Skip to main content

Advertisement

SpringerLink
Log in

CNS Infections in Immunoincompetent Patients

Neuroradiological and Clinical Features

  • review article
  • Published:
Clinical Neuroradiology Aims and scope Submit manuscript

Abstract

In patients with immunodeficiency the pathogen spectrum of central nervous system (CNS) infections is broader and different from that of immunocompetent patients. Numerous opportunistic infections are characterized by a high prevalence of viral, bacterial and parasitic pathogens, and depend on the type of impaired immune defense, for example impaired T‑cell or monocyte function, monoclonal antibody treatment, and impaired granulocyte function. Neuroradiological features as well as laboratory findings are often different and versatile in comparison to immunocompetent individuals and pathognomonic imaging findings do not exist; however, knowledge of possible pathways of pathogens in the CNS and preferred tissue affection may help in narrowing down differential diagnoses. Therefore, knowledge of the type of patient and the performed immunomodulatory therapy is essential for the neuroradiological assessment and the differential diagnostic considerations. Moreover, parenchymal reactions in the sense of an immune reconstitution inflammatory syndrome (IRIS) can occur when immunocompetence is restored. This review focus on the most common pathologies in immunocompromised patients, and an overview of imaging features but also of pathology and clinical aspects is given. The synopsis of anamnestic information, clinical findings and structured analysis of the lesion pattern, its spread and short-term follow-up may increase the correct diagnostic classification; however, the gold standard is still determination of the pathogen in the cerebrospinal fluid (CSF), blood cultures or biopsies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13
Fig. 14
Fig. 15
Fig. 16
Fig. 17
Fig. 18

Similar content being viewed by others

References

  1. Schmutzhard E, Pfausler B. Infections of the central nervous system in immuno-compromised. Nervenarzt. 2008;79 Suppl 2:93–108.

    PubMed  Google Scholar 

  2. Pruitt AA. Central nervous system infections complicating immunosuppression and transplantation. Continuum (Minneap Minn). 2018;24:1370–96.

    PubMed  Google Scholar 

  3. Williamson EM, Berger JR. Central nervous system infections with immunomodulatory therapies. Continuum (Minneap Minn). 2015;21:1577–98.

    PubMed  Google Scholar 

  4. Granerod J, Ambrose HE, Davies NW, Clewley JP, Walsh AL, Morgan D, Cunningham R, Zuckerman M, Mutton KJ, Solomon T, Ward KN, Lunn MP, Irani SR, Vincent A, Brown DW, Crowcroft NS; UK Health Protection Agency (HPA) Aetiology of Encephalitis Study Group. Causes of encephalitis and differences in their clinical presentations in England: a multicenter, population-based prospective study. Lancet Infect Dis. 2010;10:835–44.

    PubMed  Google Scholar 

  5. Kastrup O, Wanke I, Maschke M. Neuroimaging of infections of the central nervous system. Semin Neurol. 2008;28:511–22.

    PubMed  Google Scholar 

  6. Schmidt-Hieber M, Silling G, Schalk E, Heinz W, Panse J, Penack O, Christopeit M, Buchheidt D, Meyding-Lamadé U, Hähnel S, Wolf HH, Ruhnke M, Schwartz S, Maschmeyer G. 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). Ann Oncol. 2016;27:1207–25.

    CAS  PubMed  PubMed Central  Google Scholar 

  7. Bradshaw MJ, Cho TA, Chow FC. Central nervous system infections associated with immunosuppressive therapy for rheumatic disease. Rheum Dis Clin North Am. 2017;43:607–19.

    PubMed  PubMed Central  Google Scholar 

  8. Tan CS, Koralnik IJ. Progressive multifocal leukoencephalopathy and other disorders caused by JC virus: clinical features and pathogenesis. Lancet Neurol. 2010;9:425–37.

    CAS  PubMed  PubMed Central  Google Scholar 

  9. Egli A, Infanti L, Dumoulin A, Buser A, Samaridis J, Stebler C, Gosert R, Hirsch HH. Prevalence of polyomavirus BK and JC infection and replication in 400 healthy blood donors. J Infect Dis. 2009;199:837–46.

    CAS  PubMed  Google Scholar 

  10. Duarte SBL, Oshima MM, Mesquita JVDA, do Nascimento FBP, de Azevedo PC, Reis F. Magnetic resonance imaging findings in central nervous system cryptococcosis: comparison between immunocompetent and immunocompromised patients. Radiol Bras. 2017;50:359–65.

    PubMed  PubMed Central  Google Scholar 

  11. Guggenberger K, Urbach H. MRT-Veränderungen bei Immunmodulation. Nervenarzt. 2018;89:945–57.

    CAS  PubMed  Google Scholar 

  12. Server A, Bargalló N, Fløisand Y, Sponheim J, Graus F, Hald JK. Imaging spectrum of central nervous system complications of hematopoietic stem cell and solid organ transplantation. Neuroradiology. 2017;59:105–26.

    PubMed  Google Scholar 

  13. Chang L, Shukla DK. Imaging studies of the HIV-infected brain. Handb Clin Neurol. 2018;152:229–64.

    PubMed  Google Scholar 

  14. Nichtweiß M, Madlener J, Lang C, Enzensberger W, Hacker H. Charakteristika der progressiven multifokalen Leukenzephalopathie (PML). Clin Neuroradiol. 1994;4:185–95.

    Google Scholar 

  15. Naidoo A, Paruk H, Bhagwan B, Moodley A. Atypical presentations of acute disseminated encephalomyelitis (ADEM) in HIV infection. J Neurovirol. 2017;23:160–70.

    CAS  PubMed  Google Scholar 

  16. Chamie G, Marquez C, Luetkemeyer A. HIV-associated central nervous system tuberculosis. Semin Neurol. 2014;34:103–15.

    PubMed  Google Scholar 

  17. Brandsma D, Bromberg JEC. Primary CNS lymphoma in HIV infection. Handb Clin Neurol. 2018;152:177–86.

    PubMed  Google Scholar 

  18. Enriquez-Marulanda A, Valderrama-Chaparro J, Parrado L, Diego Vélez J, Maria Granados A, Luis Orozco J, Quiñones J. Cerebral toxoplasmosis in an MS patient receiving Fingolimod. Mult Scler Relat Disord. 2017;18:106–8.

    PubMed  Google Scholar 

  19. Berenguer J, Moreno S, Laguna F, Vicente T, Adrados M, Ortega A, González-LaHoz J, Bouza E. Tuberculous meningitis in patients infected with the human Immunodeficiency virus. N Engl J Med. 1992;326:668–72.

    CAS  PubMed  Google Scholar 

  20. Gottumukkala RV, Romero JM, Riascos RF, Rojas R, Glikstein RS. Imaging of the brain in patients with human immunodeficiency virus infection. Top Magn Reson Imaging. 2014;23:275–91.

    Google Scholar 

  21. Khalaf AM, Hashim MA, Alsharabati M, Fallon K, Cure JK, Pappas P, Mineishi S, Saad A. Late-onset cerebral Toxoplasmosis after Allogeneic Hematopoietic stem cell transplantation. Am J Case Rep. 2017;18:246–50.

    PubMed  PubMed Central  Google Scholar 

  22. Maschke M, Dietrich U, Prumbaum M, Kastrup O, Turowski B, Schaefer UW, Diener HC. Opportunistic CNS infection after bone marrow transplantation. Bone Marrow Transplant. 1999;23:1167–76.

    CAS  PubMed  Google Scholar 

  23. Mele A, Paterson PJ, Prentice HG, Leoni P, Kibbler CC. Toxoplasmosis in bone marrow transplantation: a report of two cases and systematic review of the literature. Bone Marrow Transplant. 2002;29:691–8.

    Google Scholar 

  24. Hua X, Boyle CP, Harezlak J, Tate DF, Yiannoutsos CT, Cohen R, Schifitto G, Gongvatana A, Zhong J, Zhu T, Taylor MJ, Campbell TB, Daar ES, Alger JR, Singer E, Buchthal S, Toga AW, Navia B, Thompson PM; HIV Neuroimaging Consortium. Disrupted cerebral metabolite levels and lower nadir CD4+ counts are linked to brain volume deficits in 210 HIV-infected patients on stable treatment. Neuroimage Clin. 2013;3:132–42.

    PubMed  PubMed Central  Google Scholar 

  25. Tan K, Roda R, Ostrow L, McArthur J, Nath A. PML-IRIS in patients with HIV infection—Clinical manifestations and treatment with steroids. Neurology. 2009;72:1458–64.

    CAS  PubMed  PubMed Central  Google Scholar 

  26. Gray F, Bazille C, Adle-Biassette H, Mikol J, Moulignier A, Scaravilli F. Central nervous system immune reconstitution disease in acquired immunodeficiency syndrome patients receiving highly active antiretroviral treatment. J Neurovirol. 2005;11 Suppl 3:16-22.

    PubMed  Google Scholar 

  27. Buckle C, Castillo M. Use of diffusion-weighted imaging to evaluate the initial response of progressive multifocal leukoencephalopathy to highly active antiretroviral therapy: early experience. AJNR Am J Neuroradiol. 2010;31:1031–5.

    CAS  PubMed  Google Scholar 

  28. Clifford DB, DeLuca A, Simpson DM, Arendt G, Giovannoni G, Nath A. Natalizumab-associated progressive multifocal leukoencephalopathy in patients with multiple sclerosis: lessons from 28 cases. Lancet Neurol. 2010;9:438–46.

    CAS  PubMed  Google Scholar 

  29. Huang D, Cossoy M, Li M, Choi D, Taege A, Staugaitis SM, Rehm S, Ransohoff RM. Inflammatory progressive multifocal leukoencephalopathy in human immunodeficiency virus-negative patients. Ann Neurol. 2007;62:34–9.

    PubMed  Google Scholar 

  30. Küker W, Mader I, Nägele T, Uhl M, Adolph C, Klose U, Herrlinger U. Progressive multifocal leukoencephalopathy: value of diffusion-weighted and contrast-enhanced magnetic resonance imaging for diagnosis and treatment control. Eur J Neurol. 2006;13:819–26.

    CAS  PubMed  Google Scholar 

  31. Wattjes MP, Barkhof F. Diagnosis of natalizumab-associated progressive multifocal leukoencephalopathy using MRI. Curr Opin Neurol. 2014;27:260–70.

    CAS  PubMed  Google Scholar 

  32. Wijburg MT, Witte BI, Vennegoor A, Roosendaal SD, Sanchez E, Liu Y, Martins Jarnalo CO, Uitdehaag BM, Barkhof F, Killestein J, Wattjes MP. MRI criteria differentiating asymptomatic PML from new MS lesions during natalizumab pharmacovigilance. J Neurol Neurosurg Psychiatr. 2016;87:1138–45.

    Google Scholar 

  33. Yousry TA, Major EO, Ryschkewitsch C, Fahle G, Fischer S, Hou J, Curfman B, Miszkiel K, Mueller-Lenke N, Sanchez E, Barkhof F, Radue EW, Jäger HR, Clifford DB. Evaluation of patients treated with Natalizumab for progressive multifocal leukoencephalopathy. N Engl J Med. 2006;354:924–33.

    CAS  PubMed  PubMed Central  Google Scholar 

  34. Yousry TA, Pelletier D, Cadavid D, Gass A, Richert ND, Radue EW, Filippi M. Magnetic resonance imaging pattern in Natalizumab-associated progressive Multifocal Leukoencephalopathy. Ann Neurol. 2012;72:779–87.

    CAS  PubMed  Google Scholar 

  35. Manea E, Munteanu D, Jipa R, Moroti R, Arama V, Diaconu IA, Hristea A. Immune reconstitution inflammatory syndrome in central nervous system tuberculosis. Pneumologia. 2015;64:32–6.

    PubMed  Google Scholar 

  36. Hodel J, Darchis C, Outteryck O, Verclytte S, Deramecourt V, Lacour A, Zins M, Pruvo JP, Vermersch P, Leclerc X. Punctate pattern—A promising imaging marker for the diagnosis of natalizumab-associated PML. Neurology. 2016;86:1516–23.

    CAS  PubMed  Google Scholar 

  37. Hinchey J, Chaves C, Appignani B, Breen J, Pao L, Wang A, Pessin MS, Lamy C, Mas JL, Caplan LR. A reversible posterior leukoencephalopathy syndrome. N Engl J Med. 1996;334:494–500.

    CAS  PubMed  Google Scholar 

  38. Bartynski WS. Posterior reversible Encephalopathy syndrome, part 1: fundamental imaging and clinical features. AJNR Am J Neuroradiol. 2008;29:1036–42.

    CAS  PubMed  Google Scholar 

  39. Bartynski WS. Posterior reversible Encephalopathy syndrome, part 2: controversies surrounding Pathophysiology of Vasogenic edema. AJNR Am J Neuroradiol. 2008;29:1043–9.

    CAS  PubMed  Google Scholar 

  40. Antunes NL, Small TN, George D, Boulad F, Lis E. Posterior leukoencephalopathy syndrome may not be reversible. Pediatr Neurol. 1999;20:241–3.

    CAS  PubMed  Google Scholar 

  41. Weidauer S, Gaa J, Sitzer M, Hefner R, Lanfermann H, Zanella FE. Posterior encephalopathy syndrome associated with vasospasm: MR imaging and DSA findings. Neuroradiology. 2003;45:869–76.

    CAS  PubMed  Google Scholar 

  42. Weidauer S, Gaa J, Neumann-Haefelin T, Lanfermann H, Zanella FE. Posterior encephalopathy: Neuroradiological findings, etiology and clinical course. Clin Neuroradiol. 2003;13:34–44.

    Google Scholar 

  43. Rykken JB, McKinney AM. Posterior reversible Encephalopathy syndrome. Semin Ultrasound CT MR. 2014;35:118–35.

    PubMed  Google Scholar 

  44. Gijtenbeek JM, van den Bent MJ, Vecht CJ. Cyclosporine neurotoxicity: a review. J Neurol. 1999;246:339–46.

    CAS  PubMed  Google Scholar 

  45. Brady E, Parikh NS, Navi BB, Gupta A, Schweitzer AD. The imaging spectrum of posterior reversible encephalopathy syndrome: a pictorial review. Clin Imaging. 2018;47:80–9.

    PubMed  Google Scholar 

  46. Shih RY, Koeller KK. Bacterial, fungal, and parasitic infections of the central nervous system: radiologic-pathologic correlation and historical perspectives. Radiographics. 2015;35:1141–69.

    PubMed  Google Scholar 

  47. Rath TJ, Hughes M, Arabi M, Shah GV. Imaging of cerebritis, encephalitis, and brain abscess. Neuroimaging Clin N Am. 2012;22:585–607.

    PubMed  Google Scholar 

  48. McGill FM, Heyderman RS, Panagiotou S, Tunkel AR, Solomon T. Acute bacterial encephalitis in adults. Lancet. 2016;388:3036–47.

    PubMed  Google Scholar 

  49. Dubey D, Pittock SJ, Kelly CR, McKeon A, Lopez-Chiriboga AS, Lennon VA, Gadoth A, Smith CY, Bryant SC, Klein CJ, Aksamit AJ, Toledano M, Boeve BF, Tillema JM, Flanagan EP. Autoimmune encephalitis: epidemiology and a comparison to infectious encephalitis. Ann Neurol. 2018;83:166–77.

    CAS  PubMed  PubMed Central  Google Scholar 

  50. Bulakbasi N, Kocaoglu M. Central nervous system infections of herpesvirus family. Neuroimaging Clin N Am. 2008;18:53–84.

    PubMed  Google Scholar 

  51. Swinburne NC, Bansal AG, Aggarwal A, Doshi AH. Neuroimaging in central nervous system infections. Curr Neurol Neurosci Rep. 2017;17:49.

    PubMed  Google Scholar 

  52. Tauber SC, Eiffert H, Brück W, Nau R. Septic encephalopathy and septic encephalitis. Expert Rev Anti Infect Ther. 2017;15:121–32.

    CAS  PubMed  Google Scholar 

  53. Tyler KL. Acute viral encephalitis. N Engl J Med. 2018;379:557–66.

    PubMed  Google Scholar 

  54. Gavito-Higuera J, Mullins CB, Ramos-Duran L, Olivas Chacon CI, Hakim N, Palacios E. Fungal infections of the central nervous system: a pictorial review. J Clin Imaging Sci. 2016;17:24.

    Google Scholar 

  55. Palacios E, Rojas R, Rodulfa J, González-Toledo E. Magnetic resonance imaging in fungal infections of the brain. Top Magn Reson Imaging. 2014;23:199–212.

    PubMed  Google Scholar 

  56. Starkey J, Moritani T, Kirby P. MRI of CNS fungal infections: review of aspergillosis to histoplasmosis and everything in between. Clin Neuroradiol. 2014;24:217–30.

    CAS  PubMed  Google Scholar 

  57. Vela-Duarte D, Nyberg E, Sillau S, Pate A, Castellanos P, Chastain DB, Franco-Paredes C, Henao-Martínez AF. Lacunar stroke in cryptococcal meningitis: clinical and radiographic features. J Stroke Cerebrovasc Dis. 2019;28:1767–72.

    PubMed  Google Scholar 

  58. Gärtner F, Forstenpointner J, Ertl-Wagner B, Hooshmand B, Riedel C, Jansen O. CT and MRI findings in cerebral aspergilloma. Rofo. 2018;190:967–70.

    PubMed  Google Scholar 

  59. Berkefeld J, Enzensberger W, Lanfermann H. MRI in human immunodeficiency virus-associated cerebral vasculitis. Neuroradiology. 2000;42:526–8.

    CAS  PubMed  Google Scholar 

  60. Küker W, Gaertner S, Nagele T, Dopfer C, Schoning M, Fiehler J, Rothwell PM, Herrlinger U. Vessel wall contrast enhancement: a diagnostic sign of cerebral vasculitis. Cerebrovasc Dis. 2008;26:23–9.

    PubMed  PubMed Central  Google Scholar 

  61. Gaa J, Weidauer S, Sitzer M, Lanfermann H, Zanella FE. Cerebral vasculitis due to Treponema pallidum infection: MRI and MRA findings. Eur Radiol. 2004;14:746–7.

    PubMed  Google Scholar 

  62. Schaller MA, Wicke F, Foerch C, Weidauer S. Central nervous system tuberculosis—etiology, clinical manifestations and Neuroradiological features. Clin Neuroradiol. 2019;29:3–18.

    PubMed  Google Scholar 

  63. Dalal PM. Observations on the involvement of cerebral vessels in tuberculous meningitis in adults. Adv Neurol. 1979;25:149–59.

    CAS  PubMed  Google Scholar 

  64. Wilkinson RJ, Rohlwink U, Misra UK, van Crevel R, Mai NTH, Dooley KE, Caws M, Figaji A, Savic R, Solomons R, Thwaites GE; Tuberculous Meningitis International Research Consortium. Tuberculous meningitis international research consortium. Tuberculous meningitis. Nat Rev Neurol. 2017;13:581–98.

    PubMed  Google Scholar 

  65. Gheuens S, Wüthrich C, Koralnik IJ. Progressive multifocal leukoencephalopathy: why grey and white matter. Annu Rev Pathol. 2013;8:189–215.

    CAS  PubMed  Google Scholar 

  66. Moll NM, Rietsch AM, Ransohoff AJ, Cossoy MB, Huang D, Eichler FS, Trapp BD, Ransohoff RM. Cortical demyelination in PML and MS—similarities and differences. Neurology. 2008;70:336–43.

    CAS  PubMed  Google Scholar 

  67. Weidauer S, Nichtweiß M, Hattingen E. Differential diagnosis of white matter lesions: non vascular causes—part II. Clin Neuroradiol. 2014;24:93–110.

    Google Scholar 

  68. Renard T, Daumas-Duport B, Auffray-Calvier E, Bourcier R, Desal H. Cytomegalovirus encephalitis: Undescribed diffusion-weighted imaging characteristics. Original aspects of cases extracted from a retrospective study, and from literature review. J Neuroradiol. 2016;43:371–7.

    PubMed  Google Scholar 

  69. Luthra G, Parihar A, Nath K, Jaiswal S, Prasad KN, Husain N, Husain M, Singh S, Behari S, Gupta RK. Comparative evaluation of fungal, tubercular, and Pyogenic brain abscesses with conventional and diffusion MR imaging and proton MR spectroscopy. AJNR Am J Neuroradiol. 2007;28:1332–8.

    CAS  PubMed  Google Scholar 

  70. Ramsey RG, Geremia GK. CNS complications of AIDS: CT and MR findings. AJR Am J Roentgenol. 1988;151:449–54.

    CAS  PubMed  Google Scholar 

  71. Ramsey RG, Gean AD. Neuroimaging of AIDS. I. Central nervous system toxoplasmosis. Neuroimaging Clin N Am. 1997;7:171–86.

    CAS  PubMed  Google Scholar 

  72. Kumar GG, Mahadevan A, Guruprasad AS, Kovoor JM, Satishchandra P, Nath A, Ranga U, Shankar SK. Eccentric target sign in cerebral toxoplasmosis: neuropathological correlate to the imaging feature. J Magn Reson Imaging. 2010;31:1469–72.

    PubMed  PubMed Central  Google Scholar 

  73. Mahadevan A, Ramalingaiah AH, Parthasarathy S, Nath A, Ranga U, Krishna SS. Neuropathological correlate of the “concentric target sign” in MRI of HIV-associated cerebral toxoplasmosis. J Magn Reson Imaging. 2013;38:488–95.

    PubMed  Google Scholar 

  74. Roche AD, Rowley D, Brett FM, Looby S. Concentric and eccentric target MRI signs in a case of HIV-associated cerebral Toxoplasmosis. Case Rep Neurol Med. 2018;2018:9876514.

    PubMed  PubMed Central  Google Scholar 

  75. Shah R, Bag AK, Chapman PR, Cure JK. Imaging manifestations of progressive multifocal leukoencephalopathy. Clin Radiol. 2010;65:431–9.

    CAS  PubMed  Google Scholar 

  76. Cortese I, Muranski P, Enose-Akahata Y, Ha SK, Smith B, Monaco M, Ryschkewitsch C, Major EO, Ohayon J, Schindler MK, Beck E, Reoma LB, Jacobson S, Reich DS, Nath A. Pembrolizumab treatment for progressive multifocal Leukoencephalopathy. N Engl J Med. 2019;380:1597–605.

    CAS  PubMed  Google Scholar 

  77. Muftuoglu M, Olson A, Marin D, Ahmed S, Mulanovich V, Tummala S, Chi TL, Ferrajoli A, Kaur I, Li L, Champlin R, Shpall EJ, Rezvani K. Allogeneic BK virus-specific T cells for progressive Multifocal Leukoencephalopathy. N Engl J Med. 2018;379:1443–51.

    CAS  PubMed  PubMed Central  Google Scholar 

  78. Bag AK, Curé JK, Chapman PR, Roberson GH, Shah R. JC virus infection of the brain. AJNR Am J Neuroradiol. 2010;31:1564–76.

    CAS  PubMed  Google Scholar 

  79. Sharma RR. Fungal infections of the nervous system: current perspective and controversies in management. Int J Surg. 2010;8:591–601.

    Google Scholar 

  80. Franco-Paredes C, Womack T, Bohlmeyer T, Sellers B, Hays A, Patel K, Lizarazo J, Lockhart SR, Siddiqui W, Marr KA. Management of Cryptococcus gattii meningoencephalitis. Lancet Infect Dis. 2015;15:348–55.

    PubMed  Google Scholar 

  81. Gaviani P, Schwartz RB, Hedley-Whyte ET, Ligon KL, Robicsek A, Schaefer P, Henson JW. Diffusion-weighted imaging of fungal cerebral infection. AJNR Am J Neuroradiol. 2005;26:1115–21.

    PubMed  Google Scholar 

  82. Sarkis RA, Mays M, Isada C, Ahmed M. MRI findings in cryptococcal meningitis of the non-HIV population. Neurologist. 2015;19:40–5.

    PubMed  Google Scholar 

  83. Marzolf G, Sabou M, Lannes B, Cotton F, Meyronet D, Galanaud D, Cottier JP, Grand S, Desal H, Kreutz J, Schenck M, Meyer N, Schneider F, Dietemann JL, Koob M, Herbrecht R, Kremer S. Magnetic resonance imaging of cerebral Aspergillosis: imaging and pathological correlations. PLoS One. 2016;11:e0152475.

    Article  CAS  Google Scholar 

  84. Seifried C, Weidauer S, Hinsch N, Bug R, Steinmetz H. Cerebral lymphomatoid granulomatosis. A case report. Nervenarzt. 2007;78:193–7.

    CAS  PubMed  Google Scholar 

  85. Haldorson IS, Espeland A, Larsson EM. Central nervous system Lymphoma: characteristic findings on traditional and advanced imaging. AJNR Am J Neuroradiol. 2011;32:984–92.

    Google Scholar 

  86. Rich A, McCordock H. The pathogenesis of tuberculous meningitis. Bull Johns Hopkins Hosp. 1933;52:5–37.

    Google Scholar 

  87. Bernaerts A, Vanhoenacker FM, Parizel PM, Van Goethem JW, Van Altena R, Laridon A, De Roeck J, Coeman V, De Schepper AM. Tuberculosis of the central nervous system: overview of neuroradiological findings. Eur Radiol. 2003;13:1876–90.

    CAS  PubMed  Google Scholar 

  88. Garcia-Monco JC. Tuberculosis. In: Biller J, Ferro J, editors. Handb Clin Neurol. Neurol Asp Syst Dis Part III. 3rd Series. Vol. 121. Amsterdam: Elsevier; 2014.

    Google Scholar 

  89. Ghosh RN, Vyas S, Singh P, Khandelwal N, Sankhyan N, Singhi P. Perfusion magnetic resonance imaging in differentiation of neurocysticercosis and tuberculoma. Neuroradiology. 2019;61:257–63.

    PubMed  Google Scholar 

  90. Gupta RK, Prakash M, Mishra AM, Husain M, Prasad KN, Husain N. Role of diffusion weighted imaging in differentiation of intracranial tuberculoma and tuberculous abscess from cysticercus granulomas—a report of more than 100 lesions. Eur J Radiol. 2005;55:384–92.

    PubMed  Google Scholar 

  91. Weidauer S, Wagner M, Nichtweiß M. Magnetic resonance imaging and clinical features in acute and subacute Myelopathies. Clin Neuroradiol. 2017;27:417–33.

    PubMed  Google Scholar 

  92. Wagner M, Klein JC. Meningeal disorders. In: Hattingen E, Weidauer S, Setzer M, Klein J, Vrionis K, editors. Diseases of the spinal cord—novel imaging, diagnosis and treatment. Heidelberg: Springer; 2015. pp. 271–99.

    Google Scholar 

  93. Grill MF. Infectious myelopathies. Continuum (Minneap Minn). 2018;24:441–73.

    PubMed  Google Scholar 

  94. Singh AK, Malhotra HS, Garg RK, Jain A, Kumar N, Kohli N, Verma R, Sharma PK. Paradoxical reaction in tuberculous meningitis: presentation, predictors and impact on prognosis. BMC Infect Dis. 2016;16:306.

    PubMed  PubMed Central  Google Scholar 

  95. Pepper DJ, Marais S, Maartens G, Rebe K, Morroni C, Rangaka MX, Oni T, Wilkinson RJ, Meintjes G. Neurologic manifestations of paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome: a case series. Clin Infect Dis. 2009;48:e96-107.

    PubMed  Google Scholar 

  96. Meintjes G, Stek C, Blumenthal L, Thienemann F, Schutz C, Buyze J, Ravinetto R, van Loen H, Nair A, Jackson A, Colebunders R, Maartens G, Wilkinson RJ, Lynen L; PredART Trial Team. Prednisone for the prevention of paradoxical tuberculosis-associated IRIS. N Engl J Med. 2018;379:1915–25.

    CAS  PubMed  Google Scholar 

  97. Heemskerk AD, Bang ND, Mai NT, Chau TT, Phu NH, Loc PP, Chau NV, Hien TT, Dung NH, Lan NT, Lan NH, Lan NN, Phong le T, Vien NN, Hien NQ, Yen NT, Ha DT, Day JN, Caws M, Merson L, Thinh TT, Wolbers M, Thwaites GE, Farrar JJ. Intensified Antituberculosis therapy in adults with tuberculous meningitis. N Engl J Med. 2016;374:124–34.

    CAS  PubMed  Google Scholar 

  98. Heemskerk AD, Bang ND, Thwaites GE. Therapy for tuberculous meningitis. N Engl J Med. 2016;374:2188–9.

    PubMed  Google Scholar 

  99. Kumar R, Pandey CK, Bose N, Sahay S. Tuberculous brain abscess: clinical presentation, pathophysiology and treatment (in children). Childs Nerv Syst. 2002;18:118–23.

    PubMed  Google Scholar 

  100. Mackert BM, Conradi J, Loddenkemper C, van Landeghem FK, Loddenkemper R, Ignatius R, Schneider T. Neurotuberculosis: a continuing clinical challenge. Nervenarzt. 2008;79:153–66.

    PubMed  Google Scholar 

  101. Thwaites GE, Tran TH. Tuberculous meningitis: many questions, too few answers. Lancet Neurol. 2005;4:160–70.

    PubMed  Google Scholar 

  102. Thwaites GE, van Toorn R, Schoeman J. Tuberculous meningitis: more questions, still too few answers. Lancet Neurol. 2013;12:999–1010.

    CAS  PubMed  Google Scholar 

  103. Nagappa M, Sinha S, Taly AB, Rao SL, Nagarathna S, Bindu PS, Bharath RD, Murthy P. Neurosyphilis: MRI features and their phenotypic correlation in a cohort of 35 patients from a tertiary care university hospital. Neuroradiology. 2013;55:379–88.

    CAS  PubMed  Google Scholar 

  104. Otto B, Hermans M, Seifried C, Buchkremer M, Lanfermann H, Sitzer M. Neurosyphilis. Important differential diagnosis of herpes simplex encephalitis. Nervenarzt. 2007;78:944–7.

    CAS  PubMed  Google Scholar 

  105. Modak J, Song X, Finelli P, Prasad A. Herpes simplex encephalitis in an immune compromised adult with novel MRI and pathology findings. Clin Neuroradiol. 2017;27:231–4.

    PubMed  Google Scholar 

  106. Meyding-Lamadé U, Strank C. Herpesvirus infections of the central nervous system in immunocompromised patients. Ther Adv Neurol Disord. 2012;5:279–96.

    PubMed  PubMed Central  Google Scholar 

  107. Hauer L, Pikija S, Schulte EC, Sztriha LK, Nardone R, Sellner J. Cerebrovascular manifestations of herpes simplex virus infection of the central nervous system: a systematic review. J Neuroinflammation. 2019;16:19.

    Article  PubMed  PubMed Central  Google Scholar 

  108. Kelley BP, Patel SC, Marin HL, Corrigan JJ, Mitsias PD, Griffith B. Autoimmune encephalitis: pathophysiology and imaging review of an overlooked diagnosis. AJNR Am J Neuroradiol. 2017;38:1070–8.

    CAS  PubMed  Google Scholar 

  109. Demaerel P, Van Dessel W, Van Paesschen W, Vandenberghe R, Van Laere K, Linn J. Autoimmune-mediated encephalitis. Neuroradiology. 2011;53:837–51.

    PubMed  Google Scholar 

  110. Graus F, Titulaer MJ, Balu R, Benseler S, Bien CG, Cellucci T, Cortese I, Dale RC, Gelfand JM, Geschwind M, Glaser CA, Honnorat J, Höftberger R, Iizuka T, Irani SR, Lancaster E, Leypoldt F, Prüss H, Rae-Grant A, Reindl M, Rosenfeld MR, Rostásy K, Saiz A, Venkatesan A, Vincent A, Wandinger KP, Waters P, Dalmau J. A clinical approach to diagnosis of autoimmune encephalitis. Lancet Neurol. 2016;15:391–404.

    PubMed  PubMed Central  Google Scholar 

  111. Provenzale JM, van Landingham K, White LE. Clinical and imaging findings suggesting human herpesvirus 6 encephalitis. Pediatr Neurol. 2010;42:32–9.

    PubMed  Google Scholar 

  112. Commins DL. Pathology of primary central nervous system lymphoma. Neurosurg Focus. 2006;2:E2.

    Google Scholar 

  113. Ferreri AJ, Cwynarski K, Pulczynski E, Ponzoni M, Deckert M, Politi LS, Torri V, Fox CP, Rosée PL, Schorb E, Ambrosetti A, Roth A, Hemmaway C, Ferrari A, Linton KM, Rudà R, Binder M, Pukrop T, Balzarotti M, Fabbri A, Johnson P, Gørløv JS, Hess G, Panse J, Pisani F, Tucci A, Stilgenbauer S, Hertenstein B, Keller U, Krause SW, Levis A, Schmoll HJ, Cavalli F, Finke J, Reni M, Zucca E, Illerhaus G; International Extranodal Lymphoma Study Group (IELSG). Chemoimmunotherapy with methotrexate, cytarabine, thiotepa, and rituximab (MATRix regimen) in patients with primary CNS lymphoma: results of the first randomisation of the International Extranodal Lymphoma Study Group-32 (IELSG32) phase 2 trial. Lancet Haematol. 2016;3:e217–27.

    PubMed  Google Scholar 

  114. Kitajima M, Korogi Y, Shigematsu Y, Liang L, Matsuoka M, Yamamoto T, Jhono M, Eto K, Takahashi M. Central nervous system lesions in adult T‑cell leukaemia: MRI and pathology. Neuroradiology. 2002;44:559–67.

    CAS  PubMed  Google Scholar 

  115. Xu H, Rewerska J, Aardsma N, Slavin K, Valyi-Nagy T, Ni H. EBV-positive post-transplant lymphoproliferative disorder presenting as primary diffuse large B‑cell lymphoma of the central nervous system. Folia Neuropathol. 2017;55:221–6.

    PubMed  Google Scholar 

  116. Ascenção BB, Gonçalves AC, Luís N, Sá J, Brito AP, Poças JM. Epstein-Barr virus hemorrhagic meningoencephalitis: case report and review of the literature. J Neurovirol. 2016;22:695–8.

    PubMed  Google Scholar 

  117. Kaulen LD, Galluzzo D, Hui P, Barbiero F, Karschnia P, Huttner A, Fulbright R, Baehring JM. Prognostic markers for immunodeficiency-associated primary central nervous system lymphoma. J Neurooncol. 2019;144:107–15.

    Article  PubMed  Google Scholar 

  118. Weber W, Henkes H, Felber S, Jänisch W, Woitalla D, Kühne D. Septic-embolic and septic metastatic brain abscess. Radiologe. 2000;40:1017–28.

    CAS  PubMed  Google Scholar 

  119. Moreillon P, Que YA. Infective endocarditis. Lancet. 2004;363:139–49.

    PubMed  Google Scholar 

  120. Li J, Shangguan J, Ren Q, Wang J. The imaging features of cerebral septic infarction in two patients with infective endocarditis. Neurol Sci. 2019;40:899–903.

    PubMed  Google Scholar 

  121. Brouwer MC, Coutinho JM, van de Beek D. Clinical characteristics and outcome of brain abscess: systematic review and meta-analysis. Neurology. 2014;82:806–13.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurology, Sankt Katharinen Hospital, Teaching Hospital, Goethe University, Seckbacher Landstraße 65, 60389, Frankfurt/Main, Germany

    Stefan Weidauer

  2. Institute of Neuroradiology, Goethe University, Frankfurt am Main, Germany

    Marlies Wagner & Elke Hattingen

  3. Department of Neuroradiology, University Bonn, Bonn, Germany

    Simon Jonas Enkirch

Authors
  1. Stefan Weidauer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marlies Wagner
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Simon Jonas Enkirch
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Elke Hattingen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Stefan Weidauer.

Ethics declarations

Conflict of interest

S. Weidauer, M. Wagner, S.J. Enkirch and E. Hattingen declare that they have no competing interests.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Weidauer, S., Wagner, M., Enkirch, S.J. et al. CNS Infections in Immunoincompetent Patients. Clin Neuroradiol 30, 9–25 (2020). https://doi.org/10.1007/s00062-019-00837-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00062-019-00837-6

Keywords

Search

Navigation