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Central nervous system infections in immunocompromised patients
Romain Sonneville1, Eric Magalhaes, Geert Meyfroidt
1aAP-HP, Bichat Hospital, Department of Intensive Care Medicine and Infectious Diseases, Paris Diderot University bUMR1148, LVTS, Sorbonne Paris Cité, INSERM/Paris Diderot University, Paris, France cDepartment of Intensive Care Medicine, University Hospitals Leuven, KULeuven, Leuven, Belgium.
Current Opinion in Critical Care
|February 8, 2017
Summary
Central nervous system (CNS) infections are serious in immunocompromised patients. Early diagnosis and treatment are key to improving outcomes for these rare but severe conditions.
Area of Science:
- Neurology
- Infectious Diseases
- Critical Care Medicine
Background:
- Central nervous system (CNS) infections are increasingly recognized in immunocompromised individuals.
- These infections pose a significant risk, particularly when accompanied by intracranial hypertension, altered mental status, or seizures.
Purpose of the Study:
- To outline a practical diagnostic strategy for intensivists managing CNS infections in immunocompromised patients.
- To review prevalent CNS infections in this vulnerable population.
Main Methods:
- Clinical examination and serum blood tests.
- Brain imaging (e.g., MRI, CT).
- Lumbar puncture with cerebrospinal fluid (CSF) PCR for pathogen identification.
Main Results:
- Neurological symptoms in immunocompromised patients warrant suspicion of CNS infection.
- Common infections include cerebral toxoplasmosis (HIV-infected) and cryptococcal/tuberculous meningitis or aspergillosis (other immunocompromised).
- Multiple pathogens are found in up to 15% of cases.
Conclusions:
- CNS infections are rare but severe complications in immunocompromised patients.
- A systematic approach involving early diagnosis, targeted antimicrobial therapy, and ICU care is crucial.
- Aggressive management of intracranial pressure can improve patient outcomes.
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