Neurological Complications of Hematopoietic Cell Transplantation

Openshaw, Harry

doi:10.1002/9780470987070.ch59

Cited by 2 publications

(4 citation statements)

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“…7 Review of the literature reveals a mycobacterial infection incidence of between 0.5 and 3%, occurring mainly in recipients of T cell-depleted allogeneic grafts or those who developed chronic extensive GVHD. [3][4][5][8][9][10][11] CNS involvement is very rare and to our knowledge this is the first case of a CNS tuberculoma reported in this setting. Cerebral tuberculomas typically present as slowly enlarging mass lesions and are diagnosed as brain tumours before surgical exploration.…”

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

“…5 Pathogens are mainly fungi (Aspergillus and Candida albicans) and parasites (Toxoplasma). 5 Mycobacterial infections are common in people with impaired cell-mediated immunity, and the incidence has been increasing particularly in urban regions, primarily due to the epidemics of HIV infection. 1 In the marrow transplant population, despite their severe immune suppression, there is a low incidence of mycobacterial infections that contrasts with the experience reported in other immune suppressed patients (AIDS and renal transplant recipients).…”

Section: Discussionmentioning

confidence: 99%

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Central nervous system (CNS) tuberculosis following allogeneic stem cell transplantation

Campos

Campilho

et al. 2000

Bone Marrow Transplant

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Summary:Tuberculosis is an uncommon infectious complication after stem cell transplantation. We report a patient who presented with a brain mass, 3 months after pulmonary tuberculosis had been diagnosed and while he was receiving triple antituberculous therapy. He had extensive chronic GVHD. The diagnosis was made after biopsy of the lesion. The cerebral mass was excised, antituberculous treatment was maintained and the patient made a complete neurologic recovery. Six months later, he died of gram-negative septic shock. Mycobacterial infections should be considered in allograft recipients with chronic GVHD and solid lesions in the brain. Bone Marrow Transplantation (2000) 25, 567-569. Keywords: stem cell transplantation; graft-versus-host disease; tuberculosis Tuberculosis remains a major problem in the world today. It is estimated that one third of the world population is infected with Mycobacterium tuberculosis, with more than eight million new cases and nearly three million deaths occurring each year.1 Tuberculosis is directly responsible for 7% of all deaths world-wide, and the global pandemic is likely to worsen as a result of the spread of drug-resistant organisms and the ongoing human immune-deficiency virus (HIV) epidemic.2 Stem cell transplant recipients have severely impaired cell-mediated immunity as a result of their underlying disease, pre-transplant chemotherapy and radiation, graft-versus-host disease (GVHD) and its treatment. Considering mycobacteria epidemiology characteristics and the severe immune-suppression after stem cell transplantation, a high incidence of mycobacterial infections would be expected. However, this infection is uncommon, even in endemic areas, and the literature is relatively sparse concerning this subject. 3,4

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Central nervous system (CNS) tuberculosis following allogeneic stem cell transplantation

Campos

Campilho

et al. 2000

Bone Marrow Transplant

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“…Headache and fever occur early, seizures and language disturbance are common, and without treatment the patient lapses into coma. Brain MRI typically has increased signal on the fluid-attenuated inversion recovery sequence in the hippocampus, and the EEG may show periodic lateralized epileptiform discharges (Figure 1) [7]. Early in the course, the MRI abnormality may be so subtle that it is overlooked.…”

Section: Clinical Introductionmentioning

confidence: 99%

The Case for Immunomodulatory Approaches in Treating HSV Encephalitis

2013

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HSV encephalitis (HSE) is the most prevalent sporadic viral encephalitis. Although safe and effective antiviral therapies and greatly improved noninvasive diagnostic procedures have significantly improved outcomes, mortality (~20%) and debilitating neurological sequelae in survivors remain unacceptably high. An encouraging new development is that the focus is now shifting away from the virus exclusively, to include consideration of the host immune response to infection in the pathology underlying development of HSE. In this article, the authors discuss results from recent studies in experimental mouse models, as well as clinical reports that demonstrate a role for exaggerated host inflammatory responses in the brain in the development of HSE that is motivating researchers and clinicians to consider new therapeutic approaches for treating HSE. The authors also discuss results from a few studies that have shown that immunomodulatory drugs can be highly protective against HSE, which supports a role for deleterious host inflammatory responses in HSE. The impressive outcomes of some immunomodulatory approaches in mouse models of HSE emphasize the urgent need for clinical trials to rigorously evaluate combination antiviral and immunomodulatory therapy in comparison with standard antiviral therapy for treatment of HSE, and support for such an initiative is gaining momentum.

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Neurological Complications of Hematopoietic Cell Transplantation

Cited by 2 publications

References 146 publications

Central nervous system (CNS) tuberculosis following allogeneic stem cell transplantation

Central nervous system (CNS) tuberculosis following allogeneic stem cell transplantation

The Case for Immunomodulatory Approaches in Treating HSV Encephalitis

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