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Toman’s tuberculosis: case detection, treatment and monitoring. Questions and answers, 2nd edition
1. A E Tattersfield

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Edited by T Frieden. Geneva: World Health Organisation, 2004, 80 Swiss Francs (US$72) (40 Swiss Francs in developing countries), pp 332. ISBN 92 4 154603 4 Tuberculosis still kills almost two million people a year worldwide and, despite the availability of curative treatment for three decades, the incidence is rising in many countries. The international target is to detect 70% of pulmonary sputum positive cases and treat 85% of these successfully. This book is an important weapon in the fight against tuberculosis. Toman’s tuberculosis was first published in 1979 and developed through the World Health Organisation to provide clear and unambiguous advice for people running tuberculosis control programmes and practical advice for fieldworkers. The first edition had a single author, Kurt Toman, and each chapter consisted of a practical question followed by a discussion and answers. Having been reprinted many times and translated into several languages, the time had come for a second edition to reflect the many changes that have occurred in the epidemiology, diagnosis, and management of tuberculosis, including HIV infection and the introduction of DOTS. The second edition edited by Dr Frieden has a large number of authors and 75 chapters ranging from 2 to 10 pages in length. As previously the chapters are grouped under the headings of case detection, treatment, and monitoring, and each chapter heading poses a question, for example, “What are the advantages and disadvantages of fluorescence microscopy?”, “How can the emergence of drug resistance be prevented?”, and “What are the advantages of direct observation of treatment?”. The questions cover newer developments such as the role of molecular epidemiology and DNA amplification, but the main emphasis is on affordable investigations and treatment where the evidence is strong. The chapters then provide answers or at least a résumé of current knowledge and the evidence on which this is based. They do not provide an exhaustive review of topics, although there are a few references after each chapter. There is overlap between questions and some repetition, but this does not matter since the book is designed to be dipped into rather than to be read from cover to cover. The advice is firmly grounded on experience in countries with a high incidence of tuberculosis, where annual government spending on health may be as little as US$1 per person a year. Much of the evidence comes from large empirical trials in the field. There is heavy emphasis on the importance of preventing drug resistance, pointing out that it is irrational to spend a lot of money on multi-drug resistant tuberculosis in situations where patients with fully susceptible organisms are not being treated appropriately.

The question and answer format works well if driven by the questions that readers ask and want answers to. The questions seem eminently sensible and likely to be those that will crop up frequently when managing tuberculosis. The reliance on data from controlled studies emphasises the enormous importance of these studies, and should help to standardise treatment across countries. The chapters are written in clear and lucid style, and provide a rational approach to the management of tuberculosis and a vision of how the main management problem for the 21st century, multi-drug resistant tuberculosis, can be reduced. The book has clearly enjoyed great success in the past, and will surely continue to be an essential reference book for people who are involved in planning tuberculosis control programmes or in managing tuberculosis, particularly in poorer countries, where the book will be available at half cost.

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