title: What caused the epidemic of Pneumocystis pneumonia in European premature infants in the mid-20th century?
abstract: An epidemic of interstitial pneumonia principally involving premature infants occurred in Germany and nearby European countries between the 1920s and 1960s. Fatalities were due to Pneumocystis. Because the principal defenses against Pneumocystis are T cells, an acquired T-cell deficiency was postulated. A number of potential causes including malnutrition were considered. All were implausible except for a retrovirus that was benign in adults but virulent in premature infants. Furthermore, we suspect that the virus was imported into Germany from former German African colonies. Premature infants were vulnerable because of the developmental status of their T cells. Given the practices in that part of Europe at that time, the virus was most likely transmitted by contaminated blood transfusions and subsequent contamination of reusable needles and syringes used in injections. Although the epidemic ended 4 decades ago, a search for the postulated retrovirus can be conducted if tissues from affected infants are available.
authors.affiliation: University of Texas Medical Branch, Galveston, TX 77555-0369, USA. agoldman@utmb.edu
authors.forename: Armond S
authors.initials: AS
authors.lastname: Goldman
authors.forename: Lynn R
authors.initials: LR
authors.lastname: Goldman
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Goldman
mesh_terms: D001803:Blood Transfusion / Q000295:instrumentation; D002163:Cameroon / Q000208:ethnology; D003586:Cytomegalovirus Infections / Q000150:complications / Q000635:transmission; D004196:Disease Outbreaks / Q000266:history*; D004198:Disease Susceptibility; D004641:Emigration and Immigration; D004866:Equipment Contamination; D005060:Europe / Q000453:epidemiology; D005260:Female; D005858:Germany / Q000453:epidemiology; D049673:History, 20th Century; D006801:Humans; D007111:Immunity, Cellular; D007153:Immunologic Deficiency Syndromes / Q000208:ethnology / Q000209:etiology / Q000266:history; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000453:epidemiology / Q000266:history* / Q000276:immunology; D017563:Lung Diseases, Interstitial / Q000453:epidemiology / Q000209:etiology / Q000266:history* / Q000276:immunology / Q000382:microbiology; D008297:Male; D044342:Malnutrition / Q000150:complications / Q000453:epidemiology; D008895:Milk, Human / Q000166:cytology / Q000821:virology; D011020:Pneumonia, Pneumocystis / Q000453:epidemiology / Q000266:history* / Q000276:immunology; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology; D012192:Retroviridae Infections / Q000150:complications / Q000453:epidemiology / Q000208:ethnology / Q000266:history / Q000276:immunology / Q000635:transmission; D014037:Togo / Q000208:ethnology; D065227:Transfusion Reaction; D014195:Travel; D014774:Virulence; D014857:Warfare; D015262:Xenobiotics / Q000009:adverse effects; D015032:Zinc / Q000172:deficiency
chemical_list: D015262:Xenobiotics; D015032:Zinc