The first large outbreak of Pneumocystis carinii pneumonia reported in the United States occurred at St. Jude Children's Research Hospital in Memphis. Seventeen cases were documented during 1968 through 1969; only two cases had been identified in the preceding six years. All 19 affected children were being given immunosuppressive drugs for malignant disease; 14 had acute leukemia. A review of 301 consecutive autopsies at St. Jude demonstrated clinically inapparent P carinii infection in 40 additional patients. Epidemiologic analysis suggested that more intensive chemotherapy caused the outbreak of Pneumocystis pneumonia by activating the inapparent Pneumocystis infection commonly associated with neoplastic disease.
Perera DR, Western KA, Johnson HD, Johnson WW, Schultz MG, Akers PV. Pneumocystis carinii Pneumonia in a Hospital for Children: Epidemiologic Aspects. JAMA. 1970;214(6):1074–1078. doi:10.1001/jama.1970.03180060052010
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