Child's Nervous System

, Volume 34, Issue 10, pp 1989–1996 | Cite as

Infections in the immunocompromised child

  • Llewellyn C. PadayachyEmail author
  • A. Graham Fieggen
Special Annual Issue


Prevention and management of opportunistic infections in children is particularly relevant in an era demonstrating an increased prevalence of immunocompromising conditions. The presence of an unusual organism which results in serious infection in a child should therefore always raise the consideration of immune compromise. The more common opportunistic infections have become easier to recognize in recent times due to improved awareness and more refined diagnostic testing. Targeted treatment is usually followed by long-term prophylactic medication. The impact of these conditions on patient outcome is of clear significance and certainly warrants further discussion.


Infection Immunocompromised child 


Compliance with ethical standards

Conflict of interest

The authors have no conflict of interest to declare.


  1. 1.
    Algar V, Novelli V (2007) Infections in the immunocompromised host. Paediatr Child Health 17(4):132–136CrossRefGoogle Scholar
  2. 2.
    Allen UD (2016) Management of infections in the immunocompromised child: general principles. LymphoSign J 3(3):87–98CrossRefGoogle Scholar
  3. 3.
    Tulius M, Silva T, Grinsztejn B (2009) Opportunistic infections in the brain in developing countries. In: Paul RH et al. (eds) HIV and the brain, Current clinical neurology, pp 293–318Google Scholar
  4. 4.
    Bonilla FA, Geha RS (2003) Primary immunodeficiency diseases. J Allergy Clin Immunol 111:S571–S581CrossRefPubMedGoogle Scholar
  5. 5.
    Chinen J, Shearer WT (2010) Secondary immunodeficiencies including HIV infection. J Allergy Clin Immunol 125(2):S195–S203CrossRefPubMedGoogle Scholar
  6. 6.
    Corbett EL, Watt CJ, Walker N, Maher D, Williams BG, Raviglione MC, Dye C (2003) The growing burden of tuberculosis: global trends and interactions with the HIV epidemic. Arch Intern Med 163(9):1009–1021CrossRefPubMedGoogle Scholar
  7. 7.
    Kumar V, Abbas AK, Fausto N, Aster JC (2010) In: Robbins and Cotran pathologic basis of disease, 8th edn. Saunders Elsevier, PhiladelphiaGoogle Scholar
  8. 8.
    Fieggen AG, Padayachy L (2015) Tuberculosis, parasitic and fungal infestations. In: Principles and practice of pediatric neurosurgery, 3rd edn. ThiemeGoogle Scholar
  9. 9.
    Thwaites GE, Lan NT, Dung NH et al (2005) Effect of antituberculosis drug resistance on response to treatment and outcome in adults with tuberculous meningitis. J Infect Dis 192(1):79–88CrossRefPubMedGoogle Scholar
  10. 10.
    Figaji AA, Fieggen AG (2010) The neurosurgical and acute care management of tuberculous meningitis: evidence and current practice. Tuberculosis 90:393–400CrossRefPubMedGoogle Scholar
  11. 11.
    Lammie GA, Hewlett RH, Schoeman JF, Donald PR (2009) Tuberculous cerebrovascular disease: a review. J Inf Secur 59:156–166Google Scholar
  12. 12.
    Campbell IA, Bah-Sow O (2006) Pulmonary tuberculosis: diagnosis and treatment. BMJ 332(7551):1194–1197CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Wait JW, Schoeman JF (2009) Behaviour profiles after tuberculous meningitis. J Trop Pediatr 56(3):166–171CrossRefPubMedGoogle Scholar
  14. 14.
    Chang L, Cornford ME, Chiang FL, Ernst TM, Sun NC, Miller BL (1995) Radiologic-pathologic correlation. Cerebral toxoplasmosis and lymphoma in AIDS. Am J Neuroradiol 16(8):1653–1663PubMedGoogle Scholar
  15. 15.
    Andronikou S, Wieselthaler N, Smith B, Douis H, Fieggen AG, van Toorn R, Wilmshurst J (2005) Value of early follow-up CT in paediatric tuberculous meningitis. Pediatr Radiol 35:1092–1099CrossRefPubMedGoogle Scholar
  16. 16.
    Idro R, Newton C (2005) Pathogenesis, clinical features, and neurological outcome of cerebral malaria. Lancet Neurol 4:827–840CrossRefPubMedGoogle Scholar
  17. 17.
    Tandon V, Mahapatra AK (2011) Management of post-tubercular hydrocephalus. Childs Nerv Syst 27:1699–1707CrossRefPubMedGoogle Scholar
  18. 18.
    Rajshekhar V (2009) Management of hydrocephalus in patients with tuberculous meningitis. Neurol India 57(4):368–374CrossRefPubMedGoogle Scholar
  19. 19.
    Bullock MRR, van Dellen JR (1982) The role of cerebrospinal fluid shunting in tuberculous meningitis. Surg Neurol 18:274–277CrossRefPubMedGoogle Scholar
  20. 20.
    Lamprecht D, Schoeman J, Donald P, Hartzenberg H (2001) Ventriculoperitoneal shunting in childhood tuberculous meningitis. Br J Neurosurg 15(2):119–125CrossRefPubMedGoogle Scholar
  21. 21.
    Sil K, Chatterjee S (2008) Shunting in tuberculous meningitis: a neurosurgeon’s nightmare. Childs Nerv Syst 24(9):1029–1032CrossRefPubMedGoogle Scholar
  22. 22.
    Palur R, Rajshekar V, Chandy MJ, Joseph T, Abraham J (1991) Shunt surgery for hydrocephalus in tuberculous meningitis: a long-tem follow-up study. J Neurosurg 74:64–69CrossRefPubMedGoogle Scholar
  23. 23.
    Figaji AA, Fieggen AG (2013) Endoscopic challenges and applications in tuberculous meningitis. World Neurosurg 79(2):S24–Se9CrossRefPubMedGoogle Scholar
  24. 24.
    Singh P, Kochhar R, Vashishta RK, Khandelwal N, Prabhakar S, Mohindra S, Singhi P (2006) Amoebic meningoencephalitis: spectrum of imaging findings. Am J Neuroradiol 27(6):1217–1221PubMedGoogle Scholar
  25. 25.
    Mathew JM, Rajshekar V, Chandy MJ (1998) Shunt surgery in poor grade patients with tuberculous meningitis and hydrocephalus: effects of response to external ventricular drainage and other variables on long-term outcome. J Neurol Neurosurg Psychiatry 65:115–118CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Peltzer K, Naidoo P, Matseke G, Louw J, Mchunu G, Tutshana B (2012) Prevalence of psychological distress and associated factors in tuberculosis patients in public primary care clinics in South Africa. BMC Psychiatry 12(1):89CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Jonathan A, Rajshekhar V (2005) Endoscopic third ventriculostomy for chronic hydrocephalus after tuberculous meningitis. Surg Neurol 63:32–35CrossRefPubMedGoogle Scholar
  28. 28.
    Janku J (1923) Pathogenesa a pathologicka anatomie tak nazveneho vrozeneho kolobomu slute skvrny v oku normalne velikem a mikrophthalmickem s nalezem parazitu v sitnici. Cas Lek Cesk 60:1021.20Google Scholar
  29. 29.
    Grant A (1996) Varicella infection and toxoplasmosis in pregnancy. J Perinat Neonatal Nurs 10:17–29CrossRefPubMedGoogle Scholar
  30. 30.
    Desmonts G, Couvreur J (1979) Congenital toxoplasmosis: a prospective study of the offspring of 54 women who acquired toxoplasmosis during pregnancy: pathophysiology of congenital disease. In: Thalhammer O, Baumgarten K, Pollak A (eds) Perinatal medicine. George Thieme, StuttgartGoogle Scholar
  31. 31.
    Arnold SJ, Kinney MC, McCormick MS, Dummer S, Scott MA (1997) Disseminated toxoplasmosis. Unusual presentations in the immunocompromised host. Arch Pathol Lab Med 121(8):869–873PubMedGoogle Scholar
  32. 32.
    Conley FK, Jenkins HT, Remington JS (1981) Toxoplasma gondii infection of the central nervous system: use of peroxidise-antiperoxidase method to demonstrate toxoplasma in formalin fixed paraffin embedded tissue sections. Hum Pathol 12:690–698CrossRefPubMedGoogle Scholar
  33. 33.
    Patel DV, Hofels E, Vogel N et al (1996) Resolution of intracerebral calcification in children with treated congenital toxoplasmosis. Radiology 199:433–440CrossRefPubMedGoogle Scholar
  34. 34.
    Luft BJ, Conley F, Remington JS (1983) Outbreak of central nervous system toxoplasmosis in Western Europe and North America. Lancet 1:781–784CrossRefPubMedGoogle Scholar
  35. 35.
    Diebler C, Dussler A, Dulac O (1985) Congenital toxoplasmosis: clinical and neuroradiological evaluation of the cerebral lesions. Neuroradiology 27:125–130CrossRefPubMedGoogle Scholar
  36. 36.
    Remington JS, Mcleod R, Thuliez P et al (2006) Toxoplasmosis. In: Js R, Klein JO, Wilson CB et al (eds) Infectious diseases of the fetus and newborn, 6th edn. W.B. Saunders, Philadelphia, pp 947–1092CrossRefGoogle Scholar
  37. 37.
    McCauley JB, Boyer KM, Remington JS, Mcleod RL (2009) Toxoplasmosis. In: Feigin RD, Cherry JD, Demmler-Harrison GJ, Kaplan SL (eds) Textbook of pediatric infectious diseases, 6th edn. WB Saunders, Philadelphia, pp 2954–2971Google Scholar
  38. 38.
    Desmonts G, Daffos F, Forrestier F et al (1985) Prenatal diagnosis of congenital toxoplasmosis. Lancet 1:500–504CrossRefPubMedGoogle Scholar
  39. 39.
    Hohlfeld P, Daffos T, Costa JM et al (1994) Prenatal diagnosis of congenital toxoplasmosis with a polymerase-chain reaction test on amniotic fluid. N Engl J Med 331:695–699CrossRefPubMedGoogle Scholar
  40. 40.
    Foulon W, Villena I, Stray-Pederson B et al (1999) Treatment of toxoplasmosis during pregnancy: a multicenter study of impact on fetal transmission and children’s sequelae at age 1 year. Am J Obstet Gynecol 180:410–415CrossRefPubMedGoogle Scholar
  41. 41.
    Wilson CB, Remington JS, Stagno S, Reynolds DW (1980) Development of adverse sequelae in children born with subclinical congenital toxoplasma infection. Pediatrics 66:767–774PubMedGoogle Scholar
  42. 42.
    Roizen N, Swisher CN, Stein M, Hopkins J, Boyer KM, Holfels E, Mets MB, Stein L, Patel D, Meier P (1995) Neurologic and developmental outcome in treated congenital toxoplasmosis. Pediatrics 95:11–20PubMedGoogle Scholar
  43. 43.
    Mitchell CD, Erlich SS, Mastrucci MT, Hutto SC et al (1990) Congenital toxoplasmosis occurring in infants perinatally infected with human immunodeficiency virus 1. Pediatr Infect Dis J 9:512–518CrossRefPubMedGoogle Scholar
  44. 44.
    Martinovic J, Sibalic D, Djordjevic M et al (1982) Frequency of toxoplasmosis in the appearance of congenital hydrocephalus. J Neurosurg 56:830–834CrossRefPubMedGoogle Scholar
  45. 45.
    Stahl W, Kaneda Y (1997) Pathogenesis of murine toxoplasmic hydrocephalus. Parasitology 114:219–229CrossRefPubMedGoogle Scholar
  46. 46.
    Porter SB, Sende MA (1992) Toxoplasmosis of the central nervous system in the acquired immunodeficiency syndrome.1992;327:1643–8Google Scholar
  47. 47.
    Holliman RE (1988) Toxoplasmosis and the acquired immune deficiency syndrome. J Inf Secur 16:121–128Google Scholar
  48. 48.
    Townsend JJ, Wolinsky JS, Baringer JR, Johnson PC (1975) Acquired toxoplasmosis. A neglected cause of treatable nervous system disease. Arch Neurol 32:335–343CrossRefPubMedGoogle Scholar
  49. 49.
    Arendt G, von Giesen HJ, Hefter H, Neuen-Jacob E, Roick H, Jablonowski H (1999) Long-term course and outcome in AIDS patients with cerebral toxoplasmosis. Acta Neurol Scand 100:178–184CrossRefPubMedGoogle Scholar
  50. 50.
    Walker M, Zunt JR (2005) Parasitic central nervous system infections in immunocompromised hosts. Clin Infect Dis 40(7):1005–1015CrossRefPubMedPubMedCentralGoogle Scholar
  51. 51.
    Mitchell WG (1999) Neurocysticercosis and acquired cerebral toxoplasmosis in children. Semin Pediatr Neurol 6:267–277CrossRefPubMedGoogle Scholar
  52. 52.
    Medina MT, DeGiorgio C (2002) Introduction to neurocysticercosis: a worldwide epidemic. Neurosurg Focus 12(6)Google Scholar
  53. 53.
    Del Brutto OH, Santibanez R, Noboa CA et al (1992) Epilepsy due to neurocysticercosis: analysis of 203 patients. Neurology 42:389–392CrossRefPubMedGoogle Scholar
  54. 54.
    Carpio A, Escobar A, Hauser WA (1998) Cysticercosis and epilepsy: a critical review. Epilepsia 39:1025–1040CrossRefPubMedGoogle Scholar
  55. 55.
    Carpio A (2002) Neurocysticercosis: an update. Lancet Infect Dis 2:751–762CrossRefPubMedGoogle Scholar
  56. 56.
    Cao W, van der Ploeg CPB, Xu J et al (1997) Risk factor for human cysticercosis morbidity: a population based case-control study. Epidemiol Infect 119:231–235CrossRefPubMedPubMedCentralGoogle Scholar
  57. 57.
    Sanchez AL, Lindback J, Schantz PM et al (1999) A population-based, case control study of Taenia solium taeniasis and cysicersosis. Ann Trop Med Parasitol 93(3):247–258CrossRefPubMedGoogle Scholar
  58. 58.
    Schantz PM, Moore AC, Muńoz JL et al (1992) Neurocysticercosis in an orthodox Jewish community in New York City. NEJM 327:692–695CrossRefPubMedGoogle Scholar
  59. 59.
    Pawlowski ZS (2002) Taenia solium: basic biology and transmission. In: Singh G, Prabhakar S (eds) Taenia solium cysticercosis. CABI Publishing, Wallingford, pp 1–23Google Scholar
  60. 60.
    Escobar A (1983) The pathology of neurocysticercosis. In: Palcios E, Rodriguez-Carbajal, Taveras JM (eds) Cysticercosis of the central nervous system. Charles C. Thomas, Springfield, pp 27–54Google Scholar
  61. 61.
    Sanz CR (1987) Host response in childhood neurocysticercosis: some pathological aspects. Childs Nerv Syst 3(4):206–207CrossRefPubMedGoogle Scholar
  62. 62.
    Carpio A, Placencia M, Santillán F, Escobar A (1994) Proposal for a new classification of neurocysticercosis. Can J Neurol Sci 21:43–47CrossRefPubMedGoogle Scholar
  63. 63.
    Estanol B, Corona T, Abad P (1986) A prognostic classification of cerebral cysticercosis: therapeutic implications. J Neurol Neurosurg Psychiatry 49:1131–1134CrossRefPubMedPubMedCentralGoogle Scholar
  64. 64.
    Pitella JEH (1997) Neurocysticercosis. Brain Pathol 7:681–693CrossRefGoogle Scholar
  65. 65.
    White AC (2000) Neurocysticercosis. Curr Treat Options Infect Dis 2:78–87Google Scholar
  66. 66.
    Del Brutto OH, Rajshekhar V, White AC et al (2001) Proposed diagnostic criteria for neurocysticercosis. Neurology 57:177–183CrossRefPubMedPubMedCentralGoogle Scholar
  67. 67.
    Schantz PM, Wilkins PP, Tsang VCW (1998) Immigrants, imaging, and immunoblots: the emergence of neurocysticercosis as a significant public health problem. In: Scheld WM, Craig WA, Hughes JM (eds) Emerging infections. ASM Press, Washington DC, pp 213–242CrossRefGoogle Scholar
  68. 68.
    Jena A, Sanchatee PC, Gupta RK et al (1998) Cysticercosis of the brain shown by magnetic resonance imaging. Clin Radiol 39:542–546CrossRefGoogle Scholar
  69. 69.
    Sinha S, Sharma BS (2009) Neurocysticercosis: a review of current status and management. J Clin Neurosci 16:867–876CrossRefPubMedGoogle Scholar
  70. 70.
    Rajshekhar V (2003) Solitary cerebral cysticercus granuloma. Epilepsia 44(Suppl):25–28CrossRefGoogle Scholar
  71. 71.
    Bittencourt PRM, Costa AJ, Oliveira TV, Gracia CM, Gorz AM, Mazer S (1990) Clinical, radiological and cerebrospinal fluid presentation of neurocysticercosis: a prospective study. Arq Neuropsiquiatr 48:286–289CrossRefPubMedGoogle Scholar
  72. 72.
    Tsang VW, Brand JA, Boyer AE (1989) An enzyme-linked immunoelectrotransfer blot assay and glycoproteins antigens for diagnosing human cysticercosis (Taenia solium). J Infect Dis 174:1007–1009Google Scholar
  73. 73.
    St Geme JW III, Maldonado YA, Enzmann D et al (1993) Consensus: diagnosis and management of neurocysticercosis in children. Pediatr Infect Dis J 12:455–461CrossRefPubMedGoogle Scholar
  74. 74.
    Garcia HH, Carlton A, Evans W, Nash TE et al (2002) Current consensus guidelines for treatment of neurocysticercosis. Clin Microbiol Rev 15(4):747–756CrossRefPubMedPubMedCentralGoogle Scholar
  75. 75.
    Takayanagui OM, Jardim E (1992) Therapy for neurocysticercosis. Comparison between albendazole and praziquantel. Arch Neurol 49:290–294CrossRefPubMedGoogle Scholar
  76. 76.
    Sotelo J, Escobedo F, Panegos P (1988) Albendazole vs praziquantel therapy for neurocysticercosis. A controlled trial. Arch Neurol 45:532–534CrossRefPubMedGoogle Scholar
  77. 77.
    Thornton CA, Houston S, Latif AS (1992) Neurocysticercosis and human immunodeficiency virus infection: a possible association. Arch Neurol 49:963–965CrossRefPubMedGoogle Scholar
  78. 78.
    Woo E, Yu L, Huang CY (1988) Cerebral infarct precipitated by praziquantel in neurocysticercosis: a cautionary note. Trop Geogr Med 40:143–146PubMedGoogle Scholar
  79. 79.
    Kelly R, Duong DH, Locke GE (2002) Characteristics of ventricular shunt malfunctions among patients with neurocysticercosis. Neurosurgery 50:757–762CrossRefGoogle Scholar
  80. 80.
    Husain M, Jha DK, Rastogi M, Husain N, Gupta RK (2007) Neuro-endoscopic management of intraventricular neurocysticercosis (NCC). Acta Neurochir 149:341–346CrossRefPubMedGoogle Scholar
  81. 81.
    Anandh B, Mohanty A, Sampath S, Praharaj SS, Kolluri S (2001) Endoscopic approach to intraventricular cysticercal lesions. Minim Invasive Neurosurg 44:194–196CrossRefPubMedGoogle Scholar
  82. 82.
    Cavalheiro S, Zymberg ST, Teixera PD, Da Silva MC (2004) Hydrocephalus in neurocysticercosis and other parasitic and infectious diseases. In: Cinalli G, Maixner WJ, Saint-Rose C (eds) Pediatric hydrocephalus, vol 17. Springer-Verlag, Milan, pp 1–14Google Scholar
  83. 83.
    Fowler M, Carter RF (1965) Acute pyogenic meningitis probably due to Acanthamoeba sp.: a preliminary report. BMJ:740–742Google Scholar
  84. 84.
    Anzil AP, Rao C, Wrzolek MA, Visvesvara GS, Sher JH, Kozlowski PB (1991) Amebic meningoencephalitis in a patient with AIDS caused by a newly recognised opportunistic pathogen, Leptomyxid ameba. Arch Pathol Lab Med 115:21–25PubMedGoogle Scholar
  85. 85.
    Harms G, Feldmeier H (2005) The impact of HIV infection on tropical diseases. Infect Dis Clin N Am 19(1):121–135CrossRefGoogle Scholar
  86. 86.
    Phillips RE, Solomon T (1990) Cerebral malaria in children. Lancet 336:1355–1360CrossRefPubMedGoogle Scholar
  87. 87.
    Greenwood BM (1997) The epidemiology of malaria. Ann Trop Med Parasitol 91:763–769CrossRefPubMedGoogle Scholar
  88. 88.
    Satishchandra P, Mathew T, Gadre G, Nagarathna S, Chandramukhi A, Mahadevan A, Shankar SK (2007) Cryptococcal meningitis: clinical, diagnostic and therapeutic overviews. Neurol India 55:226–232CrossRefPubMedGoogle Scholar
  89. 89.
    Bruckner DA, Kokkinos HM (2009) Classification of fungi. In: Feigin and Cherry’s textbook of pediatric infectious diseases, vol 2. Saunders, Elsevier, pp 2715–2736Google Scholar
  90. 90.
    Mohar A, Romo J, Salido F, Jessurun J, de León SP, Reyes E, Volkow P, Larraza O, Peredo MA, Cano C, Gomez G, Sepúlveda J, Mueller N (1992) The spectrum of clinical and pathological manifestation of AIDS in a consecutive series of autopsied patients in Mexico. AIDS 6(5):467–473CrossRefPubMedGoogle Scholar
  91. 91.
    Perfect JR, Dismukes WE, Dromer F, Goldman DL, Graybill JR, Hamill RJ, Harrison TS, Larsen RA, Lortholary O, Nguyen MH, Pappas PG, Powderly WG, Singh N, Sobel JD, Sorrell TC (2010) Practice guidelines for the management of cryptococcal disease: 2010 update by the Infectious Diseases Society of America. Clin Infect Dis 50:291–322CrossRefPubMedPubMedCentralGoogle Scholar
  92. 92.
    Baddley JW, Dismukes WE (2003) Cryptococcosis. In: Dismukes W, Pappas PG, Sobel JD (eds) Clinical mycology. Oxford University Press, New York, pp 188–205Google Scholar
  93. 93.
    Couppie P, Aznar C, Carme B et al (2006) American Histoplasmosis in developing countries with a special focus on patients with HIV: diagnosis, treatment, and prognosis. Curr Opin Infect Dis 19(5):443–449CrossRefPubMedGoogle Scholar
  94. 94.
    Ruhnke M, Grzegorz K, Otto K, Schwartz S (2007) CNS aspergillosis: recognition, diagnosis and management. CNS Drugs 21(8):659–676CrossRefPubMedGoogle Scholar
  95. 95.
    Donabedian H, O’Donnell E, Olszzewski C et al (1994) Disseminated cutaneous and meningeal sporotrichosis in an AIDS patient. Diagn Microbiol Infect Dis 18(2):111–115CrossRefPubMedGoogle Scholar
  96. 96.
    Williams P (2007) Coccidioidal meningitis. Ann N Y Acad Sci 1111:377–384CrossRefPubMedGoogle Scholar
  97. 97.
    Potter M (2005) Strategies for managing systemic fungal infections and the place of itraconazole. J Antimicrob Chemother 56(Suppl 1):i49–i59CrossRefPubMedGoogle Scholar
  98. 98.
    Emery VC (2001) Investigation of CMV disease in immunocompromised patients. J Clin Pathol 54:84–88CrossRefPubMedPubMedCentralGoogle Scholar
  99. 99.
    Reuter JD, Gomez DL, Wilson JH, van den Pol AN (2004) Systemic immune deficiency necessary for cytomegalovirus invasion of the mature brain. J Virol 78:1473–1487CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Neurosurgery, Neurosciences Institute, Faculty of Health SciencesUniversity of Cape TownCape TownSouth Africa

Personalised recommendations