An important feature of pneumonia in CLL patients is the occurrence of an inflammatory focus in places of lymphoid infiltration of the lung tissue. In 30 patients who died of CLL, the inflammatory focus was localized in the area of light leukemic infiltration. These were patients in in the terminal stage of the disease, a prolonged, recurrent course of pneumonia was characteristic of all, with frequent involvement in the process of the pleura, difficult to respond to antibiotic therapy. The appearance of extramedullary foci of hematopoiesis is a sign of the terminal stage of CLL, therefore the constantly recurring course of pneumonia involving the lung sections in the inflammatory process was typical for most patients of group III. In patients with group II, recurrence of pneumonia was less common (16 patients). In group I, there was no recurrent pneumonia.
An important cause leading to the occurrence of pneumonia and largely determining its course is secondary immunodeficiency. The analysis of the main immunological parameters of 80 patients with pneumonia was carried out. The immunogram was studied in the period of the developed clinical picture of pneumonia, and after its resolution.
As can be seen from the presented study, after the resolution of pneumonia, there is no significant improvement in cellular and humoral immunity indices. Humoral protection carries IgA and IgG, lymphoid cells, macrophages of broncho-associated lymphoid tissue and lymph nodes . IgA ensures the agglutination of bacteria and neutralizes their toxins. IgG of the lower respiratory tract agglutinates and opsonizes bacteria, activates complement, accelerating chemotaxis of neutrophils and macrophages, neutralizes bacterial toxins . Therefore, hypoimmunoglobulinemia, characteristic of all patients with C – CLL and aggravated as the tumor process develops, is an important factor contributing to the occurrence of pneumonia, their severe and protracted course.
An important factor in the occurrence, severity and protracted course of pneumonia in CLL patients is impaired microcirculation in the lungs and bronchi in the process of tumor progression, accompanied by impaired trophism of tissues and local metabolism, developed tissue hypoxia .
The main clinical symptoms of pneumonia were: pain in the chest on the affected side, shortness of breath, cough with mucopuric sputum, febrile temperature, tachycardia, hypotension, weakened breathing, wet or dry rales. Unspecific, atypical course of pneumonia is noted in 40 cases (26.7% of the total number of pneumonia). The characteristics of the course of pneumonia in these patients were: 1) mild physical symptoms; 2) frequent absence of acute onset of the disease and pain; 3) the prevalence of extrapulmonary manifestations of pneumonia in the form of bacterial toxic shock, severe intoxication; 4) long-term resorption of pulmonary infiltrate, recurrence of the disease; 5) fever was observed in 10 people, without radiographic signs of pulmonary inflammation.