Community-acquired bacterial pneumonias in homosexual men: presumptive evidence for a defect in host resistance.

Over a three year period, we encountered seven homosexual men who developed pneumonias due to S. pneumoniae or H. influenzae in the absence of apparent risk factors. When compared to heterosexual controls, the homosexual group had a much higher frequency of bacteremia, complicated primary infections, multilobar involvement, required longer antibiotic therapy, and took longer to defervesce. Three of our seven homosexual patients fulfilled criteria for the acquired immunodeficiency syndrome (AIDS); two of the others had generalized lymphadenopathy and the other two likely AIDS-related abnormalities. Overall they presented with a spectrum of clinical findings. Two of the patients developed other opportunistic infections associated with AIDS. Since recovery from these pyogenic pneumonias requires an appropriate antibody response, our patients may have had a defect in B-cell function. Moreover, these observations suggest that functional B-cell abnormalities may occur in AIDS and syndromes premonitory of AIDS.