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Foreword: 10-year special edition

Infectious disease is an ever-evolving arena of medicine. I was fascinated as a teenager that so much damage and destruction could be caused by something as small as microbes and yet be so far-reaching. The complexity of this field with so many pathogens was simply too much to resist. So it is with pleasure and honor that I accepted the task of writing the foreword for the 10th anniversary issue of Expert Review of Anti-infective Therapy. So where to begin? This issue contains experts who articulate on key topics in virology, parasitology, invasive fungal infections and the challenges of developing new antibacterials. However, before I give you a peek into the six fascinating reviews in the November issue, I thought it would be appropriate to remind ourselves that almost two-thirds of emerging infectious diseases are zoonotic, which originate from animals, with 60% of those coming from wildlife. Diseases such as Nipah (fruit bats in 1998), Ebola (infected primates or small mammals in 1976), West Nile (birds, especially robins in 1999 in USA), arenavirus (1960s) and severe acute respiratory syndrome (horseshoe bats in 2003) all originated in species other than Homo sapiens. In addition, conditions such as malaria, dengue, hantavirus, babesiosis/anaplasmosis and many other diseases are transmitted to humans via insect vectors. Indeed perhaps one of the most challenging of these latter diseases is malaria. Many, if not all, of these infections are being affected by man’s activities, whether it be encroaching into environments not previously explored and thus exposed to humans, or through our neglect or poverty, we have created environments that are ideal for many of the vectors of these contagions. Perhaps one of the most obvious man-made influences on infectious diseases has been the emergence of organisms resistant to some or all of the anti-infective agents developed to treat these maladies. Admittedly, many species probably already had the genetic wherewithal to become resistant, but our flagrant and improper use of antibiotics, antivirals and even antiparasitics has selected for organisms that provide significant clinical challenges. Perhaps in my career in infectious disease, the emergence of HIV in the early 1980s has had the most wide-ranging impact, especially in sub-Saharan Africa, although the disease has also occurred in many parts of southern Asia. The incidence varies widely with countries in southern Africa being most affected, whereas in 2009, Swaziland reported a prevalence of 25.9%, Botswana 24.8% and Lesotho 23.6% while most of Europe has <0.1% HIV prevalence [101]. However, it is noteworthy that almost every year, a ‘new pathogen’ has been reported to cause disease in humans. Clearly, the emergence of HIV stimulated research into the patho genesis and epidemiology of the disease and appropriate therapies but resistant strains soon emerged. Ultimately, multidrug regimens were devised; however, many of those infected were unable to afford these agents. Colebunders et al. review the history of antiretroviral therapy and highlight the major advances that have enabled many to have access to these new therapies in lowresource settings, which may be used in quite different ways to those of the past 25 years [1]. Kunz et al. [2] discuss another group of diseases that strikes fear into many, the hemorrhagic fevers caused by the arena viruses, which include Lassa fever, Expert Review of Anti-infective Therapy