Severe pneumonia

Severe pneumonia was noted in 75 patients with CLL in 90 cases, of which 54 people were found to be fatal. The most often severe course was observed in patients of group III (52 patients), later in patients of group II (23 patients). In patients with group I, severe pneumonia was not observed.

Among pulmonary complications, pneumonia was diagnosed with acute respiratory failure (45 cases), exudative pleurisy (40 cases), destruction of the lungs (10 cases), abscess of the lungs (10 cases), and lung disease (38 cases). Among extrapulmonary complications, infectious-toxic shock was noted – 45 cases, sepsis – 15 cases, pericarditis – 11 cases, psychosis – 7 cases, meningitis – 1 case.

In all CLL patients, when pneumonia was attached, a significant decrease in capillary blood pO 2 , a decrease in hemoglobin oxygen saturation and total oxygen in the blood were noted . A decrease in pO 2 is more pronounced in patients with a widespread involvement of the lung tissue in the inflammatory process. In many patients during the period of developed clinical manifestations of pneumonia, moderate hypercapnia occurred .

In the treatment of pneumonia in patients with CLL, the basic rules for the treatment of pneumonia in patients with neutropenia were followed . There was a significant difference between patients of CLL of the three groups in the regression of the clinical manifestations of pneumonia. Faster positive dynamics was observed in patients of group I. Not a single patient in this group had a prolonged course of pneumonia. Among 36 patients of group II, a prolonged course of pneumonia was observed in 15 people (41.7% of the total number of patients who had pneumonia in this group). In group III, a prolonged course of pneumonia was observed in 40 patients (69%).

In patients of groups I and II of CLL, there were no significant differences in the time of stopping the clinical manifestations of pneumonia as compared with patients with pneumonia without hemoblastosis (2nd control group). In patients with group III, cough, fever, tachycardia, wheezing, accelerated erythrocyte sedimentation rate were preserved for a much longer time, there was a slow radiological dynamics .

A feature of pneumonia in patients with CLL is a long-term X-ray dynamics. After stopping the main clinical manifestations of pneumonia, on radiographs long-term infiltration persists, which resolves very slowly, despite active antibacterial therapy. This causes the attending physician to conduct a differential diagnosis between inflammatory and leukemic infiltration of the lung tissue. Making a differential diagnosis in this situation is very difficult, even using modern bronchoscopic and radiological ( CT and MRI) techniques. . Puncture biopsy of the lesion in the lung, in most cases, is not feasible due to the presence of thrombocytopenia. Diagnostics helps with X-ray examination over time, inflammatory infiltration with antibacterial therapy resolves over time. In cases of the development of a lethal outcome in all patients with persistently recurrent, prolonged pneumonia, an inflammatory focus was detected in places with lymphocytic infiltration, which could only be diagnosed by histological examination.

Atypical, severe and TIGHTENING Nome pneumonia in pain GOVERNMENTAL CLL promote: a pronounced secondary immunodeficiency conducted this patient courses of chemotherapy and hormonal TE rapii, older age of most patients, lymphoid infiltration of the lungs and bronchi, impaired microcirculation and trophic tissue, presence of concomitant diseases (COPD, ischemic heart disease, diabetes mellitus, arterial hypertension, etc.), compression syndrome in the chest cavity in patients with Richter syndrome.

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