Published online May 2, 2005
PEDIATRICS Vol. 115 No. 6 June 2005, pp. e725-e736 (doi:10.1542/peds.2004-2157)
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HISTORICAL ARTICLE

What Caused the Epidemic of Pneumocystis Pneumonia in European Premature Infants in the Mid-20th Century?

Armond S. Goldman, MD*, Lynn R. Goldman, MD{ddagger} and Daniel A. Goldman, MD§

* University of Texas Medical Branch, Galveston, Texas
{ddagger} Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
§ Expert Health Data Programming, Inc, Seattle, Washington

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.

Key Words: Africa • Europe • retrovirus • premature infants • T cells • Pneumocystis pneumonia

Abbreviations: CMV, cytomegalovirus • HTLV-1, human T-cell lymphotropic virus type 1 • Ig, immunoglobulin • STLV, simian T-cell leukemia virus • MHC, major histocompatibility complex • TcR, T-cell antigen receptor

Accepted Dec 13, 2004.


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