Advertisement

Infections in Immunocompromised Individuals

  • Majda M. Thurnher
Living reference work entry

Abstract

A patient is immunocompromised because of either an acquired or inherited immune deficiency disorder. The causes of inherited immunodeficiency are numerous, such as human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), solid organ transplant, bone marrow transplant (BMT), cancer, chemotherapy, lymphoma, glucocorticoid therapy, splenectomy, and trauma. Immunocompromised patients are at increased risk for life-threatening infectious complications that should be treated aggressively as early as possible. Clinical neuroradiology plays an important role in diagnosing and therapy monitoring of central nervous system (CNS) infections in immunocompromised individuals.

Infections can be viral, bacterial, fungal, or parasitic in origin and will depend on the severity of immunodeficiency, the cause of immunodeficiency, and also the period of the most intensive immunosuppression. This chapter will discuss the most common CNS infections in immunosuppressed patients and focus on radiological techniques used for their detection and differentiation.

Keywords

Human immunodeficiency virus (HIV) Acquired immunodeficiency syndrome (AIDS) Infection (viral, parasitic, fungal) Encephalitis Magnetic Resonance Imaging (MRI) 

References

  1. Berger JR, Aksamit AJ, Clifford DB, Davis L, Koralnik IJ, Sejvar JJ, et al. PML diagnostic criteria: consensus statement from the AAN neuroinfectious disease section. Neurology. 2013;80:1430–8.CrossRefPubMedPubMedCentralGoogle Scholar
  2. Dibble EH, Boxerman JL, Baird GL, Donahue JE, Rogg JM. Toxoplasmosis versus lymphoma: cerebral lesion characterization using DSC-MRI revisited. Clin Neurol Neurosurg. 2017;152:84–9.CrossRefPubMedGoogle Scholar
  3. Eggers E, Arendt G, Hahn K, et al. HIV-1-associated neurocognitive disorder: epidemiology, pathogenesis, diagnosis, and treatment. J Neurol. 2017;264(8):1715–27.CrossRefPubMedPubMedCentralGoogle Scholar
  4. Post MJ, Thurnher MM, Clifford DB, et al. CNS-immune reconstitution inflammatory syndrome in the setting of HIV infection, part 1: overview and discussion of progressive multifocal leukoencephalopathy-immune reconstitution inflammatory syndrome and cryptococcal-immune reconstitution inflammatory syndrome. AJNR Am J Neuroradiol. 2013a;34:1297–307.CrossRefPubMedGoogle Scholar
  5. Post MJ, Thurnher MM, Clifford DB, et al. CNS-immune reconstitution inflammatory syndrome in the setting of HIV infection, part 2: discussion of neuro-immune reconstitution inflammatory syndrome with and without other pathogens. AJNR Am J Neuroradiol. 2013b;34(7):1308–18.CrossRefPubMedGoogle Scholar

Further Readings/Websites

  1. Bowen LN, Smith B, Reich D, et al. HIV-associated opportunistic CNS infections: pathophysiology, diagnosis and treatment. Nat Rev Neurol. 2016;12:662–74.CrossRefPubMedGoogle Scholar
  2. Clifford DB. HIV-associated neurocognitive disorder. Curr Opin Infect Dis. 2017;30(1):117–22.PubMedPubMedCentralGoogle Scholar
  3. Deigendesch N, Costa Nunez J, Stenzel W. Parasitic and fungal infections. Handb Clin Neurol. 2017;145:245–62.CrossRefPubMedGoogle Scholar
  4. 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(5):275–91.CrossRefPubMedGoogle Scholar
  5. Martin-Iguacel R, Ahlström MG, Touma M, et al. Incidence, presentation and outcome of toxoplasmosis in HIV infected in the combination antiretroviral therapy era. J Infect. 2017;75(3):263–73.CrossRefPubMedGoogle Scholar
  6. Sainz-de-la-Maza S, Casado JL, Pérez-Elías MJ, et al. Incidence and prognosis of immune reconstitution inflammatory syndrome in HIV-associated progressive multifocal leukoencephalopathy. Eur J Neurol. 2016;23(5):919–25.CrossRefPubMedGoogle Scholar
  7. Schwartz S, Kontoyiannis DP, Harrison T, Ruhnke M. Advances in the diagnosis and treatment of fungal infections of the CNS. Lancet Neurol. 2018;17(4):362–72.CrossRefPubMedGoogle Scholar
  8. Scutari R, Alteri C, Perno CF, et al. The role of HIV infection in neurologic injury. Brain Sci. 2017;7(4):38.CrossRefPubMedCentralGoogle Scholar
  9. Williamson PR, Jarvis JN, Panackal AA, et al. Cryptococcal meningitis: epidemiology, immunology, diagnosis and therapy. Nat Rev Neurol. 2017;13(1):13–24.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Section of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-guided TherapyUniversity Hospital ViennaViennaAustria

Section editors and affiliations

  • Majda Thurnher
    • 1
  1. 1.Section of Neuroradiology and musculoskeletal RadiologyMedical University Vienna, University Hospital ViennaViennaAustria

Personalised recommendations