Bacterial and fungal meningitis in patients with cancer

Abstract

Patients with cancer do not manifest symptoms of meningitis as often as patients without cancer and display a very different set of CSF organisms compared to a general population. The CSF inflammatory response is muted in patients with cancer with meningitis. Most patients with cancer with meningitis have had prior neurosurgery. Additionally, the organisms causing meningitis in the cancer population have shifted over time, with a decline in the organisms which typically infect immunocompromised hosts and an increase in gram-positive infections.

2017 Infectious Diseases Society of America’s Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis*

“…The underlying host defect may also affect the epidemiology. In a review of oncology patients at Memorial Sloan-Kettering Cancer Center with meningitis between 1993 and 2004 [72], 7% of patients were infected with C. neoformans and 1% with Candida albicans; 78% of these patients had prior neurosurgery. In a multistate outbreak of fungal meningitis in September 2012 as a result of contaminated methylprednisolone made at a single compounding pharmacy in Massachusetts [73][74][75], the index patient was infected with Aspergillus fumigatus, but most of the subsequent infections were caused by Exserohilum rostratum.…”

Toll-Like Receptor Stimulation Enhances Phagocytosis and Intracellular Killing of Nonencapsulated and EncapsulatedStreptococcus pneumoniaeby Murine Microglia

“…Immunocompromised patients have a higher risk of developing bacterial infections in the central nervous system (CNS) (34,37,42). The list of the pathogens includes many organisms with low pathogenicity in the immunocompetent host (34,37).…”

“…The list of the pathogens includes many organisms with low pathogenicity in the immunocompetent host (34,37). Moreover, the distribution of the pathogens also differs from the immunocompetent host and depends on the nature of the immune defect.…”

“…Polymicrobial infections, multiple organ system presentation, and the absence of typical clinical manifestations subsequent to the host's diminished inflammatory response are challenging aspects in the management of these infections (34,37,42).…”

Central Nervous System Infections in Cancer Patients and Hematopoietic Stem Cell Transplant Recipients

“…In series from tertiary care and specialized cancer centers, CNS infections occurred in association with these underlying conditions: hematologic malignancies in 25-50 %, CNS malignancy and associated surgical procedures in 16-30 %, head and neck cancers in 38 %, and other solid malignancies in 18-27 % [1,2]. In a retrospective study of meningitis at MSKCC, nearly 4 of 5 cases occurred following a neurosurgical procedure [3].…”