CNS infections in patients with hematological disorders (including allogeneic stem-cell transplantation)—Guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO)

Abstract

Diagnosis of CNS infections remains a great challenge in patients with hematological disorders since symptoms might both be masked and be mimicked by other conditions such as metabolic disturbances or consequences from antineoplastic treatment. Thus, awareness of this complication is crucial and any suspicion of a CNS infection should lead to timely and adequate diagnostics and treatment to improve the outcome in this population.

Fungal infections of the central nervous system and paranasal sinuses in onco‐haematologic patients. Epidemiological study reporting the diagnostic‐therapeutic approach and outcome in 89 cases

“…On the other hand, we found that β‐D‐Glucan has only been occasionally determined on CSF, although this is a very recent epidemiologic study. This indirect diagnostic test on the CSF should, therefore, be useful, also in accordance with recent literature results …”

“…Therefore, in patients with pulmonary mycosis, the persistence of fever, despite a pulmonary improvement, or the onset of a headache or other neurological signs, such as diplopia, should never be underestimated. With regard to the diagnosis of IFIs, our data show that indirect methods of diagnosis are now commonly used including radiological examinations and biological markers such as GM, which represents a well consolidated diagnostic method . β‐D‐Glucan appears not to be widely used, both for blood and CSF.…”

“…The diagnosis of such infectious complications can be complex because the symptoms and signs are not specific, indirect microbiology techniques are not validated on all biological fluids (i.e, CSF), and biopsy is often difficult in patients with underlying haematological malignancies . In the cases of CNS or PS‐IFI, the antifungal treatment is frequently associated with a poor efficacy and this is due both to the poor permeability of antifungal drugs in anatomical sites (such as CNS) and to the inability, in most cases, to integrate drug therapy with surgery …”

“…Unfortunately, recent epidemiological studies involving large cohorts of haematological patients with IFI‐CNS or IFI‐PS are lacking and, therefore, there are no established diagnostic‐therapeutic approaches to this serious infectious complication particularly in patients with haematological malignancies although, more recently, attempts have been made to define guidelines based on experts’ opinion …”

“…There is a lack of recent epidemiologic studies with a proper number of cases reporting the outcome of haematologic patients with IFI involving CNS and PS, and therefore, the most appropriate diagnostic and therapeutic approach remain to be clearly defined. In fact, in the literature, we found only case reports or small retrospective studies, more often not recent . The most frequently reported pathogens were moulds and especially Aspergillus and Mucormycetes .…”