Infectious Disease: Most Important of the Modern Plagues

The last few months in Canada have seemed almost biblical in character. We have had plagues, cattle disease, insect infestations, fire, darkness and, if we go back a few years, the Walkerton water disaster could substitute for blood in the Nile. I have put my eldest son on full alert!

For physicians, the most important of these modern "plagues" are those caused by infections. Not unexpectedly, new infectious diseases, like the older more established ones, often have their most devastating effects on older patients. We have known for years that the deaths attributed to influenza outbreaks are most common in older adults. The case fatality ratio for SARS increases quickly with advancing age, and the most serious consequences of last year's West Nile Virus outbreak in southern Ontario also were seen most frequently in older adults.

It is thus very timely that this issue of Geriatrics & Aging focuses on infections in the older adult. During the first wave of SARS in Toronto, a colleague in the U.S. contacted me. He is a specialist in emergency medicine who has developed a successful business providing medical coverage to cruise lines. He was desperately seeking information about SARS to inform the cruise lines about proper infection control procedures. It is perhaps not surprising that infection control is becoming a major issue for cruise lines, since cruises are essentially the confinement of a population the size of a small town to a relatively small area. I found out from my American colleague that Canadians in general, and Torontonians in particular, are high-frequency cruisers. Thus, I think the article "Prevention of Tropical Illness in Older Travellers: The Older Cruiser" is particularly relevant as we head into the first "post-SARS" cruise season.

Everybody agrees that asymptomatic bacteriuria in older adults should not be treated. The more difficult question, however, is how to know whether the patient is truly asymptomatic. One of the few people qualified to address this topic properly is Dr. Lindsay Nicolle, one of North America's leading infectious disease specialists with a long-standing interest in urinary tract infections in older adults. New treatments often come with new risks, and Dr. Richard Long discusses the new biologic therapies and the risk of tuberculosis in older patients. Dr. Shelly McNeil and colleagues focus on long-term care facilities in their review of methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci, while Dr. Lona Mody examines the clinical manifestations and treatment options for skin and soft tissue infections. Dr. I.W. Fong discusses one of the most interesting and prevalent "infectious" diseases--atherosclerosis. Although not yet confirmed, evidence for the relationship between infection and atherosclerosis, reviewed here, continues to accumulate.

Finally, I am pleased to announce that three prominent Canadian physicians (and previous contributors to Geriatrics & Aging) have joined our Advisory Board. Dr. Serge Gauthier is an internationally renowned neurologist with a special interest in dementing disorders, Dr. Jagdish Butany is a leading expert in cardiovascular diseases and cardiovascular pathology, and Dr. Rory Fisher is probably the single most important person in the development of Geriatric Medicine as a specialty in Canada. The entire editorial staff at Geriatrics & Aging is pleased to have such distinguished members join our team.

Enjoy this issue.