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Foreword
Keith P Klugman, MB, BCh, PhD, FRCPath (Lond)
Member-at-Large, Executive Committee, International Society of Infectious Diseases (ISID)
Keith P Klugman, MB, BCh, PhD, FRCPath (Lond), is a Member-at-Large of the Executive Committee of the International Society of Infectious
Diseases (ISID) and the William H Foege Chair of Global Health in the Hubert Department of Global Health at the Rollins School of Public Health,
Emory University, Atlanta. He is also a Professor of Medicine in the Division of Infectious Diseases of the School of Medicine at the same
University, and a Visiting Researcher in the Respiratory Diseases Branch of the Centers for Disease Control and Prevention (CDC). Professor
Klugman is the Co-Director of the Respiratory and Meningeal Pathogens Research Unit of the University of the Witwatersrand, the Medical
Research Council, and the National Institute for Communicable Diseases in Johannesburg, South Africa. He is also Chair of the International
Committee of the American Society for Microbiology (ASM), the largest single life science society with over 42,000 members worldwide, and
Vice Chair of the International Union of Microbiological Societies (IUMS), the umbrella organization of all national microbiology societies. He has
chaired expert committees for the World Health Organization (WHO) in Geneva and the Wellcome Trust in London, and serves as an Editor or
member of the Editorial Board of eight international journals on medicine, infectious diseases, and antimicrobials. Professor Klugman’s research
interests are in antibiotics, antimicrobial resistance, and vaccines for bacterial pathogens, particularly pneumococcus. He has published more than
350 papers on these subjects to date.
T
he AIDS pandemic continues unabated, and the opening section of this edition of US Infectious Disease addresses this
global issue. A number of papers reflect on the first 25 years of this pandemic. The interactions between HIV and herpes
contribute to the spread of both pathogens, which are rightly described in this publication as a ‘dastardly duo.’
The single greatest threat of mass mortality of humans in the next century comes from an infectious disease—influenza. While
much attention is still needed for pandemic planning to cope with the emergence and spread of the next unknown pandemic
strain, it should be remembered that influenza predisposes to bacterial infections; therefore, the treatment and prevention of
respiratory bacterial pathogens is a prudent intervention no matter what influenza strain emerges.
In the area of respiratory infections, pneumonia guidelines have for years divided the disease into community-acquired and
hospital-acquired (CAP and HAP, respectively). We now also have healthcare-associated pneumonia; however, it is unclear whether
this is in fact a separate entity or merely a bridge between CAP and HAP. Tuberculosis remains a global scourge and, with the recent
emergence of extremely drug-resistant strains and ongoing trials of the use of fluoroquinolones, an update on treatment is timely.
Respiratory syncytial virus remains the leading cause of respiratory morbidity in the first year of life, with no vaccine yet available.
A paper reviewing new antimalarials would have made slim reading just a decade ago, yet we now have new drugs of choice
for treating this important global killer. The principles of combination therapy are being used to try to preserve the artemesinin
compounds; if only such efforts could be applied to the development of new antimicrobials. The Centers for Disease Control and
Prevention (CDC) was originally situated in Atlanta, at least in part because of the prevalence of mosquito-borne pathogens such
as malaria and yellow fever in the south. As the heat of summer passes, West Nile virus is now endemic in Atlanta and across
the US, and its diagnosis, treatment, and prevention are highlighted in this issue.
Another important theme is the increasingly blurred definition of hospital versus community pathogens, especially for patients
with recent exposure to the health system. The emergence of epidemics of Clostridium difficile associated with increased
virulence and resistance to fluoroquinolones put this established pathogen back in the spotlight, and community-acquired
methicillin-resistant Staphylococcus aureus was of such interest at the recent Interscience Conference on Antimicrobial Agents
and Chemotherapy (ICAAC) meeting in Chicago that the main symposium on the topic overflowed into three additional rooms.
As our armamentarium of new antibacterials runs dry, we need to look at infection control strategies to prevent nosocomial infections.
With all the pros and cons in the setting of quality benchmarks for hospital practice, it is clear that hospital administrators are going
to be forced to pay more than lip service to infection control and the importance of an effective on-site microbiology laboratory.
US Infectious Disease 2007 promises to make fascinating, topical reading, and I thank the authors for their efforts to educate us. ■
8 US INFECTIOUS DISEASE 2007
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