Skip to main content
SpringerLink
Log in

Marasmus and pneumocystis carinii pneumonia in institutionalised infants

Observations during an endemic

  • Published:
Zeitschrift für Kinderheilkunde Aims and scope Submit manuscript

Abstract

An endemic of interstitial plasmacell pneumonia due to pneumocystis carinii, leading to 68 deaths in an orphanage, is described. Artifical nutrition led to severe intestinal infections with prolonged diarrhoea, followed by atrophy of the upper intestinal mucosa and marasmus. The IgG levels fell below 200mg% by the 3rd to 4th month of life, which is one of the preconditions for an infection with pneumocystis carinii.

Infants with much higher levels of immune-globulins could not survive before the advent of antibiotics. Epidemics with pneumocystis carinii were therefore not seen prior to World War II.

Interstitial plasmacell pneumonia leads to immunity in those infants who survive and is therefore clearly distinct from the pneumocystosis, which occurs in congenital immunodeficiency syndromes and in patients who undergo persistent therapeutic immunosuppression.

Zusammenfassung

Es wird über eine Waisenhausepidemie mit interstitieller Plasmazellenpneumonie bei Kleinkindern berichtet, die zu 68 Todesfällen führte. Die Säuglinge litten unter schweren Darminfektionen mit langdauernden Durchfällen, die von Schleimhautatrophie des Dünndarms und Marasmus gefolgt waren. Die Serum IgG-Werte sanken im 3. und 4. Lebensmonat unter 200 mg%, was die Voraussetzung für die Infektion mit Pneumozystis carinii schaffte.

Vor der Antibioticaära konnten Kinder mit selbst weit höheren IgG-Werten nicht am Leben erhalten werden. Epidemien mit Pneumozystis carinii wurden daher vor Ende des Zweiten Weltkrieges nie gesehen.

Die interstitielle Plasmazellenpneumonie, die bei Überlebenden zur Immunität führt, wird von der Pneumozytose bei kongenitalen Immunmangelsyndromen oder bei künstlich herbeigeführter Immundefizienz klar unterschieden.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Abioye, A. A.: Interstitial plasma cell pneumonia in Ibadan W. Afr. med. J. and Nigerian Pract. 16, 130 (1967)

    Google Scholar 

  • Anderson, C. D., Barrie, H. J.: Fatal pneumocystis pneumonia in an adult. Report of a case. Amer. J. clin. Path. 34, 365 (1960)

    Google Scholar 

  • Bachmann, K. D., Zur Epidemiologie und Inkubation der frühkindlichen interstitiellen Pneumonie. Z. Kinderheilk. 74, 133 (1954)

    Google Scholar 

  • Barta, K., Dvoracek, O., Kadlec, A.: Komplementbindungsreaktion bei Pneumocystispneumonien. Schweiz. Z. allg. Path. 18, 22 (1955)

    Google Scholar 

  • Berdnikoff, G.: Fourteen personal cases of pneumocytis carinii pneumonia. Canad. med. Ass. J. 80, 1 (1959)

    Google Scholar 

  • Beyer, P., Siat Stoessle, E., Klein, M. L.: Les troubles du metabolisme du calcium au course de la pneumonie interstitielle. Arch. franc. Pédiat. 19, 1377 (1962)

    Google Scholar 

  • Bosman, C.: Hypervitaminosis D in pneumocystis carinii pneumonia in an infant. Helv. paediat. Acta 20, 300 (1965)

    Google Scholar 

  • Brzosko, W. J., Krawezunski, K., Madalinski, K., Nowoslawski, A.: Immunofluorescent and immunoelectrophoretic reactions in infants with pneumonia due to pneumocystis carinii. Med. Dosw. Mikrobiol. 19, 373 (1967)

    Google Scholar 

  • Brzosko, W. J., Nowoslawski, A., Madalinski, K.: Identification of immunecomplexes in lungs from pneumocystis carinii pneumonia cases in infants. Bull. Acad. pol. Sci. Cl. VI 12, 137 (1964)

    Google Scholar 

  • Burke, B. A., Krovetz, L. G., Good, R. A.: Occurrence of pneumocystis carinii in children with agammaglobulinaemia. Pediatrics 28, 196 (1961)

    Google Scholar 

  • Callerame, M. L., Nadel, M.: Pneumocystis carinii pneumonia in two adults with multiple myeloma. Amer. J. clin. Path. 45, 258 (1966)

    Google Scholar 

  • Chagas, C.: Nova trypanomiazaes humana. Mem.Inst. Cruz 1, 159 (1909)

    Google Scholar 

  • Clarke, J. I.: The Iranian City of Shiraz. Dept. of Geography, University of Durham Research Paper Series No. 7, 1963

  • Creamer, B., Dutz, W., Post, C.: Small intestinal lesion of chronic diarrhoea and marasmus in Iran. Lancet. 1970 I, 18

  • De Vita, V. T., Emmer, M., Levine, A., Jacobs, B., Berard, C.: Pneumocystis carinii pneumonia: Successful diagnosis and treatment of two patients with associated malignant processes. New Engl. J. Med. 280, 287 (1961)

    Google Scholar 

  • Dutz, W.: Pneumocystosis carinii pneumonia. In: Pathology Annual, p. 309. New York: Appleton Century Crofts 1970

    Google Scholar 

  • Dutz, W., Sadri, S., Kohout, E., Post, C., Bandarizadeh, B.: Bowel mucosal patterns and immunoglobulins in 100 infants from birth to one year of age. Pahlavi Med. J. 1, 234 (1970)

    Google Scholar 

  • Dutz, W., Azadeh, B., Kohout, E., Vessal, K.: Infantile enteritis as cause of thymolymphatic atrophy. Z. Kinderheilk. 115, 155 (1973a)

    Google Scholar 

  • Dutz, W., Post, C., Kohout, E., Aghamohammadi, A.: Cellular reaction to pneumocystis carinii. Z. Kinderheilk. 114, 1 (1973b)

    Google Scholar 

  • Dvorak, J., Jirovec, O.: Diagnostik und Therapie der durch Pneumocystis Carinii verusachten atypischen Pneumonien bei Säuglingen. Acta paediat. (Uppsala) 42, 543 (1953)

    Google Scholar 

  • Erschul, J. E., Williams, E. P., Meighen, P. P.: Pneumocystis carinii in hypopharyngeal material. New Engl. J. Med. 267, 926 (1962)

    Google Scholar 

  • Esterly, J. E., Warner, N. E.: Pneumocystis carinii pneumonia. 12 cases in patients with neoplastic lymphoreticular disease. Arch. Path. 80, 433 (1965)

    Google Scholar 

  • Falkenbach, K. H., Bachmann, K. D., O'Loughlin B. J.: Pneumocystis carinii pneumonia. Amer. J. Roentgenol. 85, 706 (1961)

    Google Scholar 

  • Feinberg, S. B., Lester, R. G., Burke, B. A.: Roentgen findings in pneumocystis carinii pneumonia. Radiology 76, 594 (1961)

    Google Scholar 

  • Frenkel, J. K.: Disease from Pneumocystis in North America. Abstracts and Reviews 8th Int. Congr. Trop. Med. and Malaria, Teheran, Sept., 929 (1968)

  • Frenkel, J. K., Good, J. T., Schultz, J. A.: Latent pneumocystis infection of rats, relapse and chemotherapy. Lab. Invest. 15, 1559 (1966)

    Google Scholar 

  • Gaensler, E. A., Moister, V. B., Hamm, J.: Open lung biopsy in diffuse pulmonary disease. New Engl. J. Med. 207, 1319 (1964)

    Google Scholar 

  • Gajdusek, C. C.: Pneumocystis carinii. Pediatrics 19, 543 (1957)

    Google Scholar 

  • Gleiss, J.: Die interstitielle plasmazelluläre Pneumonie frühgeborener dystrophischer Säuglinge. Kinderärztl. Prax. 24, 159 (1956)

    Google Scholar 

  • Goetz, O., Orth, B.: Langdauernde Cortisonbehandlung und interstitielle Pneumonia. Z. Kinderheilk. 112, 163 (1964)

    Google Scholar 

  • Hamlin, W. B.: Pneumocystis carinii J. Amer. med. Ass. 204, 173 (1968)

    Google Scholar 

  • Hamperl, H.: Pneumocystis infection and cytomegaly of the lungs in the newborn and adult. Amer. J. Path. 32, 1 (1956)

    Google Scholar 

  • Hamperl, H.: Über heilende und abortive Pneumocystis-Pneumonie. Virchows Arch. path. Anat. 330, 325 (1957a)

    Google Scholar 

  • Hamperl H.: Variants of pneumocystis pneumonia. J. Path. Bact. 74, 353 (1957b)

    Google Scholar 

  • Hennigar, G. R., Vinijcheikul Roque, A. L., Lyons, H. A.: Pneumocystis carinii pneumonia in an adult. Amer. J. clin. Path. 35, 353 (1961)

    Google Scholar 

  • Hill R. B., Rowlands, D. T., Jr., Rifkind, D.: Infectious pulmonary disease in patients receiving immunosuppressive therapy for organ transplantation. New Engl. J. Med. 271, 1021 (1964)

    Google Scholar 

  • Ivady, G., Paldy, L.: New method of treating interstitial plasma cell pneumonie in premature infants with 5 valent antimony and aromatic diamidines. Mschr. Kinderheilk. 106, 10 (1958)

    Google Scholar 

  • Ivady, G., Paldy, L., Unger, G.: Further experiences in the treatment of interstitial plasma cell pneumonia with pentamidine. Mschr. Kinderheilk. 111, 297 (1963)

    Google Scholar 

  • Ivanoskaja, T. A., Levinas, N.: Acute diffuse fibrosis of the lungs associated with pneumocystis carinii. Arkh. Path. 24, 59 (1962)

    Google Scholar 

  • Jacobs, B. J., Vogel, C., Poweller, De Vita, V. T.: Needle biopsy in pneumocystis carinii pneumonia. Radiology 93, 525 (1969)

    Google Scholar 

  • Jarnum, S., Rasmussen, E. F., Sjoeberg-Olsen, A., Soerensen, A. W. S.: Generalized pneumocystis carinii infection with severe idiopathic hypoproteinemia. Ann. intern. Med. 68, 138 (1968)

    Google Scholar 

  • Jirovec, O.: Über die durch Pneumocystis Carinii verursachte interstitielle Pneumonie der Säuglinge. J. Hyg. Epidem. (Praha) III, 28 (1959)

    Google Scholar 

  • Kohout, E., Post, C., Azadeh, B., Dutz, W., Bandarizadeh, B., Kadivar, D.: Immunoglobulin levels in infantile pneumocytosis. J. clin. Path. 25, 135 (1972)

    Google Scholar 

  • Kohout, E., Post, C., Dutz, W., Bandarizadeh, B.: Enteropathogenic E. Coli infections and resistance to antibiotics in a nursery. Pahlavi Med. J. 1, 39 (1970)

    Google Scholar 

  • Kordyasz, E.: Successful treatment of infants with pneumonia pneumocystica with Daraprim. Pediat. pol. 41, 1381 (1966)

    Google Scholar 

  • Kossel, A.: Interstitielle plasmazelluläre Pneumonie beim älteren Kind als Folge der langdauernden Corticosteroidbehandlung. Dtsch. med. Wschr. 87, 1133 (1962)

    Google Scholar 

  • Kouvalainen, K., Hjelt, L., Wasz-Hoeckert, O.: Marked elevation of beta 2 M globulin in a patient with interstitial plasma cell pneumonia. Acta paediat. (Uppsala) 53, 465 (1964)

    Google Scholar 

  • Kramer, R. I., Cirone, V. C., Moore, H.: Interstitial pneumonia due to pneumocystis carinii, cytomegalic inclusion disease and hypogammaglobulinaemia occurring simultaneously in an infant. Pediatrics 29, 816 (1962)

    Google Scholar 

  • Krumholz, R. A.: Needle biospy of the lung: Report on its use in 112 patients and review of the literature. Ann. intern. Med. 65, 293 (1966)

    Google Scholar 

  • Kucera, K., Valousek, T.: The direct proof of pneumocystis carinii in alive nurselings and a new evolutive stage of pneumocystis. Folia Parasitologia (Praha) 13, 113 (1966)

    Google Scholar 

  • Lebeda, D.: Spontaneous fractures of the ribs from fatigue in infants. Cs. Pediat. 16, 667 (1961)

    Google Scholar 

  • Le Tanh Vinh, Cochard, A. M., Vu Trieu Dong Aned Solonuar, W.: Diagnostic in vivo de la pneumonia a pneumocyste. Arch. franç. Pédiat. 20, 773 (1963)

    Google Scholar 

  • Lillehei, J. P., Funke, J. L., Drage, C. W., Sharp, H. L., Burke, B. A.: Pneumocystis carinii pneumonia. Needle biopsy diagnosis and successful treatment. J. Amer. med. Ass. 206, 596 (1968)

    Google Scholar 

  • Linhartova, A.: Herdförmige klinisch latente Pneumocystis-Pneumonie. Zbl. allg. Path. 98, 183 (1958)

    Google Scholar 

  • Lorinczi, K.: Our experiences with pentamidine in the treatment of interstitial plasma cell pneumonia. Gyermekgyógyászat 15, 207 (1964)

    Google Scholar 

  • Marshall, W. C., Frenkel, J. K.: Pneumocystis carinii pneumonia. Lancet 1966 I, 94

  • Marshall, W. C., Weston, R. J., Bodian, M.: Pneumocystis carinii pneumonia and congenital hypogammaglobulinaemia. Arch. Dis. Child. 39, 18 (1964)

    Google Scholar 

  • Mc Kay, E., Richardson, J.: Pneumocystis carinii pneumonia associated with hypogammaglobulinaemia. Lancet 1959 II, 713

  • Meuwissen, J. H., Leeuwenberg, A. D., Heeren, J., Stumpel, A.: New method for study of infections with pneumocystis carinii. J. infect. Sis. 127, 209 (1973)

    Google Scholar 

  • Mueller, H., Vietor, G.: Klinisch-epidemiologische Beobachtungen bei der frühkindlichen interstitiellen plasmazellulären Pneumonie. Z. Kinderheilk. 79, 40 (1957)

    Google Scholar 

  • Mulligan, W. J., Baum, G. L.: Letter to the editor concerning ref. 55. Ann. intern. Med. 68, 1373 (1968)

    Google Scholar 

  • Mur, J.: Fokale Pneumocystenpneumonie in einem 26 Jahre alten Mann mit Lymphogranulomatose. Zbl. Path. 99, 386 (1959)

    Google Scholar 

  • Nakamura, R. M.: Coexistent cytomegalic inclusion body disease and pneumocystis carinii infection in an adult. Acta path. jap. 14, 45 (1964)

    Google Scholar 

  • Pavlica, F.: Erste Beobachtung von angeborener Pneumocystenpneumonie bei einem reifen ausgetragenen totgeborenem Kind. Zbl. Path. 103, 236 (1962)

    Google Scholar 

  • Post, C., Dutz, W., Nazarian, I.: Endemic pneumocystis carinii pneumonia in South Iran. Arch. Dis. Childh. 39, 35 (1964)

    Google Scholar 

  • Post, C., Fukuhi, T., Dutz, W., Bandarizadeh, B., Kohout, E.: Prophylaxis of epidemic infantile pneumocystosis with 20:1 sulfadoxin + pyrimethamine combination. Curr. ther. Res. 13, 273 (1971)

    Google Scholar 

  • Post, C., Kohout, E., Dutz, W., Bandarizadeh, B.: Experiences with enteropathogenic Escherichia coli infections in Iran. Proc. 8th Int. Congr. Trop. Med. and Malariology, Teheran, Sept., 446 (1968)

  • Pozzuoli, R., Corda, G.: Caratterizzazione della immunoglobulin nella pneumocistosi infantile. Clin. pediat. (Bologna) 48, 541 (1966)

    Google Scholar 

  • Reif, A., Sandbank, U.: Pneumonia due to pneumocystis carinii. Narefua 57, 43 (1959)

    Google Scholar 

  • Rifkind, D., Faris, D. T., Hill, R. B., Jr.: Pneumocystis carinii pneumonia. Studies on diagnosis and treatment. Ann. intern. Med. 65, 943 (1966)

    Google Scholar 

  • Rifkind, D., Starzl, T. E., Marchioro, T. L., Waddell, W. R., Rowlands, J. D., Hill, R. B.: Transplantation pneumonia. J. Amer. med. Ass. 189, 808 (1964)

    Google Scholar 

  • Robbins, J. B.: Pneumocystis carinii pneumonitis. A review. Pediat. Res. 1, 131 (1967)

    Google Scholar 

  • Robbins, J. B.: Immunological and clinicopathological aspects of pneumocystis carinii pneumonitis. In: Bergsma, Good, Immunological deficiency diseases in man. National Foundation March of Dimes 219 (1968)

  • Ryan, B.: Pneumocystis carinii infection in Melanesian children. J. Pediat. 60, 914 (1962)

    Google Scholar 

  • Salfelder, K., Schwarz, J., Sethi, K. K., Bonzalez, R., De Liscano, T. R., Carlesso, Y. J.: Neumocystosis. Merida, Venezuela: Universidad de los Andes 1966

    Google Scholar 

  • Schmid, K. O.: Studien zur Pneumocystis-Erkrankung des Menschen. I. Frankfurt. Z. Path. 74, 121 (1964)

    Google Scholar 

  • Shao-Nan Huang, Marshall, K. G.: Pneumocystis carinii infection. A cytologic, histologic and electron microscopic study of the organism. Amer. Rev. resp. Dis. 102, 623 (1970)

    Google Scholar 

  • Sheldon, W. H.: Subclinical pneumocystis pneumonia. Amer. J. Dis. Child. 97, 287 (1959)

    Google Scholar 

  • Stopka, E., Wunderhill, C., Carlson, S.: Morphologische und kulturelle Untersuchungen an Pneumocysten in Sputa und Lungenmaterial. Z. Kinderheilk. 97, 264 (1957)

    Google Scholar 

  • Thijs, A., Janssens, P. G.: Pneumocystosis in Congolese infants. Trop. geogr. Med. 15, 158 (1963)

    Google Scholar 

  • Thomas, S. F., Dutz, W., Jennings-Khodadad, E.: Pneumocystis carinii pneumonia (plasma cell pneumonia). Roentgenographic, pathologic and clinical correlation. Amer. J. Roentgenol. 98, 318 (1966)

    Google Scholar 

  • Toth, G., Balogh, E., Belay, M.: Demonstration in tracheal secretion of the causative agent of interstitial plasma cell pneumonia. Acta paediat. Acad. Sci. hung. 7, 25 (1966)

    Google Scholar 

  • Unat, E. K.: Turkieide ilk pneumocystis carinii infeksionu. Türk Tip Cem. Mec. 21, 489 (1955)

    Google Scholar 

  • Vessal, K., Post, C., Dutz, W., Bandarizadeh, B.: Roentgenologic changes in infantile Pneumocystis carinii pneumonia. Am. J. Roentgenol. 120, 254–260 (1974)

    Google Scholar 

  • Vivell, O.: Ein neues stabiles Antigen für die Serodiagnose der interstitiellen plasmazellulären Pneumonie junger Säuglinge. Dtsch. med. Wschr. 80, 1357 (1955)

    Google Scholar 

  • Western, K. A., Perera, D. A., Schultz, M. G.: Pentamidine isethionate treatment of pneumocystis carinii pneumonia. Ann. intern. Med. 73, 695 (1970)

    Google Scholar 

  • Woodward, S. C., Sheldon, W. H.: Subclinical pneumocystis pneumonitis in adults. Bull. Johns Hopk. Hosp. 109, 148 (1961)

    Google Scholar 

  • Zandanell, E.: Pneumocystis-Befund außerhald der Lunge bei interstitieller plasmazellulärer Pneumonie der Säuglinge und Frühgeborenen. Zbl. Path. 92, 74 (1954)

    Google Scholar 

  • Zukhova, E. K.: A case of pneumocystis pneumonia associated with generalized cytomegaly in a child. Arkh. Path. 24, 68 (1962)

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pathology, Pahlavi University, Shiraz

    Werner Dutz

  2. Red Lion and Sun Orphanage, Pahlavi University, Shiraz

    Ethlyn Jennings-Khodadad & Cornelius Post

  3. Pahlavi University Medical School, Pahlavi University, Shiraz

    Elfriede Kohout & Iraj Nazarian

  4. Department of Anaesthesiology, Pahlavi University, Shiraz

    Hassan Esmaili

  5. Department of Surgical Pathology, Medical College of Virginia, 23298, Richmond, Va., USA

    Werner Dutz

Authors
  1. Werner Dutz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ethlyn Jennings-Khodadad
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Cornelius Post
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Elfriede Kohout
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Iraj Nazarian
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hassan Esmaili
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

This study has been supported by NIH grant Al-06404.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Dutz, W., Jennings-Khodadad, E., Post, C. et al. Marasmus and pneumocystis carinii pneumonia in institutionalised infants. Z. Kinder-Heilk. 117, 241–258 (1974). https://doi.org/10.1007/BF00440491

Download citation

  • Received:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00440491

Key words

Search

Navigation