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Background Central nervous system (CNS) infections are severe and life-threatening complications that can occur in solid organ transplant (SOT) recipients. We describe the epidemiology, clinical presentation, diagnosis, disease course, and outcome of CNS infections in SOT. Methods We analyzed data of patients who underwent transplantation from September 2012 to February 2023, diagnosed and treated for CNS infections at our institution in Houston, TX. Data were retrospectively collected from medical charts. Results Of 1,345 patients who received a SOT, 30 (2.23%) were diagnosed with CNS infection, with a median age of 63 years, 60% were male. Time to CNS infection onset after transplant in 53.3% of the cases was after the first year. There were 15/30 (50%) cases of fungal infection, 8/30(26.7%) of viral infection, 7/30 (23.3%) of bacterial infection. There were no unknown causes. The most common etiologies were Cryptococcus neoformans 14/30(46.6%), and nocardiosis 3/30 (10%). On presentation, 22 (73.4%) patients had normal mental status, but 21 (70%) reported headaches, and 18 (60%) were febrile. Abnormal neuroimaging was found in 5 cases (16.6%) on computed tomography (CT)-scans and 10 cases (33.3%) on magnetic resonance imaging (MRI) scans. An adverse clinical outcome on discharge was noticed in 33%, and 6.7% died. Fever was associated with an increased risk of adverse clinical outcomes (OR 11; p=0.018). Conclusion The incidence of CNS infections in SOT recipients is low but associated with substantial adverse clinical outcomes. The most common causes are fungal, with no unknown etiologies seen in this study.
Background Central nervous system (CNS) infections are severe and life-threatening complications that can occur in solid organ transplant (SOT) recipients. We describe the epidemiology, clinical presentation, diagnosis, disease course, and outcome of CNS infections in SOT. Methods We analyzed data of patients who underwent transplantation from September 2012 to February 2023, diagnosed and treated for CNS infections at our institution in Houston, TX. Data were retrospectively collected from medical charts. Results Of 1,345 patients who received a SOT, 30 (2.23%) were diagnosed with CNS infection, with a median age of 63 years, 60% were male. Time to CNS infection onset after transplant in 53.3% of the cases was after the first year. There were 15/30 (50%) cases of fungal infection, 8/30(26.7%) of viral infection, 7/30 (23.3%) of bacterial infection. There were no unknown causes. The most common etiologies were Cryptococcus neoformans 14/30(46.6%), and nocardiosis 3/30 (10%). On presentation, 22 (73.4%) patients had normal mental status, but 21 (70%) reported headaches, and 18 (60%) were febrile. Abnormal neuroimaging was found in 5 cases (16.6%) on computed tomography (CT)-scans and 10 cases (33.3%) on magnetic resonance imaging (MRI) scans. An adverse clinical outcome on discharge was noticed in 33%, and 6.7% died. Fever was associated with an increased risk of adverse clinical outcomes (OR 11; p=0.018). Conclusion The incidence of CNS infections in SOT recipients is low but associated with substantial adverse clinical outcomes. The most common causes are fungal, with no unknown etiologies seen in this study.
Neurologic complications, both infectious and non-infectious, are frequent among hematopoietic cell transplant (HCT) and solid organ transplant (SOT) recipients. Up to 46% of HCT and 50% of SOT recipients experience a neurological complication, including cerebrovascular accidents, drug toxicities, as well as infections. Defects in innate, adaptive, and humoral immune function among transplant recipients predispose to opportunistic infections, including central nervous system (CNS) disease. CNS infections remain uncommon overall amongst HCT and SOT recipients, compromising approximately 1% of total cases among adult patients. Given the relatively lower number of pediatric transplant recipients, the incidence of CNS disease amongst in this population remains unknown. Although infections comprise a small percentage of the neurological complications that occur post-transplant, the associated morbidity and mortality in an immunosuppressed state makes it imperative to promptly evaluate and aggressively treat a pediatric transplant patient with suspicion for viral meningoencephalitis. This manuscript guides the reader through a broad infectious and non-infectious diagnostic differential in a transplant recipient presenting with altered mentation and fever and thereafter, elaborates on diagnostics and management of viral meningoencephalitis. Hypothetical SOT and HCT patient cases have also been constructed to illustrate the diagnostic and management process in select viral etiologies. Given the unique risk for various opportunistic viral infections resulting in CNS disease among transplant recipients, the manuscript will provide a contemporary review of the epidemiology, risk factors, diagnosis, and management of viral meningoencephalitis in these patients
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