Parasitic Infections in the Compromised Host

This is the introductory volume in an annual series on infectious disease and therapy, edited by Brian E. Scully and Harold C. Neu. This first volume addresses diseases caused by the parasitic organisms of major clinical importance in the United States, with an emphasis on infections in immunocompromised hosts. The book does not address the clinical aspects of parasitic infections seen in primary care medicine and therefore does not supplant a standard textbook of clinical parasitology; its intent is neither a broad overview of diseases caused by these parasites in normal hosts, nor the range of parasites which cause infection in immunocompromised hosts. The advantage of this tightly focused objective is the comprehensive discussion of the relatively few but important parasites which cause opportunistic infection in hosts with altered immunity, specifically due to congenital immunodeficiency, immunosuppressive chemotherapy for treatment of neoplasms, immunoregulation for organ transplantation or infection with human immunodeficiency virus (HIV). The thirteen chapter authors of this volume are all contributors in their fields of research. The chapters can be divided conceptually into two groups-three chapters which principally address the host and the immune response to parasitic infections, and six chapters which focus on individual organisms. An introductory chapter discusses the spectrum of conditions which compromise the human host, emphasizing distinctions between patient populations and the differential predisposition of different immune defects to different opportunistic infections. The second chapter uses Leishmania as model organism to discuss host defenses against intracellular protozoa but does not specifically address clinical leishmaniasis. A later chapter similarly addresses the host immune response against helminth parasitic infection. The remaining six chapters each discuss a single parasite: the protozoa Pneumocystis carinii, Toxoplasma gondii, Cryptosporidium spp., Giardia lamblia, Entamoeba histolytica, and the helminth Strongyloides stercoralis. These chapters uniformly provide a comprehensive yet coherent perspective on the biology of the parasite, its interaction with the host and the immune system, the clinical manifestation of disease, and the diagnosis and treatment of infection. Each of the sections is thoroughly detailed and complete. The sections on diagnosis and treatment would be of special interest to physicians; current treatment regimens are discussed, as well as promising new modes of therapy. Discussion of parasitic infections in the acquired immunodeficiency syndrome (AIDS) is included, but does not dominate the volume. A suitable number of diagrams, figures, and tables accompany each chapter. The photomicrographs, electron micrographs, and illustrations are all high-quality reproductions. Topics are extensively referenced to the current literature, with an average of over 250 references per chapter. Given the aggressive therapies, both recently employed and projected, for immunoregulation in organ transplant recipients and as part of the therapy for other medical illnesses, discussion of opportunistic parasitic infection is timely. This timeliness is