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Infections in Hematology pp 211–226Cite as

Central Nervous System Infections

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Abstract

Central nervous system (CNS) infections occur in up to 15 % of hematology patients, particularly after allogeneic stem cell transplantation (AlloSCT) or in conjunction with neutropenia. The most frequent causative organisms after AlloSCT are Aspergillus spp. and Toxoplasma gondii, which typically cause focal parenchymatous lesions like abscesses or strokes. Meningoencephalitis is less common in these patients and might be related to viruses (mainly human herpesvirus-6 (HHV-6)) but sometimes also to fungi (e.g., Candida spp., Cryptococcus neoformans) or bacteria (e.g., Staphylococcus aureus, coagulase-negative Staphylococcus spp.). Definitive diagnosis of CNS infections, though still often made only at autopsy, is crucial and relies mainly on neuroimaging, cerebrospinal fluid (CSF) analysis, and/or stereotactic biopsy of focal lesions. Empirical or preemptive anti-infective drug therapy should be prompted immediately after obtaining CSF and/or biopsy tissue and adjusted after identifying a causative agent and determining its in vitro susceptibility. CNS infections in hematology patients are still largely associated with a poor prognosis and a mortality rate of up to 90 %. However, particularly the introduction of new antifungal agents with improved pharmacological profiles has led to better outcomes in selected subgroups of patients such as those with CNS aspergillosis.

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Acknowledgment

The author would like to thank Dr. J. Weirowski for her editorial support.

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  1. Clinic for Hematology, Oncology and Tumorimmunology, Helios Clinic Berlin-Buch, Berlin, Germany

    Martin Schmidt-Hieber

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Correspondence to Martin Schmidt-Hieber .

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  1. Department of Hematology, Oncology and Palliative Care, Klinikum Ernst von Bergmann, Potsdam, Germany

    Georg Maschmeyer

  2. Department of Infectious Diseases, Infection Control and Employee Health, M.D. Anderson Cancer Center University of Texas, Houston, Texas, USA

    Kenneth V.I. Rolston

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Schmidt-Hieber, M. (2015). Central Nervous System Infections. In: Maschmeyer, G., Rolston, K. (eds) Infections in Hematology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-44000-1_13

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