Pneumonias in patients with chronic lymphocytic leukemia. Study of 30 episodes

BACKGROUND: To analyse the etiology, diagnostic methods and response to the rapy in 30 episodes of pneumonia diagnosed in 17 patients with chronic lymp hocytic leukemia (CLL) between 1995 and 2000. PATIENTS AND METHOD: In each episode of pneumonia the following data were a nalysed: age, gender, treatment of CLL, antiinfectious prophylaxis, granulo cytopenia, CD4/CD8 lymphocytes ratio, hipogamma-globulinemia, origin of pne umonia (nosocomial or community-acquired); localisation, respiratory insuff iciency, need for mechanical ventilation, antimicrobial therapy and respons e. Diagnostic methods included blood and sputum cultures, fiberoptic bronch oscopy and search for antigens in urine (Legionella pneumophila serogroup 1 , galactomannan, and Steptococcus pneumoniae). RESULTS: Median age of the series was 60 yr. (range 50-86) and 12 patients were male. Chlorambucil and prednisone were used in 13 cases and fludarabin e in 8. Granulocytopenia was present in 14 episodes, hypogammaglobulinemia was seen in 22 and CD4/CD8 ratio was lower than 1 in 8 cut of 14 evaluable cases. Etiology of pneumonia was established in 16 episodes (53%). Fiberopt ic bronchoscopy was the most useful technique (83% of positive diagnoses) f ollowed by blood cultures (38%). Two patients were diagnosed of aspergillos is at autopsy. Pneumococcus was the most frequent agent (5 cases) followed by Pseudomonas aeruginosa (4), Pneumocystis carinii (2) and Aspergillus fum igatus(2). One out of the two patients with P. carinii pneumonia had receiv ed fludarabin and the remaining was treated with prednisone for long time. Ten patients (30%) had died: P. aeruginosa (3 cases), P. carinii (2), A. fu migatus(2), Mycobacterium xenopi (1), and unknown microorganism (2). CONCLUSIONS: In this series of CLL patients the frequency of etiologic diag nosis of pneumonias was good. Pneumococcus was the most frequent microorgan ism. Pneumonias caused by opportunistic microorganisms were associated to t he treatment with fludarabin or prednisone and were associated to a high mo rtality rate.