Pulmonary complications of acute leukemia

Abstract

The lungs of 50 consecutive autopsied cases of acute leukemia were studied and cultures were obtained from 36. Thirty-one patients had major pulmonary lesions. Most of these were not recognizcd antemortem. Infection was the most common pulmonary complication. Pulmonary disease was present in 95% of those cases with abnormal chest x-rays but 59% of the patients with normal chest x-rays also had pulmonary pathology. Leukemic involvement was identified microscopically in 64% of the lungs. Peribronchial infiltrates were found most frequently. Patients with high levels of circulating abnormal cells had more severe leukemic involvement of the lung. Pulmonary hemorrhage was found in 54% of the lungs and was severe in 12%. The incidence of pulmonary hemorrhage was higher in patients with severe thrombocytopenia. Thirty-one major and 29 minor pulmonary infections were found in 40 of the patients. Many of these were unrecognized clinically and the offending organism was seldom isolated antemortem. The most frequently identified pathogens were Pseudomonas sp., Candidia sp., and Aspergillus sp.

Pneumonia in Acute Leukemia Patients During Induction Therapy: Experience in a Single Institution

“…In our experience, in agreement with other experiences [2,3,17] MDP was observed in 25/80 (31.2%) cases of patients with leukemia in induction therapy. Although fungal pneumonias are common in advanced phases of leukemias, they can be present in patients at disease onset; in our study, in 3 cases (12%) the BAL was positive for Aspergillus (2 A. fumigatus and 1 A. niger ), the CT was highly suggestive of disease caused by filamentous fungi and fungal pneumonia was considered probable.…”

Pneumocystis carinii pneumonia and reticuloses

“…In patients with acute leukaemia the diagnosis is more difficult. Various infections may present with the clinical picture of pulmonary oedema (Bodey, Powell, Hersh, Yeterian, and Freireich, 1966). In any suspected case of Pneumocystis carinii pneumonia chest radiographs may be helpfui, as illustrated by Fig.…”

Risks for infection in patients with myelodysplasia and acute leukemia

“…The most important factor in predicting the risk of infection is the duration of neutropenia: it was reported that there was a 60% risk of developing infection if neutropenia persisted for 3 weeks, with a further rise to 100% when the neutrophil count was below 0.10 Â 10 9 /l. Not only is the incidence of infections related to neutrophil count, but also the outcome: the highest percentage of death occurs among patients with persistent severe neutropenia [27].…”