1981年任職加州大學洛杉磯分校醫學中心的 Michael Gottlieb 診斷了一位30歲的
這狀況令Michael Gottlieb 感到非常驚訝,因為在正常情況肺囊蟲肺炎只會發生在體質易
而病患卻是一位正值壯年的年輕人,Michael Gottlieb 將這情況告訴了同樣是醫生
的Joel Weisman 和其他同行,短短幾天他們就收到很多個病例
在1981年6/25日他們在Morbidity and Mortality Weekly Report (MMWR)(發病率與死亡率周
Pneumocystis Pneumonia --- Los Angeles
In the period October 1980-May 1981, 5 young men, all active homosexuals, were treated for biopsy-confirmed Pneumocystis carinii pneumonia at 3 different hospitals in Los Angeles, California. Two of the patients died. All 5 patients had laboratory-confirmed previous or current cytomegalovirus (CMV) infection and candidal mucosal infection. Case reports of these patients follow.
Patient 1: A previously healthy 33-year-old man developed P. carinii pneumonia and oral mucosal candidiasis in March 1981 after a 2-month history of fever associated with elevated liver enzymes, leukopenia, and CMV viruria. The serum complement-fixation CMV titer in October 1980 was 256; in may 1981 it was 32.* The patient's condition deteriorated despite courses of treatment with trimethoprim-sulfamethoxazole (TMP/SMX), pentamidine, and acyclovir. He died May 3, and postmortem examination showed residual P. carinii and CMV pneumonia, but no evidence of neoplasia.
病患一:一位先前健康良好的33歲男性,在1981年三月發展成卡氏肺囊蟲肺炎,與口腔黏膜念珠菌感染,之後有兩個月發燒的病史合併肝酶升高,白細胞減少與巨細胞病毒毒尿症. 補體結合巨细胞病毒抗体滴度,在1980年十月是256,在1981年五月為32.儘管用trimethoprim-sulfamethoxazole(磺胺類抗生素), pentamidine(噴他脒) acyclovir (無環烏苷)治療,該病患的病情還是惡化.他在五月三號死亡,驗屍報告顯示殘留卡式肺囊蟲與巨細胞病毒肺炎,但是沒有證據他體內有腫瘤
Patient 2: A previously healthy 30-year-old man developed p. carinii pneumonia in April 1981 after a 5-month history of fever each day and of elevated liver-function tests, CMV viruria, and documented seroconversion to CMV, i.e., an acute-phase titer of 16 and a convalescent-phase titer of 28* in anticomplement immunofluorescence tests. Other features of his illness included leukopenia and mucosal candidiasis. His pneumonia responded to a course of intravenous TMP/.SMX, but, as of the latest reports, he continues to have a fever each day.
病患二: 一位先前健康良好的三十歲男性,在1981年四月發展成卡氏肺囊蟲肺炎之後有五個月每天發燒與肝指數偏高的病史,巨細胞病毒毒尿症,血清轉換確診為巨細胞病毒感染,使用anticomplement immunofluorescence tests(抗補體免疫螢光法測試)的急性期滴度是16而恢復期滴度是28,其他的病情包含白細胞減少口腔黏膜念珠菌感染.使用靜脈注射TMP/.SMX(磺胺類抗生素)治療他的肺炎,不過根據最新的報告他每天持續在發燒
Patient 3: A 30-year-old man was well until January 1981 when he developed esophageal and oral candidiasis that responded to Amphotericin B treatment. He was hospitalized in February 1981 for P. carinii pneumonia that responded to TMP/SMX. His esophageal candidiasis recurred after the pneumonia was diagnosed, and he was again given Amphotericin B. The CMV complement-fixation titer in March 1981 was 8. Material from an esophageal biopsy was positive for CMV.
病患三:一位健康良好的三十歲男性,直到1981年一月當他發展成食道和口腔念珠菌感染,使用Amphotericin B(兩性黴素B)治療,他在1981年二月因為卡氏肺囊蟲肺炎而住院,並使用TMP/.SMX(磺胺類抗生素)治療.在確診為肺炎後他的食道念珠菌感染又復發,又再度使用Amphotericin B(兩性黴素B)治療.補體結合巨细胞病毒抗体滴度在1981年三月是8.食道巨細胞病毒檢驗呈陽性反應
Patient 4: A 29-year-old man developed P. carinii pneumonia in February 1981. He had had Hodgkins disease 3 years earlier, but had been successfully treated with radiation therapy alone. He did not improve after being given intravenous TMP/SMX and corticosteroids and died in March. Postmortem examination showed no evidence of Hodgkins disease, but P. carinii and CMV were found in lung tissue.
Patient 5: A previously healthy 36-year-old man with clinically diagnosed CMV infection in September 1980 was seen in April 1981 because of a 4-month history of fever, dyspnea, and cough. On admission he was found to have P. carinii pneumonia, oral candidiasis, and CMV retinitis. A complement-fixation CMV titer in April 1981 was 128. The patient has been treated with 2 short courses of TMP/SMX that have been limited because of a sulfa-induced neutropenia. He is being treated for candidiasis with topical nystatin.
病患五:一位之前健康良好的36歲男性,在1980年九月被臨床診斷出巨細胞病毒感染,1981年四月因為四個月的發燒病史呼吸困難 咳嗽來就診,入院期間他被發現罹患卡氏肺囊蟲肺炎 口腔念珠菌感染 與巨細胞病毒性視網膜炎. 補體結合巨细胞病毒抗体滴度在1981年四月是128.他已經使用了TMP/.SMX(磺胺類抗生素)做了兩次短暫治療療程,由於磺胺類抗生素引起的白細胞減少,他已經被限制使用TMP/.SMX(磺胺類抗生素)來治療.他正在接受念珠菌外用制黴菌素治療中
The diagnosis of Pneumocystis pneumonia was confirmed for all 5 patients antemortem by closed or open lung biopsy. The patients did not know each other and had no known common contacts or knowledge of sexual partners who had had similar illnesses. Two of the 5 reported having frequent homosexual contacts with various partners. All 5 reported using inhalant drugs, and 1 reported parenteral drug abuse. Three patients had profoundly depressed in vitro proliferative responses to mitogens and antigens. Lymphocyte studies were not performed on the other 2 patients.
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