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Central Nervous System (CNS) Infections After Hematopoietic Stem Cell or Solid Organ Transplantation

Chapter

Abstract

Central nervous system (CNS) complications are frequent after stem cell and solid organ transplantation, a significant proportion of them are due to infectious etiologies. The clinical manifestations vary in their spectrum and clinical course, being frequently nonspecific. Brain imaging helps to classify CNS infections into two main entities: those which present predominantly as focal lesions (brain abscesses) and those presenting usually as meningitis or meningoencephalitis. MRI is usually more informative than CT scan. The main pathogen causing brain abscess in transplant recipients are fungi, Aspergillus species being the most prevalent. Infections due to other fungi, as Scedosporium apiospermum, dematiaceous fungi, and zygomycetes have become increasingly common. The more rare etiologies include nocardiosis, toxoplasmosis, and posttransplantation lymphoproliferative disorder (PTLD). Meningoencephalitis in transplant patients may be caused by fungi (Cryptococcus neoformans), bacteria (Listeria monocytogenes), viruses (Herpesvirus 6, JC virus, herpes simplex, etc.), and parasites (Acanthamoeba). Diagnosis is challenging, as laboratory examination may be normal and biopsy is frequently not feasible. Prompt appropriate workup for patients with neurological findings, attempting to identify the infectious cause followed by treatment targeted to the specific pathogen is critical for survival and for minimizing the neurological sequelae.

Prevention of primary infection or reactivation of the possible causing pathogens should lead to decrease the occurrence of the diseases caused by them, including CNS manifestations.

Keywords

Central nervous system infection Brain abscess Meningoencephalitis Aspergillus spp Scedosporium apiospermum Phaeohyphomycosis/dematiaceous fungi Mucormycosis Nocardia Toxoplasma Posttransplantation lymphoproliferative disorder (PTLD) Cryptococcus neoformans Viral meningoencephalitis Human Herpesvirus 6 (HHV-6) JC virus West Nile Virus (WNV) Listeria Acanthamoeba 

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© Springer International Publishing Switzerland 2016

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Authors and Affiliations

  1. 1.Hadassah Hebrew University Medical Center, Pediatric Infectious Diseases Unit, Hadassah Ein KeremJerusalemIsrael

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