Central Nervous System Infections Following Bone Marrow Transplantation: An Autopsy Report of 27 Cases

Abstract

The authors retrospectively assess the autopsy findings of central nervous system (CNS) infections in marrow transplant recipients. From July 1987 to June 1998, 845 patients at our institution were submitted to bone marrow transplantation (BMT). The CNS of 180 patients was studied through autopsy and these patients had their medical records reviewed. Twenty-seven (15%) patients presented brain parenchyma infection. Fungi were isolated in approximately 60% of the cases. Mean survival time was 153 days (0-1,264 days) and the majority of the patients died during the first 3 months after BMT (18 cases; 67%). Aspergillus sp. were the most prevalent fungi (approximately 30%), followed by Candida sp. infection (approximately 18%). There was one case of Fusarium sp. infection and two cases of unidentified fungus. All patients with fungal infections had documented involvement at widespread sites. Toxoplasma gondii encephalitis was demonstrated in 8 patents (approximately 30%). Bacterial abscesses were responsible for approximately 11% of the findings. Eleven (41%) of the 27 patients died secondary to cerebral causes. These results show that infectious compromise of the CNS following BMT is a highly fatal event, caused mainly by fungi and T. gondii. Furthermore, they provide a likely guide to the possible causes of brain abscesses following BMT.

Central nervous system aspergillosis in allogeneic stem cell transplant recipients

“…The present study yielded an incidence of 3% of CNS aspergillosis in a cohort of allogenic SCT recipients during a 12-year period. A similar incidence has recently been reported by de Medeiros et al 18 . Coley et al 15 observed an incidence of 1.2%.…”

“…15,16 Of other pathogens, Candida or other fungi, Toxoplasma gondii and also bacteria should be taken into consideration. 16,18,21,24 The treatment of invasive aspergillosis has proved disappointing in allogeneic SCT recipients. 5,6,25,26 Although the response rate in patients with pulmonary disease has been only 10-30%, the prognosis is even worse in patients with CNS involvement.…”

Maintaining high autopsy rates in a Canadian blood and marrow transplant program: preserving a diagnostic and research tool

“…Nevertheless, specialized clinical programs, such as hematopoietic stem cell transplantation (HSCT), are evolving rapidly and rely on strict quality control and feedback mechanisms to improve clinical outcomes. Moreover, autopsy series have been instructive in understanding patterns of graft-versushost disease (GVHD), 9 as well as infectious, 10 and toxic complications [11][12][13] of HSCT. Rates of post-mortem exams at bone marrow transplant centers, however, have not been specifically documented.…”

Intracranial hemorrhage following bone marrow transplantation: an autopsy study of 58 patients

“…[1][2][3][4][5] Few published studies have addressed the main findings in the CNS and these have found differences between the incidence of neurological and neuropathological complications following BMT. [3][4][5][6][7] Furthermore, few autopsy-based studies have been reported to date.…”

“…[3][4][5][6][7] Furthermore, few autopsy-based studies have been reported to date. 2,4 It is important to emphasize that autopsy studies seem to induce low levels of demographic bias so that observations based on autopsy series might contribute to clinical and etiopathogenic conclusions. 8,9 This report examines the autopsy findings in 58 patients who died after BMT and in whom intracranial hemorrhage was a contributory or main cause of death.…”