Page 4 - Clinical Immunology_ Principles and Practice ( PDFDrive )

vi Preface to the first edition
PREFACE TO THE FIRST EDITION

Clinical immunology is a discipline with a distinguished history, treatment of immunologic deficiency syndromes. Pathogenic
rooted in the prevention and treatment of infectious diseases in mechanisms of both congenital and acquired immune deficiency
the late nineteenth and early twentieth centuries. The conquest diseases are discussed, as are the infectious complications that
of historical scourges such as smallpox and (substantially) polio characterize these diseases. Befitting its importance, the subject of
and relegation of several other diseases to the category of medical HIV infection and AIDS receives particular attention, with separate
curiosities is often regarded as the most important achievement chapters on the problem of infection in the immunocompromised
of medical science of the past fifty years. Nevertheless, the chal- host, HIV infection in children, anti-retroviral therapy and current
lenges facing immunologists in the efforts to control infectious progress in the development of HIV vaccines.
diseases remain formidable; HIV infection, malaria and tuber- The classic allergic diseases are the most common immunologic
culosis are but three examples of diseases of global import that diseases in the population, ranging from atopic disease to drug
elude control despite major commitments of monetary and allergy to organ-specific allergic disease (e.g., of the lungs, eye
intellectual resources. and skin). They constitute a foundation for the practice of clinical
Although firmly grounded in the study and application of immunology, particularly for those physicians with a practice
defenses to microbial infection, since the 1960s clinical immunol- orientation defined by formal subspecialty training in allergy
ogy has emerged as a far broader discipline. Dysfunction of the and immunology. A major section is consequently devoted to
immune system has been increasingly recognized as a pathogenic these diseases, with an emphasis on pathophysiology as the basis
mechanism that can lead to an array of specific diseases and for rational management.
failure of virtually every organ system. Pardoxically, although The next two sections deal separately with systemic and
the importance of the immune system in disease pathogenesis organ-specific immunologic diseases. The diseases considered
is generally appreciated, the place of clinical immunology as a in the first of these sections are generally regarded as the core
practice discipline has been less clear. As most of the noninfectious practice of the clinical immunologist with subdisciplinary
diseases if the human immune system lead eventually to failure emphasis in rheumatology. The second section considers diseases
of other organs, it has been organ-specific subspecialists who of specific organ failure as consequences of immunologically
have usually dealt with their consequences. Recently, however, mediated processes that may involve virtually any organ system.
the outlook has begun to change as new diagnostic tools increas- These diseases include as typical examples the demyelinating
ingly allow the theoretical possibility of intervention much earlier diseases, insulin-dependent diabetes mellitus, the glomerulone-
in disease processes, often before irreversible target organ phritides and inflammatory bowel diseases. It is in management
destruction occurs. More importantly, this theoretical possibility of such diseases that the discipline of clinical immunology will
is increasingly realized as clinical immunologists find themselves have an increasing role as efforts focus on intervention early in
in the vanguard of translating molecular medicine from laboratory the pathogenic process and involve diagnostic and therapeutic
bench to patient bedside. tools of ever-increasing sophistication.
In many settings, clinical immunologists today function as One of the major clinical areas in which the expertise of a
primary care physicians in the management of patients with clinical immunologist is most frequently sought is that of
inmune-deficiency, allergic, and autoimmune diseases. Indeed allogeneic organ transplantation. A full section is devoted to the
many influential voices in the clinical disciplines of allergy and issue of transplantation of solid organs, with an introductory
rheumatology support increasing coalescence of these traditional chapter on general principles of transplantation and management
subspecialities around their intellectual core of immunology. In of transplantation rejection followed by separate chapters dealing
addition to his or her role as a primary care physician, the clinical with the special problems of transplantation of specific organs
immunologist is increasingly being looked to as a consultant, as or organ systems.
scientific and clinical advances enhance his or her expertise. The Appreciation of both the molecular and clinical features of
immunologist with a ‘generalist’ perspective can be particularly lymphoid malignancies is important to the clinical immunologist
helpful in the application of unifying principles of diagnosis and regardless of subspecialty background, notwithstanding the fact
treatment across the broad spectrum of immunologic diseases. that primary responsibility for management of such patients
Clinical Immunology: Principles and Practice has emerged will generally fall to the haematologist/oncologist. A separate
from this concept of the clinical immunologist as both primary section is consequently devoted to the lymphocytic leukemias and
care physician and expert consultant in the management of lymphomas that constitute the majority of malignancies seen in
patients with immunologic diseases. It opens in full appreciation the context of a clinical immunology practice. The separate issues
of the critical role of fundamental immunology in this rapidly of immune responses to tumors and immunological strategies to
evolving clinical discipline. Authors of basic science chapters treatment of malignant diseases are subjects of additional chapters.
were asked, however, to cast their subjects in a context of clinical Another important feature is the attention to therapy of
relevance. We believe the result is a well-balanced exposition of immunologic diseases. This theme is constant throughout the
basic immunology for the clinician. chapters on the allergic and immunologic diseases, and because
The initial two sections on basic principles of immunology of the importance the editors attach to clinical immunology
are followed by two sections that focus in detail on the role of as a therapeutic discipline, an extensive section is also devoted
the immune system in defenses against infectious organisms. The specifically to this subject. Subsections are devoted to issues of
approach is two-pronged. It begins first with a systematic survey immunologic reconstitution, with three chapters on treatment
of immune responses to pathogenic agents followed by a detailed of immunodeficiences, malignancies and metabolic diseases by

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