Update Opportunistic Infections of the Central Nervous System in Patients with Iatrogenic Immunosuppression

Abstract

Opportunistic infections of the central nervous system (CNS) with bacteria, parasites, fungi or viruses due to iatrogenic immunosuppression are of immense importance because of rising numbers of organ transplantations and immunomodulating treatments. Besides transplantation medicine, the most frequently involved medical subspecialties are dermatology (interferons, rituximab, fingolimod, among others), hematology/oncology (rituximab, among others), neurology (beta-interferon, glatiramer acetate, natalizumab, rituximab, teriflunomide, fingolimod, alemtuzumab, daclizumab, among others) and rheumatology (rituximab).In Europe, typical infections affecting the immunocompromised host are due to herpes viruses and, especially in immunomodulated patients, JC virus (JCV); frequently occurring fungi are Aspergillus fumigatus, Candida albicans and Cryptococcus neoformans. An important parasite is Toxoplasma gondii (TG). Typical bacterial infections of the immunocompromised patient are caused by Nocardia asteroides, Listeria monocytogenes and Mycobacterium tuberculosis.Modern diagnostic and therapeutic procedures will be described.

Diffuse Large B-Cell Epstein-Barr Virus–Positive Primary CNS Lymphoma in Non-AIDS Patients: High Diagnostic Accuracy of DSC Perfusion Metrics

“…[17][18][19][20][21]36 Also, due to the differing underlying physiopathologies of these conditions, strict monitoring of patients, and the improvement in imaging techniques, necrotic tumors have become the main radiologic differentials. 14,[37][38][39] In the authors' opinion, radiology literature regarding DLBC EBV-positive CNS lymphoma without AIDS is scarce, probably due to the constantly evolving epidemiologic scenario and the relative rarity of the disease, making it difficult to pool these patients accurately. 14,[16][17][18][19][20][21][33][34][35][37][38][39] However, DLBC EBV-positive CNS lymphoma without AIDS is a clear and specific clinical immunobiologic entity that is challenging to diagnose because of the uncommon signatures for the much more frequent PCNSL and its great similarity to glioblastoma and metastasis on conventional imaging.…”

“…14,[37][38][39] In the authors' opinion, radiology literature regarding DLBC EBV-positive CNS lymphoma without AIDS is scarce, probably due to the constantly evolving epidemiologic scenario and the relative rarity of the disease, making it difficult to pool these patients accurately. 14,[16][17][18][19][20][21][33][34][35][37][38][39] However, DLBC EBV-positive CNS lymphoma without AIDS is a clear and specific clinical immunobiologic entity that is challenging to diagnose because of the uncommon signatures for the much more frequent PCNSL and its great similarity to glioblastoma and metastasis on conventional imaging. 14,[37][38][39] Last, its identification before any surgical approach is crucial for optimal management because prompt biopsy without corticosteroids is the best choice, while surgical resection is not recommended.…”

“…14,[16][17][18][19][20][21][33][34][35][37][38][39] However, DLBC EBV-positive CNS lymphoma without AIDS is a clear and specific clinical immunobiologic entity that is challenging to diagnose because of the uncommon signatures for the much more frequent PCNSL and its great similarity to glioblastoma and metastasis on conventional imaging. 14,[37][38][39] Last, its identification before any surgical approach is crucial for optimal management because prompt biopsy without corticosteroids is the best choice, while surgical resection is not recommended. 1 In reference to the role of DSC-PWI, our literature search identified only 1 article that specifically assessed DSC-PWI of patients with DLBC EBV-positive CNS lymphoma without AIDS.…”