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The book came this afternoon and, after tea, 1 settled down to read it with a sense of keen anticipation. It’s the new, fourth, edition of Schlossberg’s textbook, substantially enlarged from the last edition and with sixty five contributors and thirty eight chapters. Most of the authors were American and so I was already prepared for a bias against BCG and multipuncture tuberculin skin testing and in favour of chemoprophylaxis.

The evening started well. Three chapters on aspects of host response and immunopathology went down well: they were illuminating and up to date. There then followed chapters on chemotherapy, epidemiology and public health considerations. These were clear but undistinguished. The section on
chemotherapy told you what you could read in the package insert but didn’t tangle with practical problems such as what to do when a patient taking three hepatotoxic drugs developed minor or major
liver dysfunction. Nor did it deal with other common problems of patients, part-way into treatment, such as fever, pruritis or rash. The authors of the section on chemotherapy disagreed with the authors of a later chapter on hepato-biliary effects of tuberculosis on the question of whether or not to monitor liver function tests. Their advice on the daily dosage of isoniazid in children was to give 10-20 mg/kg/day. But the authors of the chapter on tuberculosis in infants and children said 10-15 mg/kg/day and the BNF says 5-10 mg/kg/day. I was beginning to wonder.

I turned to Part 11, Clinical Tuberculosis. There are nineteen chapters dealing with different anatomical sites. Most of this is sound but dreary, giving the impression that the authors have reviewed
the literature but have not been able to add any key points or insights of their own. There are some notable omissions. The chapter on genitourinary disease completely ignores tuberculosis of the female genital tract and says nothing of BCG infection of the bladder after its use for the treatment of
multifocal transitional cell carcinoma of the bladder. In some UK laboratories this is the commonest source of M bovis isolates. (This topic is mentioned briefly in a later chapter but without giving much practical help.)

The discussion of tuberculous meningitis is also too bland. It underplays the demonstrated benefits of steroids in moderate or severe disease, it doesn’t help much with the problem of when to start and stop TB treatment in patients with a low likelihood of TBM and it makes no mention of when to stop treatment in patients who have not recovered completely and still have abnormal CSF.

Hoping for better, I turned to the section on nontuberculous mycobacterial infection (NTM). There was a lot of good stuff here. But once again there were important gaps. For the UK reader, the discussion of M malmoense disease was very limited and there was nothing on the syndrome of disseminated M. avium infection in HIV patients following immune reconstitution with HAART.
Outside the field of HIV, one of the commonest manifestations of NTM infection in the UK is cervical lymphadenopathy in young children. This merits only half a column. It doesn’t tell you what to do before you get the result of cultures or what to do once you receive the result of cultures in children who still show signs of lymph node suppuration.

How does this all shake down? If you know nothing, buy it; if you already know quite a lot, forget it. I ended the evening disappointed …. pass me the claret.