Oikonomou et al. examined radiological manifestations of influenza viral pneumonia in hematological patients. The patients underwent radiographs and high resolution computed tomography (CT). The authors developed pneumonia on the basis of the analysis of X-ray and CT images. Demonstrated new features in the diagnosis of this pathology using CT .
In 60–70 years, Gram-negative, aerobic bacteria were the main causative agents of infection in CLL patients; at present, gram-positive bacteria have become frequent pathogens, and erobic cocci and fungi . According to A. B. Bakirova (1996), among identified microorganisms in lymphoproliferative diseases of microorganisms, 51.9% were gram-negative, 48.1% gram-positive bacteria and yeast-like fungi. At that, 57.7% – streptococci, 22.8% – staphylococcus, 21.9% – Pseudomonas aeruginosa, 19.9% - yeast cells, 13.6% – Klebsiella, 12.7% – Neisseries, 9.6% – Enterobacteria, 14.8% – Proteus, intestinal strand, cytobacteria and serrations. Recently serѐznoy The problems of in hematological patients and are nvazivnye mycoses . In most cases, it is candida and aspergillosis . Less commonly, invasive mycoses can be caused by other micromycetes . G.A. Klyasov et al. (2007) developed an algorithm for the treatment and prevention of candidiasis and aspergillosis in adult patients with leukemias, lymphomas and blood formation depressions .
Microbial strains isolated from patients with tumors are often characterized by multiple resistance to antibiotics . Antibiotics that are effective against gram-negative aerobic microorganisms and, above all, Escherichia coli, Klebsiella pneumonis, Ps, are used as first-line drugs of empirical antibiotic therapy. aeruginosa. This is due to the fact that infections caused by gram-negative aerobic bacteria are the most rapidly developing and dangerous bacterial shock. The mortality caused by these pathogens is 50–70%. . The most commonly used combinations are aminoglycosides II – III generation (tobramycin, sisomycin, amikacin) with cephalosporins III – IV of the generation active against the pseudomonas aeruginosa; a positive result is observed in 70–78% of patients . The combinations of III – IV generation cephalosporins with ureidopenicillin ( mezlocillin, piperacillin) have proven themselves well . Combined therapy with III-IV generation cephalosporins and imipenem is most effective against gram-negative bacteria, including Ps. aeruginoza . In a comparative study of vancomycin and a glyco- peptide antibiotic — tekop lanin, some researchers have come to the conclusion that teikoplanin ef vancomycin is more effective and less nephrotoxic . Inpatients with hemoblastosis during the development of infectious complications , manifested by fever of not clear genesis, many authors of the rivers recommend to start antifungal therapy with amphotericin B, fluconazole as early as possible . In recent years, it proved high, comparable with the results of treatment with amphotericin B, Klinichev eskaya and antimycotic effectiveness ciency and trakonazola fluconazole in the treatment of fungal invariant fektsy Wu Bo lnyh hematological malignancies . G.A. Klyasov developed a protocol for empirical antibiotic therapy in patients with hemoblastosis, which consists of 4 stages, taking into account the chemotherapy and The focus of infection . This treatment protocol is currently used in most hematological clinics in Russia.
Much attention in the modern literature is given left-most cheniyu serѐznogo complications of pneumonia in patients with hemo blastosis – acute respiratory failure spine .
In addition to pneumonia in CLL, on the background of pronounced immunodeficiency, especially under the influence of active cytostatic and hormonal therapy, pulmonary tuberculosis is often diagnosed . Tuberculosis infiltration in the lungs during granulocytopenia is not always radiologically detected, not to mention the ulcer that is not detectable radiographically, ulcerous bronchoadenitis . The greatest diagnostic difficulties are posed by the differential diagnosis of pneumonia of the following forms of pulmonary tuberculosis: infiltrative pulmonary tuberculosis, limited to 1-2 segments (broncholobular infiltration); infiltrative pulmonary tuberculosis, limited to one lobe (rounded, cloud-visible infiltration, pericyssuritis and lobitis); Kaze pneumonia .
In 1991 A.G. Chuchalin described the damaging effect of cytostatic drugs on the lung tissue. According to A.N. Soko lova et al. (2007), such cytostatics used in the treatment of CLL, such as cyclophosphamide, chlorambucil, fludarabine, doxarubicin, and vincristine, have a pulmonary toxicity. V.M. Gorodetsky (1998) indicates the need for differentiation between infectious, specific lesions of the lungs in patients with hemoblastosis and pneumonitis caused by chemotherapy or radiation therapy. Since cyclophosphamide, which is often used in the treatment of CLL, reduces the level of glutathione and thereby reduces the degree of antioxidant protection, a high concentration of oxidants stimulates pulmonary damage . So far, there are no uniform criteria for predicting the pneumotoxic risk of chemotherapeutic drugs; The most informative is considered to be a rapid decrease in the diffusion capacity of the lungs at the initial stages of chemotherapy, even in the absence of significant changes in radiographs and CT scans of the lungs. . The frequency of radiation pneumonitis during irradiation of the chest is 5–15 % . Risk factors for left-of pulmonary damage during radiation exposure are involved a large amount of light (> 10%), the daily dose of radiation (> 2,67 Gy), high cumulative dose of concomitant chemotherapeutic Pius, lung collapse, young age, cancellation of glucocorticoid hormones in radiation therapy time .