Infections in Untreated Patients

Prior to the availability of effective therapeutic regimens, most infections were attributed to deficiencies in immunoglobulin production associated with the disease process. There are few data regarding the frequency, sites, and causes of infection prior to the advent of chemotherapy. In early reports, about 15-25% of patients were infected at the time of diagnosis (40). An early study of 102 patients treated with radiation reported infection in 30% of patients, and 10% died of infection (41). Most of the infections were pneumonias, upper respiratory tract infections, and septicemias. These infections were caused predominantly by encapsulated bacteria, especially S. pneumoniae and H. influenzae. S. aureus was also a frequent pathogen in some series. Urinary tract infections were common in some series, often associated with ureteral obstruction owing to enlarged abdominal lymph nodes.

Herpesvirus infections, predominantly dermatomal herpes zoster and oral herpes simplex, accounted for about 10% of infections (42,43). Other infections associated with CLL were generally identified from studies of specific infections and included tuberculosis, salmonellosis, cryptococcosis, and, rarely, pneumocystosis and progressive multifocal leukoencephalopathy. All of these infections are associated with impaired cellular immunity, indicating that hypo GG was not the sole deficiency in host defenses in nontreated and minimally treated patients.

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