Central nervous system infections in immunocompromised patients – update on diagnostics and therapy

Abstract

Infections of the central nervous system (CNS) are increasingly reported in patients with malignancies. Heavily immunocompromised patients like those after allogeneic stem cell transplantation (SCT) or previous T cell depleting treatment regimens (e.g. with fludarabine or alemtuzumab) are at highest risk for cerebral infections. The spectrum of causative organisms may vary greatly, depending on the underlying malignancy, its treatment and various other factors. Toxoplasma gondii and fungi are the leading causative organisms in patients after allogeneic SCT, but also viruses such as herpes simplex virus or JC virus may be detected in these patients. Definitive diagnosis of cerebral infection still remains a high challenge, although diagnostics have improved by the wide availability of imaging techniques and polymerase chain reaction in recent years. Novel therapeutic options are arising, particularly for fungal CNS infections. Here, we summarise aspects on epidemiology, clinical symptoms and prognosis of CNS infections in patients with malignancies. Additionally, we give an overview on the diagnostics and management of cerebral infections in these patients including evidence evaluation of efficacy of treatment.

Viral encephalitis after allogeneic stem cell transplantation: a rare complication with distinct characteristics of different causative agents

“…The Infectious Diseases Society of America (IDSA) guidelines do not recommend the use of any antiviral agent to treat EBV encephalitis, albeit other authors suggested that acyclovir or ganciclovir might be useful. 10,12,34 However, further investigations are required to draw definite conclusions.…”

“…Eligibility criteria included previous allo-SCT, a positive CSF virus PCR and neurological symptoms that were not entirely attributable to conditions other than viral encephalitis. [8][9][10][11][12][13][14][15][16][17][18]20,23,24 To minimize underreporting, eligible patients were identified whenever possible from an electronic database that was supplied by the affiliated departments of virology recording all positive CSF PCR findings of the respective transplant center. Relevant data were collected on standardized case report forms by a member of the coordinating center (J. Schwender, Charité Campus Benjamin Franklin, Berlin, Germany) together with a member of the respective participating center.…”

“…[4][5][6] Viral CNS infections have less frequently been reported in patients after allo-SCT even though they are the most common type of acute encephalitis in nonimmunocompromised hosts in Western countries. [7][8][9][10][11] The largest series published to date on viral encephalitis after allo-SCT reported on 23 human herpesvirus-6 (HHV-6) encephalitis patients. 8 The diagnosis of viral encephalitis still remains an immense challenge and can often only be established by autopsy.…”

Cerebral Toxoplasmosis in a Diffuse Large B Cell Lymphoma Patient

“…4 There are several risk factors for CNS infection in these individuals, depending on the underlying malignancy, its treatment and various other factors. Among causative organisms, Toxoplasma gondii is the most prevalent.…”

Cerebral Toxoplasmosis in a Diffuse Large B Cell Lymphoma Patient

“…4,26 Prophylactic therapy is an important factor in toxoplasmosis prevention. In immunocompromised patients with high risk of reactivation of a latent T. gondii infection (eg.…”