Follow-Up on Kaposi's Sarcoma and Pneumocystis Pneumonia
Source: Morbidity and Mortality Weekly Report , August 28, 1981, Vol. 30, No. 33(August 28, 1981), pp. 409-410
Published by: Centers for Disease Control & Prevention (CDC)
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CENTERSCENTERSFORFORDISEASEDISEASECONTROL
CONTROL

August 28,28, 1981
1981 // Vol.
Vol. 30
30 // No.
No. 33
33IIUMImmmi

Epidemiologic
Epidemiologic NotesNotes andand Reports
Reports
409 Follow-Up on Kaposi's Sarcoma andPneumocystis Pneumonia

MHYN
MmMi

ACIP Recommendation

410 Pneumococcal Polysaccharide Vaccine

MORBIDITY
MORBIDITY AND
AND MORTALITYMORTALITY WEEKLYWEEKLY REPORTREPORT

Epidemiologic Notes and Reports

Follow-Up on Kaposi's Sarcoma and Pneumocystis Pneumonia
Twenty-six cases of Kaposi's sarcoma (KS) and 15 cases of Pneumocystis carinii pneu
monia (PCP) among previously healthy homosexual men were recently reported (1,2).
Since July 3, 1981, CDC has received reports of an additional 70 cases of these 2 condi
tions in persons without known underlying disease. The sex, race, sexual preference, andmortality data known for 108 persons with either or both conditions are summarizedin Table 1.

The majority
majority ofof thethe reported
reported cases
casesofofKS
KSand/orand/orPCP
PCPhavehaveoccurredoccurredininwhite
white
men.
men.
Patients
Patients ranged
ranged inin age
age fromfrom 15-52
15-52years;
years;overover95%
95%wereweremen
men25-49
25-49years
yearsofofage.
age.
NinetyNinetyfour percent
percent (95/101)(95/101) ofof thethe men
menforforwhom
whomsexualsexualpreference
preferencewas
wasknown
knownwere
were
homo
homo
sexual oror bisexual.
bisexual. Forty
Forty percent
percentof
ofthe
thereported
reportedcases
caseswere
werefatal.
fatal.Of
Ofthe
the8282
cases
forsexualcases
forthe month
month ofof diagnosis
diagnosis isis known,
known,75
75(91%)(91%)have
haveoccurredoccurredsince
sinceJanuary
January
1980,
withwhich the1980,with55 (67%) diagnosed
diagnosed fromfrom January
January throughthroughJuly
July1981.
1981.Although
Althoughphysicians
physiciansfrom
fromseveral
severalstates have
have reported
reported cases
cases ofof KS
KS andandPCP
PCPamong
amongpreviously
previouslyhealthy
healthyhomosexualhomosexualmen,men,
the majority
majority ofof cases
cases have
have been
been reported
reportedfrom
fromNew
NewYork
YorkandandCalifornia.
California.
Reported
Reported byby SM
SM Friedman,Friedman, MD,
MD, YM
YMFetman,Felman, MD,
MD,New
NewYork
YorkCity
CityDept
DeptofofHealth;
Health;RRRothenberg,
Rothenberg,
MD, StateState Epidemiologist,Epidemiologist. New
New York
YorkStateStateDept
DeptofofHealth;
Health;S SDritz,Dritz,MD,MD,E EBraff,Braff,MD,
MD,
City/County
City/County
HealthHealth Dept,
Dept, SanSan Francisco;Francisco;SSFannin,Fannin,MD,
MD,LosLosAngeles
AngelesCounty
County
Dept
Dept
ofof
HealthHealth
Svcs;
Svcs;/ Heindl,/ Heindl,
MD,
MD,
California
CaliforniaDept
Dept
ofof
HealthHealthSvcs;
Svcs;
RK Sikes,
RK Sikes,
DVM,DVM,
State Epidemiologist,
State Epidemiologist,
Georgia Dept
Georgiaof Human
Dept ofRe Human Re
sources; RA
RA Gunn,Gunn, MD,
MD,State
StateEpidemiologist,
Epidemiologist,Florida
FloridaState
Dept
HealthandRehabilitative
Svcs;
sources;
State
Dept
ofof
HealthandRehabilitative
Svcs;
MA
MA Roberts,Roberts,PhD,PhD,State
State
Epidemiologist,
Epidemiologist,
Oklahoma
Oklahoma
State
State
DeptDeptof Health;of Health;
Task Force
Task Forceon Kaposi'son Kaposi's
Sarcoma
Sarcoma andand Opportunistic
OpportunisticInfections,
Infections,Center
Centerfor
forPrevention
Prevention
Svcs.
Svcs,
CenterCenterforforInfectious
Infectious
Diseases,
Diseases,Center for Environmental Health, Field Svcs Div, Consolidated Surveillance and Communications
Activities, Epidemiology Program Office, CDC.

Editorial Note: KS is a rare, malignant neoplasm seen predominantly in elderly men
in this country. In elderly men the disease is manifested by skin lesions and a chronicclinical course; it is rarely fatal (3). In contrast, the persons currently reported to have
KS are young to middle-aged men, and 20% of the cases have been fatal. Although someof thethe patientspatients have
havepresented
presentedwith
withthetheviolaceous
violaceous
skinskinor or
mucousmucousmembranemembranelesions
lesions

TABLE 1. Cases of Kaposi's sarcoma (KS) and Pneumocystis carinii pneumonia (PCP)
reported to CDC with dates of onset between January 1976 and July 1981
Diagnosis(number of patiants)MaleKS and PCP (N=7)

FemaleUnknown

17000441274445432/54 (59%)

11595

6643/108 (40%)

0133041

PCP only (N=54) 53

133Total (N=108)

179

912Fatality(percentage)

Heterosexual

501or bisexual

Black7U

Hispanic Unknown

WhiteKS only (N=47) 47
107

Sexual preference of men

Race of men

Sex3/7 (43%)
8/47 (17%)

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES / PUBLIC HEALTH SERVICEThis content downloaded from155.33.16.124 on Wed, 12 Aug 2020 13:28:49 UTCAll use subject to https://about.jstor.org/terms

410

MMWR

August28,

1981

Kaposi's Sarcoma — Continued

typical of KS, many such lesions have been initially overlooked. Other patients havebeen diagnosed by lymph-node biopsy after a prodrome consisting of fever, weight loss,
and lymphadenopathy. Seven (13%) of fifty-four KS patients also had PCP. In manycases the histopathologic diagnosis from skin, lymph node, or visceral-lesion tissue has
been difficult even in specialized hands.
The occurrence of Pneumocystis carinii pneumonia in patients who are not immuno
suppressed due to known underlying disease or therapy is also highly unusual (4). Al
though 7 (11%) of the 61 patients with PCP also had KS, in many instances pneumonia
preceded the tumor. Although most of the patients with PCP reported recent respiratory
symptoms, some gave a history of weeks to months of systemic symptoms including
weight loss and general malaise, similar to the prodrome described by patients who devel
oped lymphadenopathic KS. Several of the patients with PCP had other serious infec
tions, including gastrointestinal candidiasis, cryptococcal meningitis, and disseminatedinfections with Mycobacteriaceae and herpes simplex. Many of the PCP and KS patients
have had positive cultures or serologic evidence of infection with cytomegalovirus.
The apparent clustering of both Pneumocystis carinii pneumonia and KS among homosexual men suggests a common underlying factor. Both diseases have been associated withhost immunosuppression (4-6), and studies in progress are showing immunosuppression insome of these cases. The extent or cause of immune suppression is not known. Physicians
should be aware of the possible occurrence of these diseases and other opportunistic
infections, particularly among men with symptoms suggestive of these disorders or theirprodromes, since therapy is specific and verification of the diagnosis requires biopsy.

Several state and local health departments and CDC are conducting active surveil
lance for KS, PCP, and opportunistic infections in persons without known predisposingunderlying disease. A national case-control study will be implemented shortly.
References

1. CDC. Pneumocystis pneumonia — Los Angeles. MMWR 1981;30:250-2.

2. CDC. Kaposi's sarcoma and Pneumocystis pneumonia among homosexual men — New York Cityand California. MMWR 1981;30:305-8.

3. Safai B, Good RA. Kaposi's sarcoma: a review and recent developments. CA 1981 ;31:1-12.
4. Walzer PD, Perl DP, Krogstad DJ, Rawson PG, Schultz MG. Pneumocystis carinii pneumonia inthe United States. Epidemiologic, diagnostic, and clinical features. Ann Intern Med 1974;80:83-93.

5. Penn I. Kaposi's sarcoma in organ transplant recipients: report of 20 cases. Transplantation 19
27:8-11.

6. Gange RW, Jones EW. Kaposi's sarcoma and immunosuppressive therapy: an appraisal.
Dermatol 1978;3:135-46.

Recommendation of the Immunization

Practices Advisory Committee (ACIP)
Pneumococcal Polysaccharide Vaccine
INTRODUCTION

Polyvalent polysaccharide vaccine against disease caused by Streptococcus p(pneumococcus) was licensed in the United States in 1977. This statement includes asummary of current knowledge about the vaccine and a guide to its use in selected persons and groups.

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