Clinical immunology is a discipline with a distinguished history, rooted in the prevention and treatment of infectious diseases in the late nineteenth and early twentieth centuries. The conquest of historical scourges such as smallpox and (substantially) polio and relegation of several other diseases to the category of medical curiosities is often regarded as the most important achievement of medical science of the past fifty years. Nevertheless, the challenges facing immunologists in the efforts to control infectious diseases remain formidable; HIV infection, malaria and tuberculosis are but three examples of diseases of global import that elude control despite major commitments of monetary and intellectual resources Principles and Practice – 5th Edition (2018)
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Although firmly grounded in the study and application of defenses to microbial infection, since the 1960s clinical immunology has emerged as a far broader discipline. Dysfunction of the immune system has been increasingly recognized as a pathogenic mechanism that can lead to an array of specific diseases and failure of virtually every organ system. Pardoxically, although the importance of the immune system in disease pathogenesis is generally appreciated, the place of clinical immunology as a practice discipline has been less clear. As most of the noninfectious diseases if the human immune system lead eventually to failure of other organs, it has been organ-specific subspecialists who have usually dealt with their consequences. Recently, however, the outlook has begun to change as new diagnostic tools increasingly allow the theoretical possibility of intervention much earlier in disease processes, often before irreversible target organ destruction occurs. More importantly, this theoretical possibility is increasingly realized as clinical immunologists find themselves in the vanguard of translating molecular medicine from laboratory bench to patient bedside.
In many settings, clinical immunologists today function as primary care physicians in the management of patients with inmune-deficiency, allergic, and autoimmune diseases. Indeed many influential voices in the clinical disciplines of allergy and rheumatology support increasing coalescence of these traditional subspecialities around their intellectual core of immunology. In addition to his or her role as a primary care physician, the clinical immunologist is increasingly being looked to as a consultant, as scientific and clinical advances enhance his or her expertise. The immunologist with a ‘generalist’ perspective can be particularly helpful in the application of unifying principles of diagnosis and treatment across the broad spectrum of immunologic diseases.
Clinical Immunology: Principles and Practice has emerged from this concept of the clinical immunologist as both primary care physician and expert consultant in the management of patients with immunologic diseases. It opens in full appreciation of the critical role of fundamental immunology in this rapidly evolving clinical discipline. Authors of basic science chapters were asked, however, to cast their subjects in a context of clinical relevance. We believe the result is a well-balanced exposition of basic immunology for the clinician.
The initial two sections on basic principles of immunology are followed by two sections that focus in detail on the role of the immune system in defenses against infectious organisms. The approach is two-pronged. It begins first with a systematic survey of immune responses to pathogenic agents followed by a detailed treatment of immunologic deficiency syndromes. Pathogenic mechanisms of both congenital and acquired immune deficiency diseases are discussed, as are the infectious complications that characterize these diseases. Befitting its importance, the subject of HIV infection and AIDS receives particular attention, with separate chapters on the problem of infection in the immunocompromised host, HIV infection in children, anti-retroviral therapy and current progress in the development of HIV vaccines.
The classic allergic diseases are the most common immunologic diseases in the population, ranging from atopic disease to drug allergy to organ-specific allergic disease (e.g., of the lungs, eye and skin). They constitute a foundation for the practice of clinical immunology, particularly for those physicians with a practice orientation defined by formal subspecialty training in allergy and immunology. A major section is consequently devoted to these diseases, with an emphasis on pathophysiology as the basis for rational management.
The next two sections deal separately with systemic and organ-specific immunologic diseases. The diseases considered in the first of these sections are generally regarded as the core practice of the clinical immunologist with subdisciplinary emphasis in rheumatology. The second section considers diseases of specific organ failure as consequences of immunologically mediated processes that may involve virtually any organ system. These diseases include as typical examples the demyelinating diseases, insulin-dependent diabetes mellitus, the glomerulonephritides and inflammatory bowel diseases. It is in management of such diseases that the discipline of clinical immunology will have an increasing role as efforts focus on intervention early in the pathogenic process and involve diagnostic and therapeutic tools of ever-increasing sophistication.
One of the major clinical areas in which the expertise of a clinical immunologist is most frequently sought is that of allogeneic organ transplantation. A full section is devoted to the issue of transplantation of solid organs, with an introductory chapter on general principles of transplantation and management of transplantation rejection followed by separate chapters dealing with the special problems of transplantation of specific organs or organ systems.
Appreciation of both the molecular and clinical features of lymphoid malignancies is important to the clinical immunologist regardless of subspecialty background, notwithstanding the fact that primary responsibility for management of such patients will generally fall to the haematologist/oncologist. A separate section is consequently devoted to the lymphocytic leukemias and lymphomas that constitute the majority of malignancies seen in the context of a clinical immunology practice. The separate issues of immune responses to tumors and immunological strategies to treatment of malignant diseases are subjects of additional chapters.
Another important feature is the attention to therapy of immunologic diseases. This theme is constant throughout the chapters on the allergic and immunologic diseases, and because of the importance the editors attach to clinical immunology as a therapeutic discipline, an extensive section is also devoted specifically to this subject. Subsections are devoted to issues of immunologic reconstitution, with three chapters on treatment of immunodeficiences, malignancies and metabolic diseases by bonemarrow transplantation. Also included is a series of chapters on pharmaceutical agents currently available to clinical immunologists, both as anti-allergic and anti-inflammatory drugs, as well as newer agents with greater specificity for T cell-mediated immune responses. The section concludes with a series of chapters that address established and potential applications of therapeutic agents and approaches that are largely based on the new techniques of molecular medicine. In addition to pharmaceutical agents the section deals in detail with such subjects as apheresis, cytokines, monoclonal antibodies and immunotoxins, gene therapy and new experimental approaches to the treatment of autoimmunity. Principles and Practice – 5th Edition (2018) concludes with a section devoted to approaches and specific techniques involved in the diagnosis of immunologic diseases. Use of the diagnostic laboratory in evaluation of complex problems of immunopathogenesis has been a hallmark of the clinical immunologist since inception of the discipline and many clinical immunologists serve as directors of diagnostic immunology laboratories. Critical assessment of the utilization of techniques ranging from lymphocyte cloning to flow cytomeric phenotyping to molecular diagnostics are certain to continue as an important function of the clinical immunologist, particularly in his or her role as expert consultant. Principles and Practice – 5th Edition (2018)
In summary, we have intended to provide the reader with a comprehensive and authoritative treatise on the broad subject of clinical immunology, with particular emphasis on the diagnosis and treatment of immunological diseases. It is anticipated that Principles and Practice – 5th Edition (2018) will be used most frequently by the physician specialist practicing clinical immunology, both in his or her role as a primary physician and as a subsequent consultant. It is hoped, however, that Principles and Practice – 5th Edition (2018) will also be of considerable utility to the non-immunologist. Many of the diseases discussed authoritatively in Principles and Practice – 5th Edition (2018) are diseases commonly encountered by the generalist physician. Indeed, as noted, because clinical immunology involves diseases of virtually all organ systems, competence in the diagnosis and management of immunological diseases is important to virtually all clinicians. The editors would be particularly pleased to see Principles and Practice – 5th Edition (2018) among the references readily available to the practicing internist, pediatrician and family physician.
Medical Book Free: Clinical Immunology: Principles and Practice – 5th Edition (2018)