Abstract
An infectious disease sequela of the Vietnamese war of epidemiological significance is reported. A Vietnamese premature female infant, cared for in an orphanage in Saigon, was adopted by an American family at age 2 ½ mos. Physical exam and chest x-ray on arrival in N.Y. were normal. At 3 ½ mos. respiratory distress developed, treated for 3 wks. unsuccessfully with antibiotics. X-ray revealed interstitial pneumonitis. Pneumocystis carinii pneumonitis (PCP) was diagnosed by silver methionine stain of fluid obtained by bronchial lavage. Cytomegalic virus (CMV) was cultured from same fluid. Bacterial, mycobacterial, and fungal cultures were negative. Studies of immunological competence were normal. IgG to Pneumocytis carinii (PC) was positive. Family members remained asymptomatic but became serologically positive for PC. Infant died despite 11 days of pentamidine therapy. Autopsy revealed PCP with plasma cell infiltration. Thymus was normal. Brain and liver were free of CMV. PCP in the U.S. has been diagnosed almost exclusively in children with immunological disorders or with lymphoreticular malignancies, whereas PCP is endemic in underdeveloped areas. With increasing adoptions of Vietnamese infants by Americans, epidemiological surveillance, including serological screening, is advised to detect PCP in these immunologically normal infants.
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