Central Nervous System Infections in Immunocompromised Patients

Abstract

Purpose of Review This article reviews current epidemiologic trends, clinical presentations, and diagnostic strategies for central nervous system (CNS) infections in human immunodeficiency virus-negative (HIV) patients immunocompromised by their underlying disease or by receipt of immunosuppressive or immunomodulating therapies. Three patient groups are considered: (1) cancer patients; (2) hematopoietic or solid organ transplantation recipients; and (3) patients with autoimmune or inflammatory conditions requiring therapies that alter the host immune response. Recent Findings Clinical presentations, associated neuroimaging, and cerebrospinal fluid (CSF) abnormalities differ between immunocompromised and immunocompetent patients. Infections can trigger the emergence of neurotropic antibodies or inflammatory conditions due to treatment with cancer immunotherapies. Unbiased metagenomic assays to identify obscure pathogens help clinicians navigate the increasing range of conditions affecting the growing population of patients with altered immunity. Summary Awareness of clinical presentations and disease and drug-specific risks is important for early diagnosis and intervention in these often life-threatening infections and their noninfectious mimes.

Neuroimmunology of CNS HIV Infection: A Narrative Review

“…While the CNS infection echoes its systemic counterpart, it also diverges in important details, including in virus populations and particular inflammatory profiles ( 36 , 41 ). If unchecked by ART this chronic course may be complicated by a range of disorders afflicting the brain, including major OIs and direct neuropathic HIV CNS infection ( 42 , 43 ). Because of space constraints, this review omits detailed discussion of CNS OIs as well as disorders of the spinal cord and peripheral nervous system (PNS) that may be impacted by similar disease processes ( 44 ).…”

Seizures and Headaches in a 34-Year-Old Woman With Systemic Lupus Erythematosus

“…Patients who are immunocompromised pose several challenges related to diagnosing CNS infections as they may lack meningeal signs, fever, and significant CSF inflammatory findings due to disease-or treatment-related diminished immune response. 7 Any of these vascular or infectious etiologies can also cause seizures. The lack of clear focal onset of the seizures and lack of focal deficits on clinical examination do not provide additional localizing clues.…”

“…Patients who are immunocompromised pose several challenges related to diagnosing CNS infections as they may lack meningeal signs, fever, and significant CSF inflammatory findings due to disease- or treatment-related diminished immune response. 7…”

Neuroinflammation Associated With Inborn Errors of Immunity

“…Three of these patients (4%) presented with neurological symptoms in the form of intellectual disability, transient ischemic cerebral palsy, and progressive multifocal leukoencephalopathy (PML), respectively. PML is an often fatal neuroinflammatory consequence of reactivation of latent JC-virus, which is observed in patients with immunodeficiency, primary or secondary to a wide range of immunosuppressive drugs ( 234 ).…”