Legionella is a deadly pneumonia that has a high mortality rate among the elderly. The detailed protocols outlined in this new book in the 'Methods in Molecular Biology' series will extend our understanding of the bacterium and aid its elimination from our water supplies.

A there it is! guide to insects of medical and public health concern, mainly in the tropics. Each chapter covers identification, life cycle and habits of the causative stage and its medical/public health significance.

Severe Infections Caused by Pseudomonas aeruginosa emphasizes controversies worldwide in the diagnosis, treatment, prevention and pathogenesis of pseudomonas aeruginosa infections. By including both chapters written by European authors and chapters written by North American experts, the reader is ensured of receiving a broad spectrum of opinions on controversial topics. Special attention is paid to such topics as the diagnosis of hospital-acquired pneumonia caused by p. aeruginosa, scheduled antibiotic therapy for patients with cystic fibrosis, empiric therapy for febrile neurotropenic patients, combination vs. single agent antibiotic therapy for severely ill patients, and alternatives to conventional antibiotic therapies.

This excellent overview of our current understanding of pseudomonas aeruginosa pathogenesis will prove useful to clinicians and microbiologists around the globe.

Despite great advances in public health worldwide, insect vector-borne infectious diseases remain a leading cause of morbidity and mortality. Diseases that are transmitted by arthropods such as mosquitoes, sand flies, fleas, and ticks affect hundreds of millions of people and account for nearly three million deaths all over the world. In the past there was very little hope of controlling the epidemics caused by these diseases, but modern advancements in science and technology are providing a variety of ways in which these diseases can be handled. Clearly, the process of transmission of an infectious disease is a nonlinear (not necessarily linear) dynamic process which can be understood only by appropriately quantifying the vital parameters that govern these dynamics.

Over the past decade, the AIDS pandemic has propagated so widely and exerted such a dev astating impact that one may properly ask the question, Why not concentrate all AIDS efforts on disease control alone? Why link AIDS with women's reproductive health? What is the scientific basis for this linkage? And how might AID~ control and women's health objectives be promot ed simultaneously? These questions constitute the principal themes addressed in this monograph. The 15 chapters in this volume are intended to provide state-of-the-art reviews of key interac tions between AIDS and women's reproductive health for an audience of scientists and policy makers in the AIDS and population fields. Impetus for this monograph comes in pan from what we perceive to be an inadequate global response, thus far, to AIDS and women's health ;>roblems. A common platform has failed to emerge among the disparate professional communities working in the areas of AIDS, STDs, and family planning. As a result, endeavors in these fields have been isolated, and opportunities for joint action have been missed. An enormous and, as yet, unharnessed potential exists for power ful interdisciplinary collaborations that could strengthen policies and programs against these pressing health problems of humankind.

New Bacterial Vaccines focuses upon unfulfilled needs for bacterial vaccines. The increase in drug resistance among many bacterial species has increased the need for new bacterial vaccines. This book serves as a comprehensive reference on the major aspects of developing new bacterial vaccines. The distinctive feature of this book is that it focuses upon new vaccines now under development by reviewing key issues for each vaccine target and new technologies being applied to developing new vaccines. This book should prove useful for students in the life sciences, scientists, developers of vaccines and biotechnology products, clinicians, regulators, and health-care practitioners.

The explosion of new information on Helicobacter pylori-related disease, both in the basic sciences and in clinical medicine, has continued to progress at an unprecedented pace. In many instances H. pylori infection, both in man and in the laboratory animal, has become a model to investigate fundamental biological issues such as micro-organism host interactions, intracellular signaling, development of mucosal atrophy, mechanism of microbial resistance, disease modifying factors etc. In view of this bewildering flood of new information, another meeting on H. pylori in the successful series Basic mechanisms to clinical cure' was organized in January 1998 in San Diego, California, to define the state-of-affairs' in H. pylori research at this time. The main objective was to integrate this new information in a series of top-quality presentations and discussions between investigators and clinicians addressing all aspects of H. pylori research and to review the current position and future research directions. The format included state-of-the-art presentations by world experts heavily involved in H. pylori research followed by in-depth discussion on intriguing or controversial issues. The presentations were grouped according to the leading theme: characteristics of the organism, mode of transmission, mechanisms of H. pylori-induced inflammation, causation of disturbances of gastric secretory and motor function, aspects of clinical presentation and management, problems related to H. pylori-associated gastric adenocarcinoma and MALT-lymphoma, novel aspects of antimicrobial therapy and vaccination. The meeting concluded with a synoptic agenda of suggested future studies for the microbiologist, the histopathologist and the clinician. The chapters published in these proceedings accurately reflect the content of the superb presentations. The reader will readily appreciate the excellent level of the cutting-edge' research which was described and discussed. These proceedings are another testimony to the enormous impact on basic science and clinical medicine of the H. pylori discovery. Although much was achieved, it is also readily apparent that many questions remain to be answered and many problems remain to be solved.

This volume is based on the Proceedings of the International Conference on "Microbial Infections: Role of Biological Response Modifiers" held in Tampa, FL, May 29-31, 1991. The major purpose of this conference was to bring together in one forum prominent investigators from around the world studying a variety of microbial pathogens, including bacteria, viruses, and fungi, and the effects of biological response modifiers (BRM) on the immune response to these microorganisms. BRM have been widely utilized in the area of antitumor resistance and include not only experimental tumor cell vaccines, but also biologically active substances such as cytokines, i. e., interferons, tumor necrosis factor, and interleukins, as well as products from bacteria which influence host resistance mechanisms. It is the belief of the organizers of this Conference that it was very timely to discuss in detail BRMs as they impact on microbial infections per se. It is now widely accepted that immunocompromised individuals, including those exposed to immunosuppressive substances such as antimetabolites used for chemothera py of malignancies, or infectious agents, such as the human immunodeficiency virus and other viruses which depress the immune response and, in turn, affect a host so as to become highly susceptible to opportunistic microorganisms, benefit from BRM stimulation of their immune system. A wide variety of immunomodulators are now being studied in terms of treating infectious diseases, as well as malignancy and autoimmune diseases."

In the last few decades there has been an ever-increasing component in most BSc Zoology degree courses of cell biology, physiology and genetics, for spectacular developments have taken place in these fields. Some aspects of biotechnology are now also being included. In order to accommodate the new material, the old zoology courses were altered and the traditional two-year basis of systematics of the animal kingdom, comparative anatomy (and physiology) and evolution, was either severely trimmed or reduced and presented in an abridged form under another title. Soon after these course alterations came the swing to modular teaching in the form of a series of shorter, separate courses, some of which were optional. The entire BSc degree course took on a different appearance and several different basic themes became possible. One major result was that in the great majority of cases taxonomy and systematics were no longer taught and biology students graduated without this basic training. We field biologists did appreciate the rising interest in ecology and environ mental studies, but at the same time lamented the shortage of taxonomic skills, so that often field work was based on incorrect identifications. For years many of us with taxonomic inclinations have been bedevilled by the problem of teaching systematics to undergraduates. At a guess, maybe only 5% of students find systematics interesting. It is, however, the very basis of all studies in biology - the correct identification of the organism concerned and its relationships to others in the community."

Human immunodeficiency virus and AIDS have received much attention in the last decade. As the major cause of death in young adults, this concern is merited. AIDS has also ushered onto the clinical agenda a number of unusual and interesting pathogens. These have had considerably less attention than the virus itself, but are arguably as important. This book attempts to put into one volume a state of the art review of the basic biology of these opportunistic organisms. When compiling this book, the perceived difficulty was deciding how to restrict the number of chapters, as there is a large number of opportunistic organisms. It soon became clear, however, that the chapters would select themselves, as the work on many of these organisms was still in its infancy. We can be criticized for including Salmonella, which is not thought to be an opportunistic infection, and excluding Cryptococcus. Our defence is that the former has an interesting relationship with HIV and the latter is one of those organisms for which the basic biology is still in its early stages. The authors are all active researchers in their respective fields and we are grateful that they managed to review their subjects in the short turn-around time required for a book such as this not to be needlessly outdated on publication. We hope that, if nothing else, this book stimulates interest and more research on these agents: perhaps, in future editions, there will be much more to describe on their molecular biology.

The Epstein-Barr virus (EBV), isolated in 1966, continues to draw worldwide attention as an important human pathogen. Its impor tance is largely related to the continuing accumulation of evidence that implicates EBV as an etiological factor for certain types of human cancer. More recent investigations on this virus have focused on the identity of the viral genes responsible for the different disease mani festations observed following viral infection. It is hoped that by thorough investigation of this virus, clues to how cancer develops from a normal cell will surface. In addition, many of the gene products are now being exploited for the development of new and more sensitive tests for the diagnosis and clinical management of individu als with EBV -associated diseases. Thus, studies on this virus continue to provide new information of importance to our understanding of the malignant process. In an effort to attract both basic and clinical scientists to the same meeting for purposes of scientific exchange and fostering a closer interaction between these individuals, a series of international symposia was initiated in 1984. The first meeting was held in Loutraki, Greece, and was attended by approximately 100 participants. The second international symposium was held in St. Petersburg, Florida, in 1986, and was attended by approximately twice as many partici pants as attended the Loutraki meeting.

Advances in DNA sequencing and phylogenetic inference have created powerful methods to investigate many dangerous human viruses. The Molecular Epidemiology Of Viruses provides a comprehensive introduction to the use of genetic methods in molecular epidemiology and in-depth examples of analyses from many viruses. This book is of interest to researchers in the fields of infectious disease, virology, microbiology, evolutionary biology, epidemiology and molecular biology as well as anyone interested in tracking the spread of disease.

Chronic viral hepatitis has emerged as one of the most common causes of disease and death worldwide. Because of their unique modes of replication and intimate association with the host immune system, hepatitis B virus (HBV) and hepatitis C virus (HCV) pose challenging problems to scientists in basic and applied research as well as to clinicians engaged in disease management. Although approved antiviral therapy is available for chronic HBV, the emergence of viral resistance provides a rationale for the development of novel chemotherapeutic agents. The lack of a robust cell culture system for HCV replication and a readily accessible small-animal model of HCV infection have hampered the development of antiviral agents for HCV. Neverthe-less, new antiviral agents targeting HCV are now in preclinical and clinical development.

This monograph, providing an up-to-date overview of the field of Hepatitis Prevention and Treatment, includes contributions from internationally recognized experts in the field of viral hepatitis, and covers the current state of knowledge and practice regarding the molecular biology, immunology, biochemistry, pharmacology and clinical aspects of chronic HBV and HCV infection. The volume includes salient topics such as: the history and epidemiology of HBV and HCV; recent insights into the molecular mechanisms of viral replication; the host immune response to infection and a discussion of the use (HBV) or potential development (HCV) of vaccines; the current standard of care for chronically-infected patients; and emerging therapies and issues associated with current antiviral treatments. The latest information to researchers and clinicians actively engaged in viral hepatitis research is provided, but also sufficient background and discussion of the literature to benefit the newcomer to the field.

Japanese Encephalitis (JE), a mosquito borne disease, is the leading cause of viral encephalitis in 14 Asian countries due to its epidemic potential, high case fatality rate and increased possibility of lifelong disability in patients who recover from this dreadful disease. In spite of seriousness of the disease, still only few books are available for ready reference. Hence, this book will be useful for students, entomologists, paramedical staff and vector control managers in public health. The objective of the book is to disseminate the knowledge gained by the author from ecological studies on JE vectors undertaken in 2 endemic and 2 non endemic areas of Northern India over a period of last 15 years (1998-2012) of research in the field of ecology of mosquito vectors of JE virus initially at National Institute of Communicable Diseases (Ministry of Health & Family Welfare, Government of India), Delhi and later at Jamia Millia Islamia, a Central University, Delhi, to anyone who wishes to curtail death of children due to this dreaded disease. Of the thousand suspected JE deaths in India annually, more than 75% is contributed by Northern India wherein disease transmission failed to be explained based on entomological evidence due to inadequate mosquito surveillance tool used in determining JE vector density. In order to overcome the above problem, Dr Bina Pani Das, the author of this book, developed "BPD hop cage method", a simple, cost effective, and operationally feasible surveillance tool specially designed to capture predominantly day resting adult Cx. tritaeniorhynchus mosquitoes, the principal JE vector species in the country from land and aquatic vegetation.

Individualized dosing regimens specific to the patient, infection, bacteria, and antibiotic can optimize outcome. Integration of pharmacokinetic and pharmacodynamic data, called dual individualization, can be accomplished through the use of AUIe. AUIC dosing has been shown to predict bacteriological outcomes, hasten clinical outcomes, reduce the emergence of resistance, and be cost-effective. MPC dosing has been shown to predict the emergence of resistant submutants. AUIC and MPC information can provide guidance as to when low doses can be used, and when higher concentrations are required. This strategy can ensure efficacy, minimize toxicity, reduce the opportunity for resistance to occur, and save money. REFERENCES I. Paladino JA. Streamlining antibiotic therapy: clinical application of pharmacokinetic and pharmacodynamic principles. J Osteopath Med 1991; 5: 16-25. 2. Liss RH, Batchelor FR. Economic evaluations of antibiotic use and resistance - a perspective: report of task force 6. Rev Infect Dis 1987; 9 (suppI3): S297-312. 3. Holmberg SO, Solomon SL, Blake PA. Health and economic impacts of antimicrobial resistance. Rev Infect Dis 1987; 9: 1065-78. 4. Sanders cc. Mechanisms responsible for cross-resistance and dichotomous resistance among the quinolones. Clin Infect Dis 2001; 32(Suppl I ):S 1-8. 5. Ballow CH, Schentag 11. Trends in antibiotic utilization and bacterial resistance: report of the NNRSG. Diagn Microbiol Infect Dis. 1992; 15(suppl):37S-42S. 6. Rice LB, Eckstein EC, DeVente J, Shlaes OM. Ceftazidime-resistant Klebsiella pneumoniae isolates recovered at the Cleveland Department of Veterans Affairs Medical Center. Clin Infect Dis 1996; 23: 118-24.

Multidrug-resistant tuberculosis: past, present and future Ivan Bastian and Franyoise Portaels Mycobacteriology Unit. Institute of Tropical Medicine. Antwerp. Belgium The Lord hath created medicines out of the earth and he that is wise will not abhor them. Ecclesiasticus 38:4, quoted by Selman Waksman when accepting the 1952 Nobel Prize for Medicine that was awarded for the discovery of the first effective antituberculosis drug. streptomycin. which was derived from the soil bacterium, Streptomyces grisells. 1. HISTORICAL PERSPECTIVE This book has been published at the close of the twentieth century when the medical profession and the general community are increasingly concerned about the threat of multidrug-resistant tuberculosis (MDRTB)[1. 2]. However, at this epoch, it is enlightening to move back from our immediate concerns about MDRTB 'hot spots' in Asia, South America, and the former Soviet Union [3], and to place our current predicament in an historical context. If the results of the global survey of antituberculosis drug resistance conducted by the World Health Organisation (WHO) and the International Union against Tuberculosis and Lung Disease (IUATLD) can be extrapolated, only 2. 2% of TB cases worldwide are due to multi drug resistant strains [3]. At the beginning of the 20th century, all TB cases were refractory to all available therapies. Great advances had been made during the 19th century in the understanding of the epidemiology and pathogenesis of TB, and in the diagnosis of the disease (reviewed in references 4-7).

Molecular and Cell Biology of Human Diseases reviews the status of research on a range of sexually transmitted diseases whose incidence has paralleled the increase in HIV infection and examines the ways in which new methods are influencing current practice and are likely to shape future management.

Infection with the human immunodeficiency virus (HIV) and human T-cell lymphotropic virus type I (HTLV-I) is known to be associated with an increased risk of neoplastic disorders, especially Kaposi's sarcoma and aggressive B-cell lymphoma for the former, and T-cell lymphoma for the latter. The information obtained from the study of these infections has led to remarkable advances in our understanding of the immune system, as well as the biology of human neoplasms. The management of malignant diseases in such patients also poses substantial challenges to clinicians. This book provides an overview of the epidemiology, biology, clinical features, and clinical management of neoplasms occurring in such individuals. It is an important resource for clinicians treating these diseases, and for basic scientists who have an interest in this field.

An extensive assessment of combination therapy of AIDS. Main focus is put on the Highly Active Antiretroviral Therapy (HAART) but other therapies like salvage therapy are also discussed. The chapters cover efficacy, treatment, causes of treatment failure, clinical care, guidelines, pharmacology. The volume closes with an outlook on future perspectives.

In recent years much enthusiasm and energy has been directed toward the development of human gene therapies, especially for inherited conditions and cancers. However, current gene transfer technology is limited in its transduction efficiency and ability to permanently and safely correct genomic defects. Thus the promise of gene therapy for these conditions is as yet unrealized. The progression of gene transfer technology will eventually surmount these limitations. Gene Therapy for Acute and Acquired Diseases includes selected examples of ongoing studies in molecular genetics that have the potential to evolve into human therapies for acute illnesses. These chapters are intended to highlight lesser known applications of gene therapy for acquired disorders. It is expected that human gene therapy trials for these conditions will be forthcoming in the near future, leading to previously unimaginable therapies. Thus, this first-ever book about gene therapy for acute and acquired diseases is intended to serve as a glimpse into the future.

Infection Control in the ICU Environment provides the details of the most common infection control problems facing intensive care units. Authors include noted scientists, intensivists and epidemiologists from the United States and Europe as well as infection control experts from the Centers for Disease Control and Prevention. Acinetobacter, methicillin resistant staphylococcus aureus and vancomycin resistant enterococci are examined in detail. This volume also includes cutting edge information regarding the potential for prophylactic and pre-emptive therapy of fungal infections in intensive care units. Innovations in vascular catheter care and prevention of bloodstream infections are discussed in this volume as well as the newest information in mathematical modeling to understand the epidemiology and control of infections in intensive care units.

Helicobacter pylori has attracted widening interest from basic scientists and clinical investigators and the information on this organism is increasing exponentially. It is now accepted that H. Pylori is the most important cause of chronic active gastritis. Furthermore, data have confirmed a marked reduction in the relapse rate of both duodenal and gastric ulcer after eradication of the organism. These important clinical observations have served as a strong stimulus to the investigation of the basic mechanisms involved in the pathogenesis of H. pylori-associated inflammation and the subsequent alterations of gastroduodenal function and gastric mucosal architecture. The book contains chapters by a multidisciplinary, international group of basic scientists and clinical investigators who focus on various microbiological aspects of H. pylori, on the role of H. pylori in peptic ulcer and gastric cancer, and the current status of therapy. The book contains the proceedings of the conference on `Helicobacter pylori: Basic Mechanisms to Clinical Cure', held at Amelia Island, Florida, U.S.A., on November 3--6, 1993.

Since the introduction of ciprofloxacin in 1987, fluoroquinolones have expanded far beyond their early role in the treatment of urinary tract infections. Clinical applications beyond genitourinary tract infections include upper and lower respiratory infections, gastrointestinal infections, gynecologic infec- tions, sexually transmitted diseases, and some skin and soft tissue infections. Their ease of administration, favorable pharmacokinetic properties, excellent tolerability, and efficacy give them enormous potential for use and misuse alike. Quinolones have few common adverse effects, most notably nausea, headache and dizziness. Less frequent but more serious adverse events include prolongation of the corrected QT interval, phototoxicity, liver enzyme abnor- malities, arthropathy, and cartilage and tendon abnormalities. While possess- ing many of the favorable properties of intravenous agents, most fluoro- quinolones offer the convenience of oral administration, thus contributing to decreased health-care costs through increased outpatient therapy and short- ened hospital stays. With the recent introduction of agents such as gatifloxacin and moxifloxacin, the traditional Gram-negative coverage of fluoroquinolones has been expanded to include Gram-positive organisms, most importantly Streptococcus pneumoniae.

Much research over the past 30 to 40 years has shown that the inflammatory response, while critical for host defense during microbial infection, may itself play a central role in the pathogenesis of sepsis. Although key mediators responsible for this injury have been identified, efforts clinically to augment our conventional antimicrobial and supportive therapies during sepsis with agents modulating the inflammatory response have been unsuccessful. As a result, the mortality associated with this lethal syndrome, especially when complicated by shock, has remained persistently high. Unfortunately, during this same period of time, the incidence of sepsis has accelerated as other fields of medicine have relied increasingly on therapies that predispose to infection. While frustrating, overall this experience in the field of sepsis has not been without value. Most importantly, it has helped define on several different levels the complexity of the septic patient. Recognizing and addressing this complexity as discussed by each of the contributors to Evolving Concepts in Sepsis and Septic Shock may now provide new inroads into the treatment of sepsis.

Similarities in structure and function between pigs and human beings include size, feeding patterns, digestive physiology, dietary habits, kidney structure and function, pulmo nary vascular bed structure, coronary artery distribution, propensity to obesity, respiratory rates, tidal volumes and social behaviors. Since the pig is an omnivore, it provides an adaptable model to evaluate chronic and acute exposures to xenobiotics such as alcohoL caffeine, tobacco, food additives and environmental pollutants. Swine have been used successfully as models to evaluate alcoholism, diabetes, absorption, digestion, total paren teral nutrition, organ transplantation, atherosclerosis, exercise, hypertension. hemorrhagic hypotension, melanoma, gingivitis, obstructive and reflux nephropathy. osteochondrosis. dermal healing and septic shock. A severe and worsening shortage of organs and tissues for transplantation in patients with severe organ failure has encouraged the consideration of inter species or xenotransplan tation. In developing programs toward this end, the pig generally is viewed as the preferred donor because of its size, physiology and availability. The pig harbors relatively few diseases which could be transmitted inadvertently to human patients. The ability to genetically modify swine to ameliorate the consequences of the human immune response offers a further significant advantage. Another important consideration for an animal model is that basic biologic back ground information be available for investigators to design future prospective studies."