Central Nervous System Infections in Heart Transplant Recipients

Abstract

Results: Central nervous system infections developed in 8 patients (3%), all of whom presented within the first 4 years after transplantation. The most common presentations were acute or subacute confusion or headache (88%), often without the classic symptoms of fever and neck stiffness. Direct cerebrospinal fluid examination was unrevealing in most cases, though cerebrospinal fluid protein levels were elevated in all patients with infections. Diagnoses included cryptococcal meningitis (n=3), progressive multifocal leukoencephalopathy (n=2), varicellazoster virus encephalitis (n=2), and Aspergillus fumigatus infection (n=1). Three of 8 patients died (38%) and 2 (25%) survived with mild sequelae. Central nervous system infection was a significant predictor of mortality (hazard ratio, 4.39; 95% confidence interval, 1.72-11.18; P=.002). Conclusions: Central nervous system infections are rare but devastating complications of heart transplantations. Recognition of these infections is difficult owing to a paucity of clinical manifestations. We report here, for the first time, varicella-zoster virus central nervous system infection in heart transplantations.

The clinical spectrum of neurologic disorders after intestinal and multivisceral transplantation

“…The incidence of CNS infections in our study was substantially higher when compared with similar series of patients with liver and heart transplants (7% vs. 3% and 1.2%), (9, 10). High immunosuppression requirements after intestinal transplantation are associated with frequent infections and with a heavy bacterial load in the intestinal lumen, rejection, and sepsis may be intimately related, as rejection may compromise normal intestinal barriers and lead to bacterial translocation (11, 12).…”

The clinical spectrum of neurologic disorders after intestinal and multivisceral transplantation

“…The incidence of CNS infections in our study was substantially higher when compared with similar series of patients with liver and heart transplants (7% vs. 3% and 1.2%), (9, 10). High immunosuppression requirements after intestinal transplantation are associated with frequent infections and with a heavy bacterial load in the intestinal lumen, rejection, and sepsis may be intimately related, as rejection may compromise normal intestinal barriers and lead to bacterial translocation (11, 12).…”

Incidence and clinical characteristics of ocular infections after heart transplantation: a retrospective cohort study

“…Ophthalmic zoster is a serious disease with substantial periorbital edema in the early phase of the disease and contraction scars in the late phase; it can lead to incomplete eyelid closure and corneal exposure (9). One patient had concomitant central nervous system involvement with VZV and has been described previously (10). Clinical suspicion of ophthalmologic zoster infection in heart transplant recipients should prompt immediate treatment with acyclovir.…”

Neuromuscular Diseases After Cardiac Transplantation

“…The survival, basic demographic features and overall rate of neurologic complications in this group as a whole has been reported previously. 9 Clinical follow-up at this institution was complete in 98% of patients (306 of 313; median 5.5 years; interquartile range [IQR] 2.2 to 9.9 years), with 4 patients lost to follow-up after 1 year, 1 after 2 years, 6 after 3 years and 1 after 5 years.…”

“…Presence of PNS complaints did not influence survival. 9 According to the categories of PNS-related complaints, the relative frequencies of complaints were as follows: large-fiber polyneuropathy, 33%; muscle disease, 26%; were performed in 24 of 40 patients with polyneuropathy (60%). Autonomic reflex screening was performed in 3 patients, all showing widespread autonomic failure.…”

The clinical spectrum of neurologic disorders after intestinal and multivisceral transplantation

“…The incidence of CNS infections in our study was substantially higher when compared with similar series of patients with liver and heart transplants (7% vs. 3% and 1.2%), (9, 10). High immunosuppression requirements after intestinal transplantation are associated with frequent infections and with a heavy bacterial load in the intestinal lumen, rejection, and sepsis may be intimately related, as rejection may compromise normal intestinal barriers and lead to bacterial translocation (11, 12).…”

Incidence and clinical characteristics of ocular infections after heart transplantation: a retrospective cohort study

“…Ophthalmic zoster is a serious disease with substantial periorbital edema in the early phase of the disease and contraction scars in the late phase; it can lead to incomplete eyelid closure and corneal exposure (9). One patient had concomitant central nervous system involvement with VZV and has been described previously (10). Clinical suspicion of ophthalmologic zoster infection in heart transplant recipients should prompt immediate treatment with acyclovir.…”

Neuromuscular Diseases After Cardiac Transplantation

“…The survival, basic demographic features and overall rate of neurologic complications in this group as a whole has been reported previously. 9 Clinical follow-up at this institution was complete in 98% of patients (306 of 313; median 5.5 years; interquartile range [IQR] 2.2 to 9.9 years), with 4 patients lost to follow-up after 1 year, 1 after 2 years, 6 after 3 years and 1 after 5 years.…”

“…Presence of PNS complaints did not influence survival. 9 According to the categories of PNS-related complaints, the relative frequencies of complaints were as follows: large-fiber polyneuropathy, 33%; muscle disease, 26%; were performed in 24 of 40 patients with polyneuropathy (60%). Autonomic reflex screening was performed in 3 patients, all showing widespread autonomic failure.…”

The clinical spectrum of neurologic disorders after intestinal and multivisceral transplantation

“…The incidence of CNS infections in our study was substantially higher when compared with similar series of patients with liver and heart transplants (7% vs. 3% and 1.2%), (9, 10). High immunosuppression requirements after intestinal transplantation are associated with frequent infections and with a heavy bacterial load in the intestinal lumen, rejection, and sepsis may be intimately related, as rejection may compromise normal intestinal barriers and lead to bacterial translocation (11, 12).…”

Incidence and clinical characteristics of ocular infections after heart transplantation: a retrospective cohort study

“…Ophthalmic zoster is a serious disease with substantial periorbital edema in the early phase of the disease and contraction scars in the late phase; it can lead to incomplete eyelid closure and corneal exposure (9). One patient had concomitant central nervous system involvement with VZV and has been described previously (10). Clinical suspicion of ophthalmologic zoster infection in heart transplant recipients should prompt immediate treatment with acyclovir.…”

Neuromuscular Diseases After Cardiac Transplantation

“…The survival, basic demographic features and overall rate of neurologic complications in this group as a whole has been reported previously. 9 Clinical follow-up at this institution was complete in 98% of patients (306 of 313; median 5.5 years; interquartile range [IQR] 2.2 to 9.9 years), with 4 patients lost to follow-up after 1 year, 1 after 2 years, 6 after 3 years and 1 after 5 years.…”

“…Presence of PNS complaints did not influence survival. 9 According to the categories of PNS-related complaints, the relative frequencies of complaints were as follows: large-fiber polyneuropathy, 33%; muscle disease, 26%; were performed in 24 of 40 patients with polyneuropathy (60%). Autonomic reflex screening was performed in 3 patients, all showing widespread autonomic failure.…”