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Published on: May 12, 2013
[Infections of the central nervous system in immunodeficiency]
1Neurologische Universitätsklinik Regensburg, medbo Bezirksklinikum, Universitätsstraße 84, 93042, Regensburg, Deutschland. klemens.angstwurm@medbo.de.
Insights
Immunosuppression from cancer, transplant, or immunology treatments can cause opportunistic central nervous system (CNS) infections. This review details common infections like VZV, Cryptococcus, and Toxoplasma, with diagnostic and treatment strategies.
Area of Science:
- Neurology
- Infectious Diseases
- Immunology
Background:
- Cancer treatments, transplantation, and immunology therapies often result in patient immunodeficiency.
- Immunodeficiency increases the risk of opportunistic infections, particularly affecting the central nervous system (CNS).
Purpose of the Study:
- To review the most significant opportunistic neurologic infections in immunocompromised patients.
- To outline clinical signs, symptoms, diagnostic approaches, and therapeutic options for these CNS infections.
Main Methods:
- Literature review focusing on opportunistic neurologic infections in immunocompromised patients.
- Synthesis of information on common pathogens, differential diagnoses, and treatment strategies.
Main Results:
- Common opportunistic CNS infections include those caused by varicella zoster virus (VZV), Cryptococcus neoformans, and Toxoplasma gondii.
- Less common causes of encephalitis include JC virus (JCV) and cytomegalovirus (CMV).
- Differential diagnoses are broad, encompassing non-opportunistic infections, neurotoxicity, CNS lymphoma, malignancy recurrence, and non-infectious conditions.
Conclusions:
- Effective management requires considering patient history, previous therapies, and neurologist involvement.
- Prompt diagnosis and appropriate treatment are crucial for managing opportunistic CNS infections in immunocompromised individuals.
Abstract:
Treatments in oncology, transplantation medicine and immunology frequently lead to immunodeficiency. This review presents the most important opportunistic neurologic infections, mostly of the central nervous system (CNS). Signs and symptoms, diagnostic procedures and therapeutic options are presented. The most frequent infections are due to varicella zoster virus (VZV), Cryptococcus neoformans and Toxoplasma gondii; JC virus (JCV) and cytomegalovirus (CMV) are rare causes of encephalitis. Differential diagnoses include infection by non-opportunistic causatives, therapy associated neurotoxicity, Epstein-Barr virus (EBV) associated CNS lymphoma, recurrence of the malignancy, as well as non-infectious diseases like intracranial bleeding, ischemic stroke, autoimmune diseases and posterior reversible leukencephalopathy syndrome. Treatment of these patients, moreover, needs to consider all previous therapies and to involve a neurologist.
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