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Infections of the central nervous system in transplant recipients
1VA Medical Center and University of Pittsburgh, Thomas E. Starzl Transplantation Institute, Pittsburgh, Pennsylvania 15240, USA. nis5+@pitt.edu
Abstract:
Central nervous system (CNS) infections, accounting for 4-29% of CNS lesions in transplant recipients, are a significant post-transplant complication. Focal CNS infectious lesions or brain abscesses have been documented in 0.36-1% of the transplant recipients. Mycelial fungi, particularly Aspergillus, are by far the most frequent etiologies of post-transplant brain abscesses. Bacteria, with the exception of Nocardia, are rarely associated with brain abscesses in transplant recipients. Time of onset and concurrent extraneural lesions have implications relevant towards invasive diagnostic procedures in transplant recipients with brain abscesses. Meningoencephalitis in transplant recipients is predominantly due to viruses, e.g., herpesviruses, and less frequently due to Listeria monocytogenes, Toxoplasma gondii, and Cryptococcus. Despite a wide, and at times perplexing array of opportunistic pathogens that can cause CNS infections, the temporal association of the infection with the time elapsed since transplantation, risk factors, clinical manifestations, and neuroimaging characteristics of the lesion can allow a reasoned and rational approach towards the recognition, diagnosis, and appropriate management of CNS infections in transplant recipients.
Insights
Central nervous system (CNS) infections are common in transplant recipients. Fungi like Aspergillus cause most brain abscesses, while viruses are frequent in meningoencephalitis.
Area of Science:
- Neuroscience
- Infectious Diseases
- Transplantation Medicine
Background:
- Central nervous system (CNS) infections are a significant complication in transplant recipients, occurring in 4-29% of cases.
- Focal CNS infectious lesions, including brain abscesses, affect 0.36-1% of this population.
- Identifying causative pathogens and understanding disease patterns are crucial for patient outcomes.
Purpose of the Study:
- To review the epidemiology, etiology, and clinical presentation of CNS infections in transplant recipients.
- To highlight the diagnostic challenges and management strategies for these infections.
- To provide a framework for approaching CNS infections based on timing, risk factors, and clinical findings.
Main Methods:
- Literature review of studies on CNS infections in transplant recipients.
- Analysis of reported cases of brain abscesses and meningoencephalitis.
- Synthesis of information regarding pathogens, clinical manifestations, and diagnostic approaches.
Main Results:
- Mycelial fungi, especially Aspergillus, are the primary cause of brain abscesses in transplant recipients.
- Bacterial brain abscesses are rare, except for Nocardia infections.
- Viral infections, including herpesviruses, are the most common cause of meningoencephalitis, with Listeria, Toxoplasma, and Cryptococcus also implicated.
Conclusions:
- The timing of CNS infection post-transplantation, presence of extraneural lesions, and clinical presentation are key to diagnosis.
- A systematic approach considering risk factors, clinical signs, and neuroimaging aids in recognizing and managing CNS infections.
- Effective management relies on prompt diagnosis and targeted therapy against specific opportunistic pathogens.