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The Daily Agenda for Tuesday, June 5

Jim Burroway

June 5th, 2012

TODAY’S AGENDA:
Ninth Circuit Court of Appeals Expected to Rule on Prop 8 En Banc Hearing: Sacramento, CA. Last February, a three judge panel of the Ninth Circuit Court of Appeals upheld a lower court’s ruling that Prop 8 was unconstitutional. The Alliance Defense Fund, which is defending Prop 8 in federal court, then petitioned for an en banc re-hearing of the appeal before an eleven judge panel of the Ninth Circuit. Yesterday, the Ninth Circuit announced that it will issue an order today in the case of the federal lawsuit against Prop 8. That order is expected to address the request for an en banc hearing. In case you missed it, Timothy Kincaid yesterday laid out the various paths the appeals process might take here, depending on today’s order.

TODAY IN HISTORY:
Pneumocystis Pneumonia — Los Angeles: 1981. The Centers for Disease Control and Prevention published this notice in the June 5, 1981 edition of the Morbidity and Mortality Weekly Report. This report would be the first clinical description of a new disease which we would later know as AIDS.

Pneumocystis Pneumonia — Los Angeles
In the period October 1980-May 1981, 5 young men, all active homosexuals, were treated for biopsy-confirmed Pneumocystis carinii pneumonia at 3 different hospitals in Los Angeles, California. Two of the patients died. All 5 patients had laboratory-confirmed previous or current cytomegalovirus (CMV) infection and candidal mucosal infection. Case reports of these patients follow.

Patient 1: A previously healthy 33-year-old man developed P. carinii pneumonia and oral mucosal candidiasis in March 1981 after a 2-month history of fever associated with elevated liver enzymes, leukopenia, and CMV viruria. The serum complement-fixation CMV titer in October 1980 was 256; in may 1981 it was 32.* The patient’s condition deteriorated despite courses of treatment with trimethoprim-sulfamethoxazole (TMP/SMX), pentamidine, and acyclovir. He died May 3, and postmortem examination showed residual P. carinii and CMV pneumonia, but no evidence of neoplasia.

Patient 2: A previously healthy 30-year-old man developed p. carinii pneumonia in April 1981 after a 5-month history of fever each day and of elevated liver-function tests, CMV viruria, and documented seroconversion to CMV, i.e., an acute-phase titer of 16 and a convalescent-phase titer of 28* in anticomplement immunofluorescence tests. Other features of his illness included leukopenia and mucosal candidiasis. His pneumonia responded to a course of intravenous TMP/.SMX, but, as of the latest reports, he continues to have a fever each day.

Patient 3: A 30-year-old man was well until January 1981 when he developed esophageal and oral candidiasis that responded to Amphotericin B treatment. He was hospitalized in February 1981 for P. carinii pneumonia that responded to TMP/SMX. His esophageal candidiasis recurred after the pneumonia was diagnosed, and he was again given Amphotericin B. The CMV complement-fixation titer in March 1981 was 8. Material from an esophageal biopsy was positive for CMV.

Patient 4: A 29-year-old man developed P. carinii pneumonia in February 1981. He had had Hodgkins disease 3 years earlier, but had been successfully treated with radiation therapy alone. He did not improve after being given intravenous TMP/SMX and corticosteroids and died in March. Postmortem examination showed no evidence of Hodgkins disease, but P. carinii and CMV were found in lung tissue.

Patient 5: A previously healthy 36-year-old man with clinically diagnosed CMV infection in September 1980 was seen in April 1981 because of a 4-month history of fever, dyspnea, and cough. On admission he was found to have P. carinii pneumonia, oral candidiasis, and CMV retinitis. A complement-fixation CMV titer in April 1981 was 128. The patient has been treated with 2 short courses of TMP/SMX that have been limited because of a sulfa-induced neutropenia. He is being treated for candidiasis with topical nystatin.

The diagnosis of Pneumocystis pneumonia was confirmed for all 5 patients antemortem by closed or open lung biopsy. The patients did not know each other and had no known common contacts or knowledge of sexual partners who had had similar illnesses. Two of the 5 reported having frequent homosexual contacts with various partners. All 5 reported using inhalant drugs, and 1 reported parenteral drug abuse. Three patients had profoundly depressed in vitro proliferative responses to mitogens and antigens. Lymphocyte studies were not performed on the other 2 patients.

Reported by MS Gottlieb, MD, HM Schanker, MD, PT Fan, MD, A Saxon, MD, JD Weisman, DO, Div of Clinical Immunology-Allergy; Dept of Medicine, UCLA School of Medicine; I Pozalski, MD, Cedars-Mt. Siani Hospital, Los Angeles; Field services Div, Epidemiology Program Office, CDC.

Editorial Note: Pneumocystis pneumonia in the United States is almost exclusively limited to severely immunosuppressed patients (1). The occurrence of pneumocystosis in these 5 previously healthy individuals without a clinically apparent underlying immunodeficiency is unusual. The fact that these patients were all homosexuals suggests an association between some aspect of a homosexual lifestyle or disease acquired through sexual contact and Pneumocystis pneumonia in this population. All 5 patients described in this report had laboratory-confirmed CMV disease or virus shedding within 5 months of the diagnosis of Pneumocystis pneumonia. CMV infection has been shown to induce transient abnormalities of in vitro cellular-immune function in otherwise healthy human hosts (2,3). Although all 3 patients tested had abnormal cellular-immune function, no definitive conclusion regarding the role of CMV infection in these 5 cases can be reached because of the lack of published data on cellular-immune function in healthy homosexual males with and without CMV antibody. In 1 report, 7 (3.6%) of 194 patients with pneumocystosis also had CMV infection’ 40 (21%) of the same group had at least 1 other major concurrent infection (1). A high prevalence of CMV infections among homosexual males was recently reported: 179 (94%) had CMV viruria; rates for 101 controls of similar age who were reported to be exclusively heterosexual were 54% for seropositivity and zero fro viruria (4). In another study of 64 males, 4 (6.3%) had positive tests for CMV in semen, but none had CMV recovered from urine. Two of the 4 reported recent homosexual contacts. These findings suggest not only that virus shedding may be more readily detected in seminal fluid than urine, but also that seminal fluid may be an important vehicle of CMV transmission (5).

All the above observations suggest the possibility of a cellular-immune dysfunction related to a common exposure that predisposes individuals to opportunistic infections such as pneumocystosis and candidiasis. Although the role of CMV infection in the pathogenesis of pneumocystosis remains unknown, the possibility of P. carinii infection must be carefully considered in a differential diagnosis for previously healthy homosexual males with dyspnea and pneumonia.

References

  1. Walzer PD, Perl DP, Krogstad DJ, Rawson G, Schultz MG. Pneumocystis carinii pneumonia in the United States. Epidemiologic, diagnostic, and clinical features. Ann Intern Med 1974;80:83-93.
  2. Rinaldo CR, Jr, Black PH, Hirsh MS. Interaction of cytomegalovirus with leukocytes from patients with mononucleosis due to cytomegalovirus. J Infect Dis 1977;136:667-78.
  3. Rinaldo CR, Jr, Carney WP, Richter BS, Black PH, Hirsh MS. Mechanisms of immunosuppression in cytomegaloviral mononucleosis. J Infect Dis 1980;141:488-95.
  4. Drew WL, Mintz L, Miner RC, Sands M, Ketterer B. Prevalence of cytomegalovirus infection in homosexual men. J Infect Dis 1981;143:188-92.
  5. Lang DJ, Kummer JF. Cytomegalovirus in semen: observations in selected populations,. J Infect Dis 1975; 132:472-3.

TODAY’S BIRTHDAY:
John Maynard Keynes: 1883. The British economist has had a profound infliuence on macroeconomics and government economic policy. His ideas now carry his name — Keynesian economics — which argued that free markets didn’t always provide the best solutions in times of economic turmoil. He argued that counter cyclic spending during economic downturns could provide vital demand to keep businesses and industries afloat in times of lower employment levels. He advocated economic stimulus policies to keep people employed. “With men and plants unemployed, it is ridiculous to say that we cannot afford these new developments,” he wrote in 1928 of the need for spending on public works. “It is precisely with these plants and these men that we shall afford them.”

Keynes’s economic policies weren’t the only thing revolutionary about him in the early twentieth century. He was also very open about his sexuality. Between 1901 and 1915, he kept separate diaries where he tabulated his sexual encounters in a kind of a code that has baffled historians and biographers since then. He was a member of the Bloomsbury Group, a group of English writers, artists and philosophers which included E.M. Forster, Virginia Woolf, Lytton Stratchy, and the artist Duncan Grant, who is said to have been Keynes’s great love. Stratchy was also a lover, but he must have gotten a glimpse at Keynes’s diary: Stratchy was put off by Keynes’s manner of “treat[ing] his love affairs statistically.” Keynes eventually married the Russian ballerina Lydia Lopokova, and their marriage did appear to have been a satisfactory one.

Suze Orman: 1951. She started out with a B.A. in social work and worked as a waitress in Berkeley before becoming a financial adviser for Merril Lynch. In 1983, she moved to Prudential Bacahe Securities, where she became vice-president of investments. Four years later, she quit to found her own financial firm. Not bad for someone without an MBA. In 2007, she began appearing on television. After she gave away a million copies of her e-book, Women and Money,following an appearance on Oprah, she began hosting her own financial advice program, The Suze Orman Show, which airs on weekends on CNBC. She is also a regular columnist for Oprah Winfrey’s O magazine, and she continues to appear occasionally on Oprah’s OWN network. In 2010, Orman married Kathy Travis, a co-producer of on The Suze Orman Show.

Chad Allen: 1974. I didn’t know this: one of Chad’s early major roles was on the television series St. Elsewhere, where he played the autistic son of Dr. Westphall from 1983, to 1988. He also appeared in Our House and Dr. Quinn, Medicine Woman. In 1996, he was outed by the supermarket tabloid The Globe, which published photos of him kissing another man in a hot tub. When he was cast to play the role of real-life Christian missionary Nate Saint in the 2006 docudrama End of the Spear, conservative Christians were outraged over an openly gay man in the role. The real Steve Saint, Nate’s son, however put aside his own reservations. After seeing the film, he felt that God was pleased with Chad playing his father. End of the Spear became one of the few independently released Christian movies to draw more than a million dollars in its first three weekends of release. In 2007, he took on Christian themes again when he starred in Save Me, about a drug-addicted man who entered an ex-gay program.  In 2011, he co-produced and appeared in Hollywood to Dolllywood, a documentary about twin brothers who travel across country in an RV named “Joline” to meet their idol, Dolly Parton.

If you know of something that belongs on the agenda, please send it here. Don’t forget to include the basics: who, what, when, where, and URL (if available).

And feel free to consider this your open thread for the day. What’s happening in your world?

Comments

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MattNYC
June 5th, 2012 | LINK

Another Anti-gay caught with man (last week):

http://www.knoxnews.com/news/2012/may/24/kpd-county-commissioner-arrested-charged-with/

http://www.knoxnews.com/news/2012/jun/02/knox-co-commissioner-says-he-will-not-resign/

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