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seemed to share was the fact that they had emigrated from Haiti. We all had theories. I was most interested in why tuberculosis was not confined to the lungs, as is usually the case, but rather spread throughout the body. Art P., who knew a lot about tuberculosis, was not impressed with this. He thought disseminated tuberculosis was always more common in younger populations. Danny was interested in how malnutrition might explain what was happening. Mark and Gordon were more interested in the various kinds of unusual infections.

We decided to review all Haitian admissions during the previous year according to a clinical research protocol. In addition to tuberculosis, several unusual infections were documented. Strangely, a single patient frequently had more than one unusual infection. Some patients received an autopsy after they died. We were surprised to find that what we had assumed to be tuberculosis was frequently a parasitic infection of the brain. Suddenly, our pathologists became interested.

New information began falling into place. Fungal infections of the central nervous system, other infections that usually affect only cancer patients receiving chemotherapy, and disseminated viral infections were discovered by our review. My focus on the question of tuberculosis clearly was too narrow. Our patients were behaving as if their immune systems weren’t working. Our suspicions grew further when the pathologists began reporting pneumocystis in biopsy and autopsy specimens. Pneumocystis is an amoeba-like organism that only infects patients with weakened immune systems. The Haitian AIDS mystery began to unfold.



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