Four homosexual men presented with gradually enlarging perianal ulcers, from which herpes simplex virus was cultured. Each patient had a prolonged course characterized by eight loss, fever, and evidence of infection by other opportunistic microorganisms including cytomegalovirus, Pneumocystis carinii, and Candida albicans. Three patients died; Kaposi's sarcoma developed in the fourth. All were found to have depressed cell-mediated immunity, as evidenced by skin anergy, lymphopenia, and poor or absent responses to plant lectins and antigens in vitro. Natural-killer-cell activity directed against target cells infected with herpes simplex virus was depressed in all patients. The absence of a history of recurrent infections or of histologic evidence of lymphoproliferative or other neoplastic diseases suggests that the immune defects were acquired.

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Twenty-seven episodes of Pseudomonas aeruginosa bacteremia in 21 patients with AIDS were evaluated at the Mount Sinai Medical Center in 1987-1992. Of 21 primary episodes, 12 were acquired in the community, 8 were nosocomial, and one was acquired in a nursing home. Sources of bacteremia (i.e., sites of infection; n = 30) included the lungs (12 cases) an indwelling vascular catheter (9), and the upper respiratory tract (5, including 2 cases of sinusitis, 2 cases of malignant external otitis, and 1 case of epiglottis/pharyngeal cellulitis); in 4 cases the source was unknown. White blood cell counts ranged from 0.1 to 26.2 (mean, 4.32) x 10(3)/mm3; in 19 of 26 cases, the absolute neutrophil count was > 1 x 10(3)/mm3. With the exclusion of primary episodes of bacteremia that resulted in death, the rate of relapse was 33.3% (5 of 15 cases). Mortality for the 25 evaluable episodes of bacteremia was 40% (32% for primary infection and 80% for relapse; P = .06); 52.6% of evaluable patients (10 of 19) ultimately died of P. aeruginosa bacteremia. The institution of appropriate therapy at presentation did not positively affect outcome. Rates of response were higher among episodes treated with a drug combination (an antipseudomonal beta-lactam or monobactam antibiotic plus an aminoglycoside) than among those treated with a single agent (P = .036).

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