The association between cryptococcosis and CLL has been recognized for many years. In a study from 1956 to 1972, the estimated occurrence of cryptococcosis among CLL patients was 24 episodes/1000 admissions, the highest among all cancers (57). The most common form of infection is meningitis, but some patients have fulminant pneumonia, fungemia, disseminated infection, or skin and subcutaneous lesions.
P. carinii (now considered to be a fungus) occasionally caused pneumonia in CLL patients prior to the introduction of fludarabine therapy, but most cases of Pneumocystis pneumonia have occurred in patients who were treated with fludarabine plus prednisone (46,58). The association of this infection with adrenocorticosteroid therapy is well recognized; hence, the role of fludarabine is less certain. Systemic Candida infections have been reported in patients receiving fludarabine, as well as sporadic cases of infection caused by Aspergillus species, Fusarium species, Histoplasma capsulatum, and Onchocronis species (59). It is somewhat surprising that superficial Candida infections and Aspergillus sinusitis have not been reported more frequently, the former infections being associated with low CD4+ lymphocyte counts and the latter with neutropenia and adrenal corticosteroid therapy.
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