The Conquest of Infectious Diseases: Who Are We Kidding?

The 20th century has seen unprecedented scientific progress and so it is ironic that as the century draws to a close, scientists and clinicians must learn to deal with emerging new infectious agents whose existence in human beings was proved only in the past few years [1].

Almost a quarter century ago, the Surgeon General of the United States testified to Congress that it was time to close the book on infectious diseases [2]. The wide use of effective antibiotics, the potential for universal vaccination for many major childhood illnesses, and success stories, such as the eradication of smallpox in 1977, encouraged the perception that infectious diseases had been conquered.

The stark reality is that infectious diseases are the leading cause of death worldwide [3] and remain a leading cause of illness and death in the United States [4]. Human immunodeficiency virus (HIV) infection, pneumonia, and influenza rank among the 10 leading causes of death in the United States. Lyme disease has become the leading vector-borne disease with more than 50 000 cases reported since 1982, many resulting in chronic disability. Old diseases such as tuberculosis and measleslong thought to have been under controlhave recently re-emerged in the United States.

Our once seemingly invincible array of antimicrobial drugs is declining in effectiveness for many hospital- and community-acquired infections. For a large proportion of Staphylococcus aureus isolates, for example, only vancomycin remains effective, and vancomycin resistance has now been reported in enterococci [5] and coagulase-negative staphylococci [6]. If the resistance acquired by these organisms spreads to methicillin-resistant S. aureus, no effective treatment will remain for this organism. Similarly, resistance to penicillin is increasing among strains of Streptococcus pneumoniae, the most common cause of community-acquired pneumonia [7-10]. Penicillin resistance is emerging in some geographic areas …