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Fungal brain abscess in transplant recipients: epidemiologic, microbiologic, and clinical features
John W Baddley1, Donna Salzman, Peter G Pappas
1Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, 35294-0006, USA. jbaddley@uab.edu
Abstract:
Fungal brain abscess is an unusual but serious complication associated with solid organ and hematopoietic stem cell transplantation. To examine the epidemiology and clinical features of fungal brain abscess in transplant recipients, we reviewed retrospectively all cases of fungal brain abscess diagnosed during a 3-yr period among 1,620 adult patients who underwent allogeneic or autologous stem cell, liver, heart, lung, or renal transplantation at one institution. Seventeen cases of fungal brain abscess were identified and occurred a median of 140 d post-transplantation. Fungal brain abscess was more common among allogeneic stem cell transplant recipients (p < 0.01). Aspergillus species were most commonly isolated, but unusual, opportunistic molds were also identified. Altered mental status was present in 65% of patients, and multiple brain lesions were commonly seen on imaging studies. Although fungal brain abscess is an uncommon disease in this population, outcome was poor, suggesting that early recognition of this disease might be helpful.
Insights
Fungal brain abscess is a rare but severe complication after transplantation. Early recognition is crucial as outcomes are poor in transplant recipients.
Area of Science:
- Infectious Diseases
- Transplantation Medicine
- Neurology
Background:
- Fungal brain abscess is a rare but serious complication in solid organ and hematopoietic stem cell transplant recipients.
- Transplant patients have a higher risk of opportunistic infections, including fungal brain abscesses.
Purpose of the Study:
- To investigate the epidemiology and clinical characteristics of fungal brain abscesses in transplant recipients.
- To identify risk factors and outcomes associated with fungal brain abscess in this vulnerable population.
Main Methods:
- Retrospective review of 1,620 adult patients undergoing various transplantations over a 3-year period.
- Analysis of 17 identified cases of fungal brain abscess, focusing on timing, causative agents, and clinical presentation.
Main Results:
- Fungal brain abscess occurred a median of 140 days post-transplantation, being more frequent in allogeneic stem cell recipients.
- Aspergillus species were the most common pathogens, alongside other opportunistic molds.
- Altered mental status (65%) and multiple brain lesions on imaging were common findings.
Conclusions:
- Fungal brain abscess, though uncommon, presents a significant challenge in transplant recipients.
- Poor outcomes underscore the need for early diagnosis and intervention strategies.
- Further research into timely recognition and treatment is warranted.