Opportunistic CNS Viral Infections in Immunocompromised Patients

Immunocompromised patients face increased morbidity and mortality from central nervous system (CNS) opportunistic viral infections, with risk level driven by specific immune defects. While our diagnostic capacity expands, immunocompromised patients may present atypically or with mild symptoms, delaying or complicating diagnosis. Treatment options are often limited, although novel agents show promise. This review discusses why immunocompromised patients carry higher immunologic risk and how certain viral classes display neurotropism to invade the CNS. We outline the utility and limitations of current and emerging diagnostic strategies. We discuss specific opportunistic viral pathogens, denoting specific epidemiology or pathogenesis, clinical presentation, diagnostic findings, and treatment and prevention methods. While there still remain knowledge and treatment gaps, advancements in diagnostics and understanding of pathogens have begun to improve outcomes.