Frequent Central Nervous System (CNS) Infections in the Immunosuppressed Patient

  • Rafael AraosEmail author
  • Grecia Aldana
Reference work entry


Infections of the central nervous system among immunocompromised patients are of major clinical relevance due to the high morbidity and mortality they convey.

The clinical approach to central nervous system (CNS) infections is based on keeping a low threshold of suspicion and recognizing the classic clinical syndromes together with the particularities that occur in immunocompromised patients: subacute onset, subtle and overlapped clinical presentation, and the presence of opportunistic agents in addition to traditional pathogens and sometimes the presence of more than one infectious agent.

The etiologic study should be oriented according to the clinical presentation syndrome and the underlying immunodepression model. Imaging studies should always be performed, and the cerebrospinal fluid should be analyzed. Finally, and particularly in the case of brain lesions with mass effect, early tissue collection should be considered.

The treatment has to be directed to agents related to the clinical syndrome and the underlying immune defect model identified. The timely initiation of empirical antimicrobials is warranted, and it should include broad-spectrum antimicrobials with adequate penetration to the central nervous system. Finally, the availability of adjunctive therapies to antimicrobials that may have additional utility in particular cases (e.g., corticoids in the case of pneumococcal meningitis) should be taken into account.


Infection Immunosuppression CNS Meningitis Encephalitis 


  1. 1.
    Armstrong R, Fung P. Brainstem encephalitis (Rhombencephalitis) due to Listeria monocytogenes: case report and review. Clin Infect Dis. 1993;16:689–702. Scholar
  2. 2.
    Balaguer Rosello A, Bataller L, Lorenzo L, et al. Infections of the central nervous system after unrelated donor umbilical cord blood transplantation or human leukocyte antigen–matched sibling transplantation. Biol Blood Marrow Transplant. 2017;23:134–9. Scholar
  3. 3.
    Cunha B. Central nervous system infections in the compromised host: a diagnostic approach. Infect Dis Clin N Am. 2001;15:567–90. Scholar
  4. 4.
    Denkinger C, Schumacher S, Boehme C, et al. Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis. Eur Respir J. 2014;44:435–46. Scholar
  5. 5.
    Hanajiri R, Kobayashi T, Yoshioka K, et al. Central nervous system infection following allogeneic hematopoietic stem cell transplantation. Hematol Oncol Stem Cell Ther. 2017;10:22–8. Scholar
  6. 6.
    Pappas P, Chetchotisakd P, Larsen R, et al. A phase II randomized trial of amphotericin B alone or combined with fluconazole in the treatment of HIV-associated cryptococcal meningitis. Clin Infect Dis. 2009;48:1775–83. Scholar
  7. 7.
    Patterson T, Thompson G, Denning D, et al. Executive summary: practice guidelines for the diagnosis and management of aspergillosis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis. 2016;63:433–42. Scholar
  8. 8.
    Schmidt-Hieber M, Silling G, Schalk E, et al. 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. Scholar
  9. 9.
    Schwartz S, Kontoyiannis D, Harrison T, Ruhnke M. Advances in the diagnosis and treatment of fungal infections of the CNS. Lancet Neurol. 2018;17:362–72. Scholar
  10. 10.
    Sonneville R, Magalhaes E, Meyfroidt G. Central nervous system infections in immunocompromised patients. Curr Opin Crit Care. 2017;23:128–33. Scholar
  11. 11.
    Tanner D, Weinstein M, Fedorciw B, et al. Comparison of commercial kits for detection of cryptococcal antigen. J Clin Microbiol. 1994;32:1680–4.PubMedPubMedCentralGoogle Scholar
  12. 12.
    Tunkel A, Hartman B, Kaplan S, et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis. 2004;39:1267–84. Scholar
  13. 13.
    van Veen K, Brouwer M, van der Ende A, van de Beek D. Bacterial meningitis in hematopoietic stem cell transplant recipients: a population-based prospective study. Bone Marrow Transplant. 2016;51:1490–5. Scholar
  14. 14.
    Wheat J, Myint T, Guo Y, et al. Central nervous system histoplasmosis: multicenter retrospective study on clinical features, diagnostic approach and outcome of treatment. Medicine. 2018;97:e0245. Scholar
  15. 15.
    Wu M, Huang F, Jiang X, et al. Herpesvirus-associated central nervous system diseases after allogeneic hematopoietic stem cell transplantation. PLoS One. 2013;8:e77805. Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Genomics and Resistant Microbes (GeRM) LabFacultad de Medicina Clínica Alemana Universidad del Desarrollo,Millennium Nucleus for Collaborative Research on Bacterial Resistance (MICROB-R)SantiagoChile
  2. 2.Department of Pulmonary MedicineThe University of Texas MD Anderson Cancer CenterHoustonUSA

Section editors and affiliations

  • Yenny Cardenas
    • 1
  1. 1.Critical Care DepartmentUniversidad del Rosario Hospital Universitario Fundacion Santa Fe deBogotaColombia

Personalised recommendations