Download PDF
Semin Neurol 2004; 24(4): 435-452
DOI: 10.1055/s-2004-861538
Copyright © 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Central Nervous System Infections in Cancer Patients

Amy A. Pruitt1
  • 1Associate Professor of Neurology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Further Information

Publication History

Publication Date:
07 January 2005 (online)

    Permissions and Reprints

ABSTRACT

With improved therapies, patients with cancer survive longer. However, both the acute complications of intensive therapies and the risks of chronic immunosuppression have led to an increased incidence of central nervous system (CNS) infections. The presentation and course of common infections may be different from those in patients without cancer, and new syndromes related both to the underlying diseases and to their treatment have complicated the differential diagnosis. Noninfectious disorders such as drug treatment complications, vascular lesions, and radiation effects can mimic CNS infections. The major clinical presentations of CNS infections can be divided into meningoencephalitic syndromes and deficits due to focal mass lesions. The range of pathogens can be narrowed by considering the type of immune deficit present. The two groups of patients who most frequently develop CNS infections are those undergoing procedures for primary brain tumors and hematopoietic stem cell transplant recipients. Among several recently recognized syndromes in the latter are infections due to human herpesviruses 6 and 7, West Nile virus, and the immune reconstitution inflammatory syndrome.

KEYWORDS

Opportunistic infection - encephalitis - hematopoietic stem cell transplantation - meningitis - brain abscess

REFERENCES

  • 1 Pruitt A A. Nervous system infections in patients with cancer.  Neurol Clin. 2003;  21 193-219
    CrossrefPubMedGoogle Scholar
  • 2 Cunha B A. Central nervous system infections in the compromised host: a diagnostic approach.  Infect Dis Clin North Am. 2001;  15 567-590
    CrossrefPubMedGoogle Scholar
  • 3 Gilden D H, Kleinschmidt-DeMasters B K, Wellish M, Hedley-Whyte E T, Rentier B, Mahalingam R. Varicella zoster virus, a cause of waxing and waning vasculitis: the New England Journal of Medicine case 5-1995 revisited.  Neurology. 1996;  47 1441-1446
    PubMedGoogle Scholar
  • 4 Gilden D H, Lipton H, Wolf J et al.. Two patients with unusual forms of varicella-zoster virus vasculopathy.  N Engl J Med. 2002;  347 1500-1503
    CrossrefPubMedGoogle Scholar
  • 5 Guermazi A, Gluckman E, Tabti B, Miaux Y. Invasive central nervous system aspergillosis in bone marrow transplantation recipients: an overview.  Eur Radiol. 2003;  13 377-388
    PubMedGoogle Scholar
  • 6 Mylonakis E, Hohmann E L, Calderwood S B. Central nervous system infection with Listeria monocytogenes. 33 years' experience at a general hospital and review of 776 episodes from the literature.  Medicine (Baltimore). 1998;  77 313-336
    PubMedGoogle Scholar
  • 7 Bartt R. Listeria and atypical presentations of Listeria in the central nervous system.  Semin Neurol. 2000;  20 361-373
    Article in Thieme ConnectPubMedGoogle Scholar
  • 8 Singh N, Paterson D L. Encephalitis caused by human herpesvirus-6 in transplant recipients: relevance of a novel neurotropic virus.  Transplantation. 2000;  69 2474-2479
    PubMedGoogle Scholar
  • 9 Wainwright M S, Martin P L, Morse R P et al.. Human herpesvirus 6 limbic encephalitis after stem cell transplantation.  Ann Neurol. 2001;  50 612-619
    CrossrefPubMedGoogle Scholar
  • 10 Tsujimura H, Iseki T, Date Y et al.. Human herpesvirus-6 encephalitis after bone marrow transplantation: magnetic resonance imaging could identify the involved sites of encephalitis.  Eur J Haematol. 1998;  61 284-285
    PubMedGoogle Scholar
  • 11 MacLean H J, Douen A G. Severe amnesia associated with human herpesvirus 6 encephalitis after bone marrow transplantation.  Transplantation. 2002;  73 1086-1089
    PubMedGoogle Scholar
  • 12 Hagensee M E, Bauwens J E, Kjos B, Bowden R A. Brain abscess following marrow transplantation: experience at the Fred Hutchinson Cancer Research Center, 1984-1992.  Clin Infect Dis. 1994;  19 402-408
    CrossrefPubMedGoogle Scholar
  • 13 Kalita J, Bansal R, Ayagiri A, Misra U K. Midbrain infarction: a rare presentation of cryptococcal meningitis.  Clin Neurol Neurosurg. 1999;  101 23-25
    CrossrefPubMedGoogle Scholar
  • 14 Choucino C, Goodman S A, Greer J P, Stein R S, Wolff S N, Dummer J S. Nocardial infections in bone marrow transplant recipients.  Clin Infect Dis. 1996;  23 1012-1019
    CrossrefPubMedGoogle Scholar
  • 15 Elliott M A, Tefferi A, Marshall W F, Lacy M Q. Disseminated nocardiosis after allogeneic bone marrow transplantation.  Bone Marrow Transplant. 1997;  20 425-426
    CrossrefPubMedGoogle Scholar
  • 16 Mizock B A, Bartt R, Agbemazdo B. Herpes zoster oticus with pontine lesion: segmental brain-stem encephalitis.  Clin Infect Dis. 2000;  30 229-230
    CrossrefPubMedGoogle Scholar
  • 17 Mele A, Paterson P J, Prentice H G, Leoni P, Kibbler C C. Toxoplasmosis in bone marrow transplantation: a report of two cases and systematic review of the literature.  Bone Marrow Transplant. 2002;  29 691-698
    CrossrefPubMedGoogle Scholar
  • 18 Kastrup O, Maschke M, Diener H C, Wanke I. Progressive multifocal leukoencephalopathy limited to the brain stem.  Neuroradiology. 2002;  44 227-229
    CrossrefPubMedGoogle Scholar
  • 19 Snanoudj R, Durrbach A, Leblond V et al.. Primary brain lymphomas after kidney transplantation: presentation and outcome.  Transplantation. 2003;  76 930-937
    PubMedGoogle Scholar
  • 20 Shelburne III S A, Hamill R J. The immune reconstitution inflammatory syndrome.  AIDS Rev. 2003;  5 67-79
    PubMedGoogle Scholar
  • 21 Shelburne III S A, Hamill R J, Rodriguez-Barradas M C et al.. Immune reconstitution inflammatory syndrome: emergence of a unique syndrome during highly active antiretroviral therapy.  Medicine (Baltimore). 2002;  81 213-227
    CrossrefPubMedGoogle Scholar
  • 22 Stoll M, Schmidt R E. Immune restoration inflammatory syndromes: the dark side of successful antiretroviral treatment.  Curr Infect Dis Rep. 2003;  5 266-276
    CrossrefPubMedGoogle Scholar
  • 23 Powles T, Thirlwell C, Nelson M, Bower M. Immune reconstitution inflammatory syndrome mimicking relapse of AIDS related lymphoma in patients with HIV 1 infection.  Leuk Lymphoma. 2003;  44 1417-1419
    CrossrefPubMedGoogle Scholar
  • 24 Doherty M J, Watson N F, Uchino K, Hallam D K, Cramer S C. Diffusion abnormalities in patients with Wernicke encephalopathy.  Neurology. 2002;  58 655-657
    CrossrefPubMedGoogle Scholar
  • 25 Banerjee A K. Posterior leukoencephalopathy syndrome.  Postgrad Med J. 2001;  77 551
    CrossrefPubMedGoogle Scholar
  • 26 Higman M A, Port J D, Beauchamp Jr N J, Chen A R. Reversible leukoencephalopathy associated with re-infusion of DMSO preserved stem cells.  Bone Marrow Transplant. 2000;  26 797-800
    CrossrefPubMedGoogle Scholar
  • 27 Seok J I, Yi H, Song Y M, Lee W Y. Metronidazole-induced encephalopathy and inferior olivary hypertrophy: lesion analysis with diffusion-weighted imaging and apparent diffusion coefficient maps.  Arch Neurol. 2003;  60 1796-1800
    CrossrefPubMedGoogle Scholar
  • 28 Russell M, Nassif A, Cacayorin E, Awwad E, Perman W, Dunphy F. Gemcitabine-associated posterior reversible encephalopathy syndrome: MR imaging and MR spectroscopy findings.  Magn Reson Imaging. 2001;  19 129-132
    PubMedGoogle Scholar
  • 29 Sostak P, Padovan C S, Yousry T A, Ledderose G, Kolb H J, Straube A. Prospective evaluation of neurological complications after allogeneic bone marrow transplantation.  Neurology. 2003;  60 842-848
    PubMedGoogle Scholar
  • 30 Lawn N D, Westmoreland B F, Kiely M J, Lennon V A, Vernino S. Clinical, magnetic resonance imaging, and electroencephalographic findings in paraneoplastic limbic encephalitis.  Mayo Clin Proc. 2003;  78 1363-1368
    CrossrefPubMedGoogle Scholar
  • 31 Gultekin S H, Rosenfeld M R, Voltz R, Eichen J, Posner J B, Dalmau J. Paraneoplastic limbic encephalitis: neurological symptoms, immunological findings and tumour association in 50 patients.  Brain. 2000;  123 1481-1494
    CrossrefPubMedGoogle Scholar
  • 32 Thieben M, Lennon V, Boeve B, Aksamit A J, Keegan M, Vernino S. Potentially reversible autoimmune limbic encephalitis with neuronal potassium channel antibody.  Neurology. 2004;  62 1177-1182
    CrossrefPubMedGoogle Scholar
  • 33 Vincent A, Buckley C, Schott J M et al.. Potassium channel antibody-associated encephalopathy: a potentially immunotherapy-responsive form of limbic encephalitis.  Brain. 2004;  127 701-712
    CrossrefPubMedGoogle Scholar
  • 34 Socie G, Curtis R E, Deeg H J et al.. New malignant diseases after allogeneic marrow transplantation for childhood acute leukemia.  J Clin Oncol. 2000;  18 348-357
    PubMedGoogle Scholar
  • 35 Curtis R E, Rowlings P A, Deeg H J et al.. Solid cancers after bone marrow transplantation.  N Engl J Med. 1997;  336 897-904
    CrossrefPubMedGoogle Scholar
  • 36 Panigrahi S, Das M, Stagler D et al.. Development of secondary anaplastic oligoastrocytoma after matched unrelated bone marrow transplantation in a child with acute myeloid leukemia.  Acta Haematol. 2003;  109 196-198
    CrossrefPubMedGoogle Scholar
  • 37 Schiff D, O'Neill B, Wijdicks E F, Antin J H, Wen P Y. Gliomas arising in organ transplant recipients. An unrecognized complication of transplantation?.  Neurology. 2001;  57 1486-1488
    PubMedGoogle Scholar
  • 38 Filley C M, Kleinschmidt-DeMasters B K. Toxic leukoencephalopathy.  N Engl J Med. 2001;  345 425-432
    CrossrefPubMedGoogle Scholar
  • 39 Ma M, Barnes G, Pulliam J, Jezek D, Baumann R J, Berger J R. CNS angiitis in graft vs host disease.  Neurology. 2002;  59 1994-1997
    PubMedGoogle Scholar
  • 40 Provenzale J, Graham M. Reversible leukoencephalopathy associated with graft-versus-host disease: MR findings.  AJNR Am J Neuroradiol. 1996;  17 1290-1294
    PubMedGoogle Scholar
  • 41 Boque C, Petit J, Aguilera C, Vicente L, Granena A. Central and extrapontine myelinolysis following allogeneic peripheral haematopoietic progenitor cell transplantation. Favourable outcome in a patient with chronic myeloid leukaemia.  Bone Marrow Transplant. 2003;  31 61-64
    CrossrefPubMedGoogle Scholar
  • 42 Balmaceda C, Walker R W, Castaro-Malaspina H, Dalmau J. Reversal of amphotericin-B-related encephalopathy.  Neurology. 1994;  44 1183-1184
    PubMedGoogle Scholar
  • 43 Antonini G, Morino S, Fiorelli M, Fazi P, Ceschin V, Petti C. Reversal of encephalopathy during treatment with Amphotericin B.  J Neurol Sci. 1996;  144 212-213
    CrossrefPubMedGoogle Scholar
  • 44 Mott S, Packer R, Vezina L et al.. Encephalopathy with Parkinsonian features in children following bone marrow transplantations and high-dose Amphotericin B.  Ann Neurol. 1995;  37 810-814
    CrossrefPubMedGoogle Scholar
  • 45 Sirvent-Von Bueltzingsloewen A, Sirvent N, Morand P, Cassuto J P. Fatal central nervous system lesions emerging during anti-CD20 monoclonal antibody therapy (Rituximab) for a post transplantation Epstein Barr virus-linked lymphoma.  Med Pediatr Oncol. 2003;  40 408-409
    CrossrefPubMedGoogle Scholar
  • 46 Blindauer K A, Harrington G, Morris III G L, Ho K C. Fulminant progression of demyelinating disease after valproate-induced encephalopathy.  Neurology. 1998;  51 292-295
    PubMedGoogle Scholar
  • 47 Blohm M E, Nurnberger W, Aulich A, Engelbrecht V, Burdach S. Reversible brain MRI changes in acyclovir neurotoxicity.  Bone Marrow Transplant. 1997;  19 1049-1051
    CrossrefPubMedGoogle Scholar
  • 48 Maschke M, Kastrup O, Diener H C. CNS manifestations of cytomegalovirus infections: diagnosis and treatment.  CNS Drugs. 2002;  16 303-315
    CrossrefPubMedGoogle Scholar
  • 49 Moris G, Garcia-Monco J C. The challenge of drug-induced aseptic meningitis.  Arch Intern Med. 1999;  159 1185-1194
    CrossrefPubMedGoogle Scholar
  • 50 Nettis E, Calogiuri G, Colanardi M C, Ferrannini A, Tursi A. Drug-induced aseptic meningitis.  Curr Drug Targets Immune Endocr Metabol Disord. 2003;  3 143-149
    CrossrefPubMedGoogle Scholar
  • 51 Jolles S, Sewell W A, Leighton C. Drug-induced aseptic meningitis: diagnosis and management.  Drug Saf. 2000;  22 215-226
    CrossrefPubMedGoogle Scholar
  • 52 DeBiasi R L, Tyler K L. Polymerase chain reaction in the diagnosis and management of central nervous system infections.  Arch Neurol. 1999;  56 1215-1219
    CrossrefPubMedGoogle Scholar
  • 53 De Marcaida J A, Reik Jr L. Disorders that mimic central nervous system infections.  Neurol Clin. 1999;  17 901-941
    CrossrefPubMedGoogle Scholar
  • 54 DeBiasi R L, Kleinschmidt-DeMasters B K, Weinberg A, Tyler K L. Use of PCR for the diagnosis of herpesvirus infections of the central nervous system.  J Clin Virol. 2002;  25(Suppl 1) S5-11
    CrossrefPubMedGoogle Scholar
  • 55 Weinberg A, Li S, Palmer M, Tyler K L. Quantitative CSF PCR in Epstein-Barr virus infections of the central nervous system.  Ann Neurol. 2002;  52 543-548
    CrossrefPubMedGoogle Scholar
  • 56 Update: Investigations of West Nile virus infections in recipients of organ transplantation and blood transfusion: Michigan, 2002.  MMWR Morb Mortal Wkly Rep. 2002;  51 879
    PubMedGoogle Scholar
  • 57 West Nile virus infection in organ donor and transplant recipients: Georgia and Florida, 2002. MMWR Morb Mortal Wkly Rep 2002 51: 790
    Google Scholar
  • 58 Pealer L N, Marfin A A, Petersen L R et al.. Transmission of West Nile virus through blood transfusion in the United States in 2002.  N Engl J Med. 2003;  349 1236-1245
    CrossrefPubMedGoogle Scholar
  • 59 Wong S J, Boyle R H, Demarest V L et al.. Immunoassay targeting nonstructural protein 5 to differentiate West Nile virus infection from dengue and St. Louis encephalitis virus infections and from flavivirus vaccination.  J Clin Microbiol. 2003;  41 4217-4223
    CrossrefPubMedGoogle Scholar
  • 60 Olin J, Gugliotta J. Possible valacyclovir-related neurotoxicity and aseptic meningitis.  Ann Pharmacother. 2003;  37 1814-1817
    CrossrefPubMedGoogle Scholar
  • 61 Sekul E A, Cupler E J, Dalakas M C. Aseptic meningitis associated with high-dose intravenous immunoglobulin therapy: frequency and risk factors.  Ann Intern Med. 1994;  121 259-262
    CrossrefPubMedGoogle Scholar
  • 62 Creel G B, Hurtt M. Cephalosporin-induced recurrent aseptic meningitis.  Ann Neurol. 1995;  37 815-817
    CrossrefPubMedGoogle Scholar
  • 63 An S F, Groves M, Martinian L, Kuo L T, Scaravilli F. Detection of infectious agents in brain of patients with acute hemorrhagic leukoencephalitis.  J Neurovirol. 2002;  8 439-446
    PubMedGoogle Scholar
  • 64 Padovan C S, Bise K, Hahn J et al.. Angiitis of the central nervous system after allogeneic bone marrow transplantation?.  Stroke. 1999;  30 1651-1656
    CrossrefPubMedGoogle Scholar
  • 65 Quan D, Hackney D B, Pruitt A A, Lenkinski R E, Cecil K M. Transient MRI enhancement in a patient with seizures and previously resected glioma: use of MRS.  Neurology. 1999;  53 211-213
    CrossrefPubMedGoogle Scholar
  • 66 Guzman R, Barth A, Lovblad K O et al.. Use of diffusion-weighted magnetic resonance imaging in differentiating purulent brain processes from cystic brain tumors.  J Neurosurg. 2002;  97 1101-1107
    CrossrefPubMedGoogle Scholar
  • 67 Dorenbeck U, Butz B, Schlaier J, Bretschneider T, Schuierer G, Feuerbach S. Diffusion-weighted echo-planar MRI of the brain with calculated ADCs: a useful tool in the differential diagnosis of tumor necrosis from abscess?.  J Neuroimaging. 2003;  13 330-338
    CrossrefPubMedGoogle Scholar
  • 68 Camacho D L, Smith J K, Castillo M. Differentiation of toxoplasmosis and lymphoma in AIDS patients by using apparent diffusion coefficients.  AJNR Am J Neuroradiol. 2003;  24 633-637
    PubMedGoogle Scholar
  • 69 Nadal Desbarats L, Herlidou S, de Marco G et al.. Differential MRI diagnosis between brain abscesses and necrotic or cystic brain tumors using the apparent diffusion coefficient and normalized diffusion-weighted images.  Magn Reson Imaging. 2003;  21 645-650
    CrossrefPubMedGoogle Scholar
  • 70 Kessler L S, Ruiz A, Donovan Post M J, Ganz W I, Brandon A H, Foss J N. Thallium-201 brain SPECT of lymphoma in AIDS patients: pitfalls and technique optimization.  AJNR Am J Neuroradiol. 1998;  19 1105-1109
    PubMedGoogle Scholar
  • 71 Licho R, Litofsky N S, Senitko M, George M. Inaccuracy of Tl-201 brain SPECT in distinguishing cerebral infections from lymphoma in patients with AIDS.  Clin Nucl Med. 2002;  27 81-86
    CrossrefPubMedGoogle Scholar
  • 72 Gilden D H, Kleinschmidt-DeMasters B K, LaGuardia J, Mahalingam R, Cohrs R. Neurologic complications of the reactivation of varicella-zoster virus.  N Engl J Med. 2000;  342 635-645
    CrossrefPubMedGoogle Scholar
  • 73 Sommers L M, Hawkins D S. Meningitis in pediatric cancer patients: a review of forty cases from a single institution.  Pediatr Infect Dis J. 1999;  18 902-907
    CrossrefPubMedGoogle Scholar
  • 74 Cohen L F, Dunbar S A, Sirbasku D M, Clarridge III J E. Streptococcus bovis infection of the central nervous system: report of two cases and review.  Clin Infect Dis. 1997;  25 819-823
    PubMedGoogle Scholar
  • 75 Cabellos C, Viladrich P F, Corredoira J, Verdaguer R, Ariza J, Gudiol F. Streptococcal meningitis in adult patients: current epidemiology and clinical spectrum.  Clin Infect Dis. 1999;  28 1104-1108
    CrossrefPubMedGoogle Scholar
  • 76 Barazi S A, Gnanalingham K K, Chopra I, van Dellen J R. Delayed postoperative intracerebral abscess caused by Proprionibacterium acnes: case report and review of the literature.  Br J Neurosurg. 2003;  17 336-339
    CrossrefPubMedGoogle Scholar
  • 77 Lishner M, Perrin R G, Feld R et al.. Complications associated with Ommaya reservoirs in patients with cancer. The Princess Margaret Hospital experience and a review of the literature.  Arch Intern Med. 1990;  150 173-176
    CrossrefPubMedGoogle Scholar
  • 78 Schreffler R, Schreffler A, Wittler R. Treatment of cerebrospinal fluid shunt infections: a decision analysis.  Pediatr Infect Dis J. 2002;  21 632-636
    CrossrefPubMedGoogle Scholar
  • 79 Westphal M, Hilt D C, Bortey E et al.. A phase 3 trial of local chemotherapy with biodegradable carmustine (BCNU) wafers (Gliadel wafers) in patients with primary malignant glioma.  Neuro-oncol. 2003;  5 79-88
    PubMedGoogle Scholar
  • 80 McGovern P C, Lautenbach E, Brennan P J, Lustig R A, Fishman N O. Risk factors for postcraniotomy surgical site infection after 1,3-bis (2-chloroethyl)-1-nitrosourea (Gliadel) wafer placement.  Clin Infect Dis. 2003;  36 759-765
    CrossrefPubMedGoogle Scholar
  • 81 Schaller B, Baumann A. Headache after removal of vestibular schwannoma via the retrosigmoid approach: a long-term follow-up-study.  Otolaryngol Head Neck Surg. 2003;  128 387-395
    CrossrefPubMedGoogle Scholar
  • 82 Riel-Romero R M, Baumann R J. Herpes simplex encephalitis and radiotherapy.  Pediatr Neurol. 2003;  29 69-71
    CrossrefPubMedGoogle Scholar
  • 83 Klein N C, Go C H, Cunha B A. Infections associated with steroid use.  Infect Dis Clin North Am. 2001;  15 423-432
    CrossrefPubMedGoogle Scholar
  • 84 Bartlett J A, Hulette C. Central nervous system pneumocystosis in a patient with AIDS.  Clin Infect Dis. 1997;  25 82-85
    PubMedGoogle Scholar
  • 85 Tsukada Y, Nagayama H, Mori T et al.. Granulocyte transfusion as a treatment for enterococcal meningoencephalitis after allogeneic bone marrow transplantation from an unrelated donor.  Bone Marrow Transplant. 2003;  31 69-72
    CrossrefPubMedGoogle Scholar
  • 86 Centers for Disease Control and Prevention IDSoA . American Society of Blood and Marrow Transplantation. Guidelines for preventing opportunistic infections among hematopoietic stem cell transplant recipients.  MMWR Morb Mortal Wkly Rep. 2000;  49(RR-10) 1-125 CE 121-127
    PubMedGoogle Scholar
  • 87 Antonini G, Ceschin V, Morino S et al.. Early neurologic complications following allogeneic bone marrow transplant for leukemia: a prospective study.  Neurology. 1998;  50 1441-1445
    PubMedGoogle Scholar
  • 88 Maschke M, Dietrich U, Prumbaum M et al.. Opportunistic CNS infection after bone marrow transplantation.  Bone Marrow Transplant. 1999;  23 1167-1176
    CrossrefPubMedGoogle Scholar
  • 89 Krouwer H G, Wijdicks E F. Neurologic complications of bone marrow transplantation.  Neurol Clin. 2003;  21 319-352
    CrossrefPubMedGoogle Scholar
  • 90 Padovan C S, Yousry T A, Schleuning M, Holler E, Kolb H J, Straube A. Neurological and neuroradiological findings in long-term survivors of allogeneic bone marrow transplantation.  Ann Neurol. 1998;  43 627-633
    CrossrefPubMedGoogle Scholar
  • 91 Dockrell D H, Paya C V. Human herpesvirus-6 and -7 in transplantation.  Rev Med Virol. 2001;  11 23-36
    CrossrefPubMedGoogle Scholar
  • 92 Mendez J C, Dockrell D H, Espy M J et al.. Human beta-herpesvirus interactions in solid organ transplant recipients.  J Infect Dis. 2001;  183 179-184
    CrossrefPubMedGoogle Scholar
  • 93 Chan P K, Peiris J S, Yuen K Y et al.. Human herpesvirus-6 and human herpesvirus-7 infections in bone marrow transplant recipients.  J Med Virol. 1997;  53 295-305
    CrossrefPubMedGoogle Scholar
  • 94 Cree B C, Bernardini G L, Hays A P, Lowe G. A fatal case of coxsackievirus B4 meningoencephalitis.  Arch Neurol. 2003;  60 107-112
    CrossrefPubMedGoogle Scholar
  • 95 Link K, Orenstein R. Bacterial complications of strongyloidiasis: Streptococcus bovis meningitis.  South Med J. 1999;  92 728-731
    CrossrefPubMedGoogle Scholar
  • 96 Razonable R R, Rivero A, Rodriguez A et al.. Allograft rejection predicts the occurrence of late-onset cytomegalovirus (CMV) disease among CMV-mismatched solid organ transplant patients receiving prophylaxis with oral ganciclovir.  J Infect Dis. 2001;  184 1461-1464
    CrossrefPubMedGoogle Scholar
  • 97 Mookerjee B P, Vogelsang G. Human herpes virus-6 encephalitis after bone marrow transplantation: successful treatment with ganciclovir.  Bone Marrow Transplant. 1997;  20 905-906
    CrossrefPubMedGoogle Scholar
  • 98 Hashimoto K, Yasukawa M, Tohyama M. Human herpesvirus 6 and drug allergy.  Curr Opin Allergy Clin Immunol. 2003;  3 255-260
    PubMedGoogle Scholar
  • 99 Fujino Y, Nakajima M, Inoue H, Kusuhara T, Yamada T. Human herpesvirus 6 encephalitis associated with hypersensitivity syndrome.  Ann Neurol. 2002;  51 771-774
    CrossrefPubMedGoogle Scholar
  • 100 Yoshikawa T, Yoshida J, Hamaguchi M et al.. Human herpesvirus 7-associated meningitis and optic neuritis in a patient after allogeneic stem cell transplantation.  J Med Virol. 2003;  70 440-443
    CrossrefPubMedGoogle Scholar
  • 101 Ward K N, White R P, Mackinnon S, Hanna M. Human herpesvirus-7 infection of the CNS with acute myelitis in an adult bone marrow recipient.  Bone Marrow Transplant. 2002;  30 983-985
    CrossrefPubMedGoogle Scholar
  • 102 Gea-Banacloche J, Johnson R, Bagic A, Butman J, Murray P, Guillet Agrawal A. West Nile virus: pathogenesis and therapeutic options.  Ann Intern Med. 2004;  140 545-553
    PubMedGoogle Scholar
  • 103 Hamdan A, Green P, Mendelson E, Kramer M R, Pitlik S, Weingerber M. Possible benefit of intravenous immunoglobulin therapy in a lung transplant recipient with West Nile encephalitis.  Transpl Infect Dis. 2002;  4 160-162
    CrossrefPubMedGoogle Scholar
  • 104 Azuno Y, Yaga K, Kaneko T, Kaku K, Oka Y. Chronic graft-versus-host disease and seizure.  Blood. 1998;  91 2626-2628
    PubMedGoogle Scholar
  • 105 Solaro C, Murialdo A, Giunti D, Mancardi G, Uccelli A. Central and peripheral nervous system complications following allogeneic bone marrow transplantation.  Eur J Neurol. 2001;  8 77-80
    CrossrefPubMedGoogle Scholar
  • 106 Neill T A, Lineberry K, Nabors L B. Incidence of post-transplant lymphoproliferative disease isolated to the central nervous system in renal transplant patients.  Neurology. 2004;  62(Suppl 5) A479
    PubMedGoogle Scholar
  • 107 Behrens G M, Meyer D, Stoll M, Schmidt R E. Immune reconstitution syndromes in human immuno-deficiency virus infection following effective antiretroviral therapy.  Immunobiology. 2000;  202 186-193
    PubMedGoogle Scholar
  • 108 Buckanovich R J, Liu G, Stricker C et al.. Nonmyeloablative allogeneic stem cell transplantation for refractory Hodgkin's lymphoma complicated by interleukin-2 responsive progressive multifocal leukoencephalopathy.  Ann Hematol. 2002;  81 410-413
    CrossrefPubMedGoogle Scholar
  • 109 Jenny-Avital E R, Abadi M. Immune reconstitution cryptococcosis after initiation of successful highly active antiretroviral therapy.  Clin Infect Dis. 2002;  35 e128-e133
    CrossrefPubMedGoogle Scholar
  • 110 Du Pasquier R A, Koralnik I J. Inflammatory reaction in progressive multifocal leukoencephalopathy: harmful or beneficial?.  J Neurovirol. 2003;  9(Suppl 1) 25-31
    PubMedGoogle Scholar
  • 111 Hoffmann C, Horst H A, Albrecht H, Schlote W. Progressive multifocal leucoencephalopathy with unusual inflammatory response during antiretroviral treatment.  J Neurol Neurosurg Psychiatry. 2003;  74 1142-1144
    CrossrefPubMedGoogle Scholar
  • 112 Domingo P, Torres O H, Ris J, Vazquez G. Herpes zoster as an immune reconstitution disease after initiation of combination antiretroviral therapy in patients with human immunodeficiency virus type-1 infection.  Am J Med. 2001;  110 605-609
    CrossrefPubMedGoogle Scholar
  • 113 King M D, Perlino C A, Cinnamon J, Jernigan J A. Paradoxical recurrent meningitis following therapy of cryptococcal meningitis: an immune reconstitution syndrome after initiation of highly active antiretroviral therapy.  Int J STD AIDS. 2002;  13 724-726
    CrossrefPubMedGoogle Scholar
  • 114 Aboulafia D M, Taylor L. Vacuolar myelopathy and vacuolar cerebellar leukoencephalopathy: a late complication of AIDS after highly active antiretroviral therapy-induced immune reconstitution.  AIDS Patient Care STDS. 2002;  16 579-584
    CrossrefPubMedGoogle Scholar
  • 115 Makela P, Howe L, Glover S, Ferguson I, Pinto A, Gompels M. Recurrent Guillain-Barre syndrome as a complication of immune reconstitution in HIV.  J Infect. 2002;  44 47-49
    CrossrefPubMedGoogle Scholar
  • 116 Piliero P J, Fish D G, Preston S et al.. Guillain-Barre syndrome associated with immune reconstitution.  Clin Infect Dis. 2003;  36 e111-e114
    CrossrefPubMedGoogle Scholar
  • 117 Cinti S K, Armstrong W S, Kauffman C A. Case report. Recurrence of increased intracranial pressure with antiretroviral therapy in an AIDS patient with cryptococcal meningitis.  Mycoses. 2001;  44 497-501
    CrossrefPubMedGoogle Scholar
  • 118 Pintado V, Cabellos C, Moreno S, Meseguer M A, Ayats J, Viladrich P F. Enterococcal meningitis: a clinical study of 39 cases and review of the literature.  Medicine (Baltimore). 2003;  82 346-364
    CrossrefPubMedGoogle Scholar
  • 119 Durand M L, Calderwood S B, Weber D J et al.. Acute bacterial meningitis in adults. A review of 493 episodes.  N Engl J Med. 1993;  328 21-28
    CrossrefPubMedGoogle Scholar
  • 120 Cunha B A, Filozov A, Reme P. Listeria monocytogenes encephalitis mimicking West Nile encephalitis.  Heart Lung. 2004;  33 61-64
    CrossrefPubMedGoogle Scholar
  • 121 Whitney C G, Farley M M, Hadler J et al.. Increasing prevalence of multidrug-resistant Streptococcus pneumoniae in the United States.  N Engl J Med. 2000;  343 1917-1924
    CrossrefPubMedGoogle Scholar
  • 122 Hughes W, Armstrong D, Bodey G et al.. 2002 guidelines for the use of antimicrobial agents in neutropenic patients with cancer.  Clin Infect Dis. 2002;  34 730-751
    CrossrefPubMedGoogle Scholar
  • 123 Krasner A. Glucocorticoid-induced adrenal insufficiency.  JAMA. 1999;  282 671-676
    CrossrefPubMedGoogle Scholar
  • 124 Coursin D, Wood K. Corticosteroid supplementation for adrenal insufficiency.  JAMA. 2002;  287 236-240
    CrossrefPubMedGoogle Scholar
  • 125 van de Beek D, de Gans J, McIntyre P, Prasad K. Steroids in adults with acute bacterial meningitis: a systematic review.  Lancet Infect Dis. 2004;  4 139-143
    CrossrefPubMedGoogle Scholar
  • 126 de Gans J, van de Beek D. Dexamethasone in adults with bacterial meningitis.  N Engl J Med. 2002;  347 1549-1556
    CrossrefPubMedGoogle Scholar
  • 127 Chen S, Sorrell T, Nimmo G et al.. Epidemiology and host- and variety-dependent characteristics of infection due to Cryptococcus neoformans in Australia and New Zealand. Australasian Cryptococcal Study Group.  Clin Infect Dis. 2000;  31 499-508
    CrossrefPubMedGoogle Scholar
  • 128 Gottfredsson M, Perfect J R. Fungal meningitis.  Semin Neurol. 2000;  20 307-322
    Article in Thieme ConnectPubMedGoogle Scholar
  • 129 Schmutzhard E. Fungal infections. In: Noseworthy JH Neurological Therapeutics: Principles and Practice. Vol. 1. New York; Martin Dunitz 2003: 972-1002
    Google Scholar
  • 130 Rex J H, Larsen R A, Dismukes W E, Cloud G A, Bennett J E. Catastrophic visual loss due to Cryptococcus neoformans meningitis.  Medicine (Baltimore). 1993;  72 207-224
    PubMedGoogle Scholar
  • 131 Jantunen E, Volin L, Salonen O et al.. Central nervous system aspergillosis in allogeneic stem cell transplant recipients.  Bone Marrow Transplant. 2003;  31 191-196
    CrossrefPubMedGoogle Scholar
  • 132 DeLone D R, Goldstein R A, Petermann G et al.. Disseminated aspergillosis involving the brain: distribution and imaging characteristics.  AJNR Am J Neuroradiol. 1999;  20 1597-1604
    PubMedGoogle Scholar
  • 133 Gnann J, Whitley R. Herpes zoster.  N Engl J Med. 2002;  347 340-346
    CrossrefPubMedGoogle Scholar
  • 134 Fox R J, Galetta S L, Mahalingam R, Wellish M, Forghani B, Gilden D H. Acute, chronic, and recurrent varicella zoster virus neuropathy without zoster rash.  Neurology. 2001;  57 351-354
    PubMedGoogle Scholar
  • 135 de Silva S M, Mark A S, Gilden D H et al.. Zoster myelitis: improvement with antiviral therapy in two cases.  Neurology. 1996;  47 929-931
    PubMedGoogle Scholar
  • 136 Gilden D H, Beinlich B R, Rubinstien E M et al.. Varicella-zoster virus myelitis: an expanding spectrum.  Neurology. 1994;  44 1818-1823
    PubMedGoogle Scholar
  • 137 Weaver S, Rosenblum M K, DeAngelis L M. Herpes varicella zoster encephalitis in immunocompromised patients.  Neurology. 1999;  52 193-195
    PubMedGoogle Scholar
  • 138 Greenlee J E. Progressive multifocal leukoencephalopathy-progress made and lessons relearned.  N Engl J Med. 1998;  338 1378-1380
    CrossrefPubMedGoogle Scholar
  • 139 Re D, Bamborschke S, Feiden W et al.. Progressive multifocal leukoencephalopathy after autologous bone marrow transplantation and alpha-interferon immunotherapy.  Bone Marrow Transplant. 1999;  23 295-298
    CrossrefPubMedGoogle Scholar
  • 140 Thorner A R, Katz J T. Progressive multifocal leukoencephalopathy.  Curr Infect Dis Rep. 2001;  3 352-359
    PubMedGoogle Scholar
  • 141 Przepiorka D, Jaeckle K A, Birdwell R R et al.. Successful treatment of progressive multifocal leukoencephalopathy with low-dose interleukin-2.  Bone Marrow Transplant. 1997;  20 983-987
    CrossrefPubMedGoogle Scholar
  • 142 Dodd R Y. Emerging infections, transfusion safety, and epidemiology.  N Engl J Med. 2003;  349 1205-1206
    CrossrefPubMedGoogle Scholar

Amy A PruittM.D. 

Associate Professor of Neurology, University of Pennsylvania School of Medicine

3400 Spruce Street

Philadelphia, PA 10104

      >