Central nervous system disorders after hematopoietic stem cell transplantation: a prospective study of the Infectious Diseases Working Party of EBMT
Adult
Male
Adolescent
ISAVUCONAZOLE
DIAGNOSIS
Young Adult
03 medical and health sciences
Central Nervous System Infections
0302 clinical medicine
FUNGAL-INFECTIONS
NEUROLOGIC COMPLICATIONS
Humans
MARROW-TRANSPLANTATION
Prospective Studies
Child
Aged
ENCEPHALITIS
Hematopoietic Stem Cell Transplantation
Infant
Middle Aged
3. Good health
Cerebrovascular Disorders
Adolescent; Adult; Aged; Central Nervous System Infections; Cerebrovascular Disorders; Child; Child, Preschool; Female; Hematopoietic Stem Cell Transplantation; Humans; Infant; Male; Middle Aged; Prospective Studies; Young Adult
Child, Preschool
Female
DOI:
10.1007/s00415-019-09578-5
Publication Date:
2019-10-30T20:53:50Z
AUTHORS (25)
ABSTRACT
We performed a prospective study to evaluate the types and characteristics of central nervous system (CNS) disorders in patients after hematopoietic stem cell transplantation. The study included 163 episodes of CNS disorders of which 58 (36%) were infections. Proven or probable infections were documented in 34 patients and included fungi (n = 10, 29%), viruses (n = 12, 35%), Toxoplasma spp. (n = 9, 27%) and bacteria (n = 3, 9%). Non-infectious neurological disorders (n = 105, 64%) frequently encompassed metabolic/drug-induced abnormalities (n = 28, 27%) or cerebral vascular events (n = 22, 21%). Median onset times were later for infectious (day + 101) vs non-infectious neurological disorders (day + 50, p = 0.009). An unremarkable cranial CT scan was found in 33% of infection episodes. Absence of cerebrospinal fluid pleocytosis despite a normal or increased peripheral blood white blood cell count occurred in 26% of infections. Day-30 mortality rates were significantly higher for fungal (87%) vs non-fungal infections (40%, p < 0.001). Significantly higher mortality rates were also documented for cerebral vascular events than for other non-infectious disorders (86% vs 34%, p < 0.001). Our prospective study shows that diagnostic findings in CNS infections might differ between hematopoietic stem cell transplant recipients and immunocompetent hosts. Special awareness and timely initiation of adequate diagnostics are crucial to improve the prognosis of these patients.
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