Showing papers in "Morbidity and Mortality Weekly Report in 1981"

Pneumocystis pneumonia--Los Angeles.

Abstract: This article describes 5 cases of Pneumocystis carinii pneumonia occurring in homosexual men in Los Angeles California. All 5 patients had previous or current cytomegalovirus and candidal mucosal infection. The men 2 of whom have died ranged from 29-36 years of age. The patients did not know each other and had no known common contacts or knowledge of sexual partners with similar illnesses. The 5 did not have comparable histories of sexually transmitted disease. 4 had serologic evidence of past hepatitis B infection but no evidence of current hepatitis B surface antigen. 2 of the men reported frequent homosexual contact with various partners. All 5 reported use of inhalant drugs. The 3 patients in whom lymphocyte studies were performed had profoundly depressed in vitro proliferative responses to mitogens and antigens. The occurrence of pneumocystosis in these 5 previously healthy men without a clinically apparent underlying immunodeficiency is unusual but seems to reflect some association with a homosexual lifestyle or disease acquired through sexual contact. Cytomegalovirus infection has been shown to induce transient abnormalities of in vitro cellular immune function in healthy homosexual men with and without antibody and a high prevalence of cytomegalovirus infections has been reported among male homosexuals. In additon there is some evidence that seminal fluid may be an important vehicle of cytomegalovirus transmission. Although the role of cytomegalovirus infection in the pathogenesis of pneumocystosis reamins unknown the possibility of P. carinii infection should be carefully considered in previously healthy homosexuals with dyspnea and pneumonia.

Kaposis sarcoma and Pneumocystis pneumonia among homosexual men--New York City and California.

Abstract: Accurate incidence and mortality rates in the US for Kaposis sarcoma are not available but the annual incidence has been estimated at 0.02-0.06/100000. The disease has tended to affect primarily elder males. A departure from this pattern is the diagnosis in the past 30 months of Kaposis sarcoma in 26 homosexual men in New York City and California whose mean age was 39 years (range 26-51 years). In contrast to the clinical course in elderly men in whom the mean survival time is 8-13 years after diagnosis 8 of the homosexual patients died within 2 years after diagnosis. A review of the New York University Coordinated Cancer Registry for Kaposis sarcoma revealed no such cases in men under 50 years of age for the 1970-79 period. Presenting complaints in 20 of the homosexual men included skin lesions only (50%) and skin lesions plus lymphadenopathy (20%). After the initial physician visit 6 patients developed pneumonia and 1 had necrotizing toxoplasmosis of the central nervous system. Serologic evidence of past or present cytomegalovirus infection was found in all 12 patients who were tested. Also of concern is the incidence of 15 cases of Pneumocystis in homosexual men in California since 1979. These findings indicate that physicians should be alert for Kaposis sarcoma Pneumocystis pneumonia and other opportunistic infections associated with immunosuppression in homosexual men.