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Intracranial, Spinal, and Paraspinal Infections in the Transplant Recipient

  • Matthew W. McCarthyEmail author
  • Axel Rosengart
  • Thomas J. Walsh
Chapter

Abstract

Infections of the central nervous system (ICNS) contribute significantly to morbidity and mortality in patients receiving solid organ and stem cell transplants. The risk for ICNS is influenced by multiple factors, including the organ transplanted, type and degree of immunosuppression, post-transplant adverse events, as well as donor characteristics. These infections may be classified by anatomic location – intracranial, spinal, and paraspinal – as well as by time of onset. The early post-transplant period is generally defined as the first month after transplantation. Because the major effects of exogenous immunosuppression are not yet apparent, the causes of ICNS in this time period are those derived from either the donor or recipient and infectious complications of the transplant and hospitalization. In the period 1 to 6 months after transplantation, also known as the intermediate time period, the composition of the pathogens changes. Opportunistic infections prevail; however, there is geographic variation given the inter-institution variation in immunosuppressive and antimicrobial prophylaxis strategies. During the late time period, generally defined as more than 6 months after transplantation, most patients with good graft function receive stable and reduced levels of immunosuppression while continuing on some form of antimicrobial prophylaxis. The pathogens that cause CNS infection tend to more closely resemble the community-acquired pathogens responsible for these infections in immunocompetent hosts.

Keywords

CNS infection Meningitis Brain abscess Encephalitis Immunosuppressive drugs Geographic variation Post-transplant infection 

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Matthew W. McCarthy
    • 1
    Email author
  • Axel Rosengart
    • 2
  • Thomas J. Walsh
    • 3
    • 4
    • 5
    • 6
  1. 1.Weill Cornell Medicine, Department of General Internal MedicineNew YorkUSA
  2. 2.Cedars-Sinai Medical Center, Departments of Neurology, Neurosurgery and Biomedical SciencesLos AngelesUSA
  3. 3.Transplantation-Oncology Infectious Diseases Program, New York-Presbyterian/Weill Cornell Medical CenterNew YorkUSA
  4. 4.Department of PediatricsNew York-Presbyterian/Weill Cornell Medical CenterNew YorkUSA
  5. 5.Department of Microbiology and ImmunologyNew York-Presbyterian/Weill Cornell Medical CenterNew YorkUSA
  6. 6.Transplant Infectious Diseases Program, Division of Infectious DiseasesIcahn School of Medicine at Mount SinaiNew YorkUSA

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