsC/Spx protein family, so the review touches upon the bioinformatic support for the protein family composition and its meaning with regard to protein structure/function.

It is now just 20 years since Gomatos and his co-workers at the Rocke feller University showed that the nucleic acid in reovirus particles is double-stranded RNA (dsRNA). This discovery created great excitement, for dsRNA was at that time under intense investigation as the replicative form of viral genomes consisting of single-stranded RNA. An equally interesting and important finding followed soon after: it was found that the reovirus genome consists, not of a single nucleic acid molecule, but of 10 discrete "segments," each with its specific sequence content and each transcribed into its own messenger RNA. It is clear now that these segments are genes. Not surprisingly, the availability of a viral genome 10 unlinked genes has permitted some unique lines of in consisting of vestigation in molecular biology. Mammalian and avian reoviruses proved to be but the first of several viruses recognized as sharing Similarity in size and morphology and ge nomes consisting of 10, II, or 12 separate genes. These viruses are dis tributed throughout living organisms; among the natural hosts of mem bers of this virus family are vertebrates, Insects, and plants. Members of the Reoviridae family differ widely in the virulence that they exhibit toward their hosts . . For example, the first discovered mam malian reovirus literally is, as the name signifies, a "respiratory enteric orphan" virus, that is, a virus unassociated with disease."

Reproductive tract infections (RTis) have become a silent epidemic that is devastating women's lives. Each year, thousands of women die needlessly from the consequences of these infections, including cervical cancer, ectopic pregnancy, acute and chronic infections of the uterus and the fallopian tubes, and puerperal infections. For many women, this happens because they receive medical attention too late, if at all. The terrible irony of this tragedy is that early diagnosis of and treatment for many RTis do not require high-technology health care. For the hundreds of millions of women with chronic RTis acquired from their sexual partners, life can become a living hell. Infection is a major cause of infertility, and it leads to scorn and rejection in many countries. These women may experience constant pain, have festering lesions of the genital tract, be at enhanced risk of second ary diseases, and endure social ostracism. The problems associated with RT s have grown even greater in the past decade with the emergence of human immunodeficiency virus (HIV) and AIDS. Preexisting sexually transmitted disease, particularly when associated with genital tract ulcers, raises women's vulnerability to the transmission of HIV 3-5 fold."

Iron Acquisition by the Genus Mycobacterium summarizes the early evidence for the necessity of iron in mycobacteria and the discovery of the mycobacterial siderophores mycobactin, carboxymycobactin, and exochelin. The structural characterization of the mycobacterial siderophores is described. The genes so far identified as essential for iron acquisition and maintenance of an infection by pathogenic mycobacteria are discussed. The potential role of siderocalin in iron gathering by M. tuberculosis is featured. Because new drugs for M. tuberculosis are needed, this brief also emphasizes the design of antibiotics that interfere with siderophore biosynthesis and the use of siderophore analogs and/or conjugates.

Research on cholera has contributed both to knowledge of the epidemic in particular, and to a broader understanding of the fundamental ways in which cells communicate with each other. This volume presents current knowledge in historical perspective to enable the practitioner to treat cholera in a more effective manner, and to provide a comprehensive review for the researcher.

This book, Mechanisms in the Pathogenesis of Enteric Diseases, is the outcome of the First International Rushmore Conference on Mechanisms in the Pathogenesis of En teric Diseases, held in September 1995 at Rapid City, South Dakota. The meeting was or ganized by members of the North-Central Regional Research Committee "NC-62," a United States Department of Agriculture-sponsored consortium of swine enteric disease researchers from land-grant institutions. This conference was conceived as a forum for an interdisciplinary discussion of mechanisms of infectious diseases. It was intended that such a discussion would stimulate cross-fostering of ideas and nurture synergistic collabo rations among scientists working on enteric diseases of humans and animals_. In atten dance, there were more than 140 participants from the United States and 12 foreign countries representing all of the world's continents. Participants brought expertise from many disciplines in both human and veterinary medicine. Multiple perspectives and an in formal atmosphere provided an environment for lively and thought-provoking discussions. Conference topics included Pathobiology of Gastroenteric Diseases, Mechanisms of Iden tity and Interaction between Host and Pathogen, Effector Mechanisms in the Pathogenesis of Enteric Diseases, Regulation of Pathogenic Activity in Enteric Diseases, and Novel Ap proaches to Prevention and Therapy of Enteric Diseases. Ten internationally renowned scientists gave keynote presentations in addition to 30 oral presentations and 39 poster presentations. The keynote speakers were Drs."

The intent of this book is to provide a practical approach to the recognition and therapy of selected outpatient problems faced by the internist, family practi tioner, house officer, physician's assistant, and nurse. The topics selected were based on problems often encountered by clinicians in the outpatient setting, as well as by the interests of the authors. No attempt was made to write an all encompassing textbook of infectious disease. We want to thank Dr. John Czachor, infectious disease fellow, Saint Vin cent Hospital, for his contributions to two chapters: mononucleosis and mono nucleosislike syndromes and selective laboratory studies. We want to thank Suzanne Hedstrom and Sharon Budzyna for typing and preparing the manuscript. Finally, we would like to give special recognition to our wives, Brenda, Roberta, and Bonnie, for their support during the preparation of this book. Richard A. Gleckman Nelson M. Gantz Richard B. Brown Worcester and Springfield v Contents 1 Immunization in Adults Richard B. Brown Definitions and Principles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Immunization in Special Clinical Situations . . . . . . . . . . . . . . . . 5 Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 College Students and Military Recruits . . . . . . . . . . . . . . . . . 6 Health Care Personnel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Travelers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Vaccines of Especial Use to Travelers . . . . . . . . . . . . . . . . . . . . 7 Typhoid Fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Yellow Fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Cholera. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Japanese B Encephalitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Immune Serum Globulin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Strategies for Use of Other Commonly Employed Vaccines in Specific Clinical Situations . . . . . . . . . . . . . . . 9 Tetanus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Rabies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Pneumococcal Vaccine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Viral Influenza . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Hepatitis B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 vii viii CONTENTS 2 Infectious Disease Problems for the Traveler Richard B."

The papers assembled in this collection comprise a majority of the oral presentations as well as several poster presentations given at the 22nd Annual Symposium arranged by the Bastern Pennsylvania Branch of the American Society for MicrobioloS)'. The symposium would not be possible without the generous support of the many sponsors (see sponsor list) or without the concerted effort of a11 the Committee members. This Symposium series has evolved into an annual Bastern Pennsylvania Branch ASM event that attracts participants from a wide geographie area. It should be noted that one of the hallmarks of these symposia involves interaction between the presenters and those in attendance. Several authors have altered their by the participants. Therefore, the manuscript that manuscripts based on comments fo11ows should be viewed as a group effort of both the participants and presenters. J ames Poupard Lori Walsh Bruee Kleger ix CONTENTS 1 Introduction 1: CURRENT METHODS The Evolution of Antimicrobial Susceptibility Testing Methods . . . . . . . . . . . . . . . 3 James A. Poupard, Stephen F. Rittenhouse, and Lori R. Walsh Antimicrobial Susceptibility Tests: Testing Methods and Interpretive Problems. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Patrick R. Murray Clinician Utilization of Rapid Antibiotic Susceptibility Data: A Prospective Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Franklin P. Koontz SESSION 2: CONTEMPORARY ISSUES IN SUSCEPTIBILITY TESTING When We Should Be Testing, How Often and What to Report . . . . . . . . . . . . . . . 35 Raymond C. Bartlett Areas of Recent Emphasis of the National Committee for Clinical Laboratory Standards Subcommittee on Antimicrobial Susceptibility Testing . . . . . . . . . . . . . . . . . . . . . . . 61 James H. Jorgensen Non-Traditional Approaches for Quality Control of Antimicrobial Susceptibility Tests . . . . . . . . . . . . . . . . . . . . . . . . .

Chlamydia pneumoniae is a bacteria that is most commonly known for causing colds and pneumonia. However, researchers have recently found a link between C. pneumoniae and atherosclerosis, a clogging of the arteries that causes heart attack and stroke. In addition, ongoing research is showing that certain strains may play a role in asthma, multiple sclerosis, Alzheimer's disease, and arthritis. This volume, part of the Infectious Agents and Pathogenesis series, is a complete portrait of C. pneumoniae and what is currently known about it.

The electrocardiogram (ECG) remains the most accessible and inexpensive diagnostic tool to evaluate the patient presenting with symptoms suggestive of acute myocardial ischemia. It plays a crucial role in decision making about the aggressiveness of therapy especially in relation to reperfusion therapy, because such therapy has resulted in a considerable reduction in mortality from acute myocardial infarction. Several factors play a role in the amount of myocardial tissue that can be salvaged by reperfusion therapy, such as the time interval between onset of coronary occlusion and reperfusion, site and size of the jeopardized area, type of reperfusion attempt (thrombolytic agent or an intracoronary catheter intervention), presence or absence of risk factors for thrombolytic agents, etc. Most important in decision making on reperfusion therapy and the type of intervention is to look for markers indicating a higher mortality rate from myocardial infarction. The ECG is a reliable, inexpensive, non-invasive instrument to obtain that information. Recently it has become clear that both in anterior and inferior myocardial infarction, the ECG frequently allows not only to identify the infarct related coronary artery, but also the site of occlusion in that artery and therefore the size of the jeopardized area. Obviously, the more proximal the occlusion, the larger the area at risk and the more aggressive the reperfusion attempt.

Although there are a number of excellent current reviews on one or another aspect of cytomegalovirus, the last comprehensive treatment of this subject was that of Krech et al. (197la). In view of the amazing advances in the virological, epidemiologic, and clinical knowledge of cytomegaloviruses, an up-to-date book is needed. Such a work should cover many areas of expertise and a voluminous technical literature. Each area might have been reviewed and analyzed by workers more expert than myself. However, I have embarked on the entire venture alone in order to attain unity and continuity in this book, characteristics that are not easily achieved in the more popular multiauthored works. I have tried to review the Iiterature and provide a critical summary for each area discussed. To do this, I provide as much of the primary data of the relevant works as needed and not just the qualitative conclusions. Inevitably, the flow of the narrative may be interrupted by dry facts and figures. However, such information is essential to make this a meaningful reference work. But for those not interested in such details, I have provided at what I hope are crucial points critiques and summaries. This book is not an exhaustive review of all the literature. This is probably no Ionger possible or even desirable. By selection, however, one runs the risk of having missed or ignored important papers. I am keenly aware of this, and I wish to apologize for such oversight, if that is possible.

It would have been difficult at the beginning of the 80's to have predicted that by the end of the decade, Medical Virology would have become one of the most important topics in the area of both basic and clinical research. Although we were expecting a progressive increase in awareness of the role played by viruses in different diseases, we did not expect the outbreak of a fatal disease that was going to shake the roots of our society. The appearance of the human immunodeficiency virus (HIV-1) in the early 80's, has prompted a unique re search impetus in the area of Medical Virology. The knowledge that we are gaining in our attempt to understand the biology of HIV-1 and the immuno logical response to this virus should not only help us control the spread of this virus, but should also help us to better understand other viral infections. Let us hope that during the 1990's we can learn how to control HIV-1 infections so that by the end of the decade, no more human lives succumb to an infection with this virus. Luis M. de la Maza Irvine, California Ellena M. Peterson March, 1990 v ACKNO EDGEMENTS We would like to thank all the speakers that came to San Francisco and shared their knowledge during the lectures and for writing the chapters in this book."

Proceedings of the FEMS Symposium on Genes and Proteins Underlying Microbial Urinary Tract Virulence: Basic Aspects and Applications, held September 16-19, 1999, in Pecs, Hungary. Urinary tract infections are among the most frequent diseases caused by microbial pathogens. In this volume, researchers, clinical microbiologists and clinicians exchange the latest ideas covering four major aspects of this important topic: * Genetic information, synthesis and assembly of virulence factors in urinary pathogens; * Regulation of genes involved in the phenotypic appearance of virulence; * Host-parasite interactions determining the process and outcome of the infection; * Possible applications of the above aspects in diagnosis, therapy and prevention.

This volume contains selected contributions from individuals who attended the Sec ond International Conference of the International Council for Global Health Progress (ICGHP) held at UNESCO in Paris, France, on January 15-17, 1996. This conference brought together experts in many disciplines that deal with the devastating diseases of cancer and AIDS with a focus on the concerns for quality of life. The ICGHP fosters mul ticultural and, multidisciplinary approaches to global health problems to help influence governments and other international health organizations to emphasize prevention and care of diseases and to understand their scientific, social, and cultural features. The Coun cil encourages the interchange of information on health problems and policy and supports educational funding for the public at large. Its objective is to effect diseases-free lives in the world community. Participants of the conference included scientists, sociologists, government leaders, physicians, health care providers, epidemiologists, religious leaders, company officials, ethicists, and philosophers. They examined and discussed the many variables involved in quality of life for people affected with cancer and with AIDS. The volume's text begins with introductory comments by officials attending the JCGHP conference. Subsequently, a chapter is dedicated to one aspect of quality of life, be it definition, scientific research, evolution, cultural changes, ethics, measurements, or other issues dealing with health care and treatment survival. The second part of the volume includes commentaries dealing with fi ve aspects of quality of life which merit consideration."

The idea for compiling a book on coccidioidomycosis first began to take shape in my mind in 1976 at an annual meeting of the Coccidioidomycosis Study Group (see Chapter 23) in Palo Alto. In my discussions with the chairman, Demosthenes Pappagianis, we agreed that considerable data had accumulated in the almost 20 years since the publication of Marshall Fiese's landmark book, Coccidioidomycosis (Charles C Thomas, Spring field, Ill. , 1958). Pappagianis encouraged me to consider writing a new book. Also about this time, my Stanford colleague Tom Merigan was collaborating in assembling a series of texts on infectious diseases, and he added his encouragement to that of Pappagianis. I planned to enlist the collaboration of my colleagues for the multiauthored work I had conceived to encompass the various facets of coccidioidomycosis. The more I worked, the more I appreciated the effort that had gone into the Fiese book. I hope the final product is a useful, readable, and comprehensive text and reference source for this disease and a worthy successor to the Fiese book. This volume places greater emphasis on the basic science background of present clinical experience and attempts to examine critically the data base and how it fits with recommendations made in the clinical literature. In some of the contributed chapters, I made virtually no changes; in others, I battered them to fit my preconceptions.

Catheter-Related Infections in the Critically Ill provides an overview from an international perspective on intravascular catheters and the risk of infection. This volume highlights: Epidemiology Diagnosis Impact of Infection Management and Treatment Prevention - including Education as the Primary Tool for Prevention The purpose of this book is to provide the practitioner with the most interesting and useful data in the field of catheter-related infection. It is hoped that the strategies to prevent infection detailed by the authors will be implemented and have a measurable impact in decreasing rates of infection in the intensive care unit setting.

Busy clinicians and health practitioners recognize the importance of speedy detection of pathogens to impede the further spread of infection, and to ensure their patients' rapid and complete recovery. This reader-friendly reference is a unique collection of the newest and most effective diagnostic techniques currently in use in clinical and research laboratories. Instructive commentary regarding the application of these often complex methods is provided. This essential text aids readers in selecting the most efficient method, finding the necessary resources, and avoiding the most common pitfalls in implementation.

Although virology and immunology are now considered separate disciplines, history shows that these areas ofinvestigation always overlapped and one cannot really exist without the other. This trend has become particularly significant and fruitful in the past few years in the area of herpesvirus research. The genomes of the most important herpesviruses have been sequenced, a significant portion of their genes have been identified, and many secrets of regulation of gene expr- sion have been unraveled. Now this progress sets the stage for a true revolution in herpesvirus research: analysis of interactions between the host and the virus. Because herpesviruses can induce, suppress, and fool the immune system, the most productive herpesvirologists are also expert immunologists, and the current results ofthis interdisciplinary effort are truly remarkable. Because herpesviruses cause many important human diseases, the devel- ment of vaccines against these agents is a very significant goal. This effort is also very challenging because of the complexity of herpesviruses and the lack of sufficient information about immune responses. The remarkable ability of herpesviruses to escape immune responses is - other feature that brings immunology and virology together. Herpesviruses - code many proteins that interact with and down-regulate some key elements of the immune system. Thisproperty of herpesviruses represents amajor challenge in developing strategies against these viruses. On the positive side, these viral proteins also provide novel tools for analyzing specific immune reactions and molecular mechanisms.

The aim of this book is not to encourage defensive medical practice, but to help provide better, optimum care to patients and to be forth right and honest to our dear customers about our inevitable mistakes.This book will focus on clinical issues facing physicians in different settings (which can lead to malpractice), and the best approach to use to avoid litigations, and practice good medicine.