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An explosion of pathogens, or perhaps just of fear

The New Killer Diseases: How the Alarming Evolution of Mutant Germs Threatens Us All, Elinor Levy and Mark Fischetti, Crown: 312 pp., $24.95

August 24, 2003|Claire Panosian Dunavan | Claire Panosian Dunavan is professor of medicine at UCLA school of medicine and a practicing infectious disease and tropical medicine specialist at UCLA Medical Center.

Over the last decade or so, popular works on infectious diseases have lined bookstore shelves and pumped adrenaline through readers' veins. Laurie Garrett's groundbreaking "The Coming Plague" launched the trend, followed by such apocalyptic titles as "Epidemic," "Timebomb," "Maneater" and "Scourge." "The New Killer Diseases" now joins this company, released just in time to snag Californians fearful of the recent arrival of the mosquito-borne West Nile virus.

From the perspective of an infectious diseases specialist, all such books serve a worthy mission. They deliver current facts and research, even vivid battle scenes (picture brave cells and molecules versus evildoers played by viruses and bacteria) with the thoroughness of a class in Immunology 101.

But one problem of "The New Killer Diseases" is that several villains profiled -- like E. coli 0157 or Group A strep -- aren't mutants in the technical sense at all. Literary license? For organisms like HIV and antibiotic-resistant bacteria, the term comes close enough. More troubling, however, is the alarmism of the book's title, which weaves through its chapters. This book, even more than some of its brethren, tries to scare readers' pants off by suggesting that humanity is facing an onslaught of murderous plagues unlike any other time in history -- a debatable view at best.

Take "The Case of Jeannie Brown," a chapter based on the true story of a single mom from North Carolina. Jeannie's painful shoulder plus fever, vomiting and sunburn-like rash go undiagnosed for days. After a blow-by-blow account of her illness, the authors deliver their coup de grace with ghoulish fervor:

"The autopsy had been a revolting experience.... It showed that Jeannie was killed by a wild infection doctors call 'invasive Group A streptococcus.' The media call it 'flesh-eating bacteria.' This ravenous bacteria had turned Jeannie's kidneys into a mass of jellylike pus, her heart into a squishy sponge. A microbial war had been raging inside her body for at least a week, the rapidly multiplying bacteria knifing through muscle, organ and blood vessel cells while a few meager white cells tried to tackle them."

Ever since Jim Henson, the beloved Muppeteer, died in 1990 of invasive Group A strep infection, tabloid-style journalists have exploited its drama. Aside from its usual mischief (tonsillitis, skin infections and the like), the classic sore throat germ dives deep into the blood and tissues of 10,000 to 15,000 Americans per year, killing roughly 20%. But there's a back story that isn't found in "The New Killer Diseases." Since microbiologists started tracking Group A strep in the mid-19th century, it has periodically made deadly sorties. Though it is always the same bug, its virulence varies according to its changing portfolio of toxins and "M proteins." Consequently, today's uptick in cases doesn't really represent a new breed at all, despite the horror of Brown's death. Most experts believe it's just another phase of a historic cycle.

A few decades ago, in fact, Group A strep wreaked a different kind of havoc. Back then its signature ranged from scarlet fever and postpartum sepsis to chronic nephritis (patients with this insidious kidney condition can be well one day and on dialysis the next) and rheumatic fever, still a leading cause of heart disease. In many countries with limited health care, these syndromes continue to abound. Doctors must remain on the lookout for Group A strep, but the problem with the story told in "The New Killer Diseases" is that it sheds little light by focusing on one badly handled case.

Elinor Levy, a biophysicist-turned-immunology professor, and Mark Fischetti, a veteran science writer, fare better in treating the recent crop of animal-to-man diseases that are genuinely new or newly imported -- for example, severe acute respiratory syndrome, bovine spongiform encephalopathy (also known as mad cow disease) and West Nile virus. They excel at describing the sleuthing and science that helped to break the code on these and other emerging infections.

Along the way, the authors introduce more victims: the heroic Italian public health specialist working in Vietnam who recognized, then succumbed to SARS; a young woman in England with neurologic meltdown from BSE; a retired resident of Queens, N.Y., who acquired a strain of West Nile virus that hitched a ride from Israel and quickly spawned paralysis and brain inflammation (such complications usually occur in only 1 in 150 West Nile-infected patients). Three heart-rending sagas, yes, but aren't such richly detailed disasters bound to alarm?

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