Infections of the central nervous system in transplant recipients

Abstract

Central nervous system (CNS) infections, accounting for 4-29% of CNS lesions in transplant recipients, are a significant post-transplant complication. Focal CNS infectious lesions or brain abscesses have been documented in 0.36-1% of the transplant recipients. Mycelial fungi, particularly Aspergillus, are by far the most frequent etiologies of post-transplant brain abscesses. Bacteria, with the exception of Nocardia, are rarely associated with brain abscesses in transplant recipients. Time of onset and concurrent extraneural lesions have implications relevant towards invasive diagnostic procedures in transplant recipients with brain abscesses. Meningoencephalitis in transplant recipients is predominantly due to viruses, e.g., herpesviruses, and less frequently due to Listeria monocytogenes, Toxoplasma gondii, and Cryptococcus. Despite a wide, and at times perplexing array of opportunistic pathogens that can cause CNS infections, the temporal association of the infection with the time elapsed since transplantation, risk factors, clinical manifestations, and neuroimaging characteristics of the lesion can allow a reasoned and rational approach towards the recognition, diagnosis, and appropriate management of CNS infections in transplant recipients.

Bacterial meningitis in solid organ transplant recipients: a population‐based prospective study

“…Meningitis caused by E. coli and P. aeruginosa is usually described in patients with bacteremia and other foci of infection, consistent with our patients 12. Based on our findings, empiric treatment for transplant patients should be broad and include at least amoxicillin for Listeria coverage and an extended‐spectrum cephalosporin.…”

Neurological complications of solid organ transplantation

“…However, in recent years, there has been a reduction in cases of opportunistic infections after organ transplantation 3 . This is a consequence of effective prophylactic strategies against opportunistic pathogens and a more prudent management for immunosuppression 3 .…”

“…However, in recent years, there has been a reduction in cases of opportunistic infections after organ transplantation 3 . This is a consequence of effective prophylactic strategies against opportunistic pathogens and a more prudent management for immunosuppression 3 . Headache, low-grade fever and mental status impairment are the most common clinical symptoms caused by opportunistic infections in organ transplant recipients 4,5 .…”

“…Abscesses appear preferentially in the frontal and parietal lobes 3 , but the cerebellum and brainstem can also be affected ( Figure 4). Cerebral ischemia and hemorrhages may also appear due to vascular injuries from Aspergillus…”

Lung Diseases - Selected State of the Art Reviews

“…In the case of single-lung transplantation, Nocardia can infect both the native and the transplanted organ (Husain et al, 2002). Haematogenous spread has been reported in up to 50% of cases (Clark, 2009), so it is important to exclude Nocardia clinically and/or radiologically in other organs, especially in the CNS (Singh & Husain, 2000). Moreover, and especially when the patient has a central venous catheter, blood should be cultured to rule out Nocardia.…”