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Central Nervous System Infections in Neutropenic Cancer Patients

  • Shylah M. Moore-Pardo
  • Olga Klinkova
Chapter

Abstract

Neutropenic cancer patients are more susceptible to central nervous system (CNS) infections due to impaired host defense mechanisms (Zunt, Neurol Clin 20(1):1–22, 2002). Clinical diagnosis can be challenging due to subtle or atypical presentation or symptoms (Zunt, Neurol Clin 20:1–22, 2002; Lukes et al. Neurology 34(3):269–275, 1984; Schmidt-Hieber et al. Ann Oncol 27(7):1207–1225, 2016). CNS infections typically manifest as four clinical syndromes that may overlap. These are meningitis, encephalitis, brain abscess, and post-surgical neurological infections (Schmidt-Hieber et al. Ann Oncol 27(7):1207–1225, 2016).

Risk factors for CNS infections in this patient population depend on age, type of malignancy, duration of neutropenia, treatment used (type of a transplant, chemotherapy, steroids, immunosuppressant agents, neurosurgical interventions), and environmental exposures.

Keywords

Central nervous infections Bacterial meningitis Viral meningitis Non infectious meningitis Enterovirus meningitis HSV encephalitis VZV meningitis HHV6 encephalitis JC progressive leukoencephalopathy (PML) Candida meningitis Rhomboencephalitis Brain abscess 

References

  1. 1.
    Zunt JR. Central nervous system infection during immunosuppression. Neurol Clin. 2002;20(1):1–22.PubMedPubMedCentralCrossRefGoogle Scholar
  2. 2.
    Lukes SA, Posner JB, Nielsen S, Armstrong D. Bacterial infections of the CNS in neutropenic patients. Neurology. 1984;34(3):269–75.PubMedCrossRefGoogle Scholar
  3. 3.
    Schmidt-Hieber M, Silling G, Schalk E, Heinz W, Panse J, Penack O, et al. CNS infections in patients with hematological disorders (including allogeneic stem-cell transplantation)-Guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO). Ann Oncol. 2016;27(7):1207–25.PubMedPubMedCentralCrossRefGoogle Scholar
  4. 4.
    Safdieh JE, Mead PA, Sepkowitz KA, Kiehn TE, Abrey LE. Bacterial and fungal meningitis in patients with cancer. Neurology. 2008;70(12):943–7.PubMedCrossRefGoogle Scholar
  5. 5.
    Sommers LM, Hawkins DS. Meningitis in pediatric cancer patients: a review of forty cases from a single institution. Pediatr Infect Dis J. 1999;18(10):902–7.PubMedCrossRefGoogle Scholar
  6. 6.
    Pomar V, Benito N, Lopez-Contreras J, Coll P, Gurgui M, Domingo P. Characteristics and outcome of spontaneous bacterial meningitis in patients with cancer compared to patients without cancer. Medicine (Baltimore). 2017;96(19):e6899.CrossRefGoogle Scholar
  7. 7.
    Gruson D, Hilbert G, Pigneux A, Vargas F, Guisset O, Texier J, et al. Severe infection caused by Stomatococcus mucilaginosus in a neutropenic patient: case report and review of the literature. Hematol Cell Ther. 1998;40(4):167–9.PubMedGoogle Scholar
  8. 8.
    McWhinney PH, Kibbler CC, Gillespie SH, Patel S, Morrison D, Hoffbrand AV, et al. Stomatococcus mucilaginosus: an emerging pathogen in neutropenic patients. Clin Infect Dis. 1992;14(3):641–6.PubMedCrossRefGoogle Scholar
  9. 9.
    Hoffmann S, Ersgaard H, Justesen T, Friis H. Fatal meningitis with group JK Corynebacterium in a leukopenic patient. Eur J Clin Microbiol. 1983;2(3):213–5.PubMedCrossRefGoogle Scholar
  10. 10.
    Costerus JM, Brouwer MC, van der Ende A, van de Beek D. Community-acquired bacterial meningitis in adults with cancer or a history of cancer. Neurology. 2016;86(9):860–6.PubMedCrossRefGoogle Scholar
  11. 11.
    Laguna-Del Estal P, Lledo-Ibanez GM, Rios-Garces R, Pintos-Pascual I. Meningitis due to Listeria monocytogenes in adults. Rev Neurol. 2013;56(1):13–8.PubMedGoogle Scholar
  12. 12.
    Lee BE, Davies HD. Aseptic meningitis. Curr Opin Infect Dis. 2007;20(3):272–7.PubMedCrossRefGoogle Scholar
  13. 13.
    Graber JJ, Rosenblum MK, DeAngelis LM. Herpes simplex encephalitis in patients with cancer. J Neuro-Oncol. 2011;105(2):415–21.CrossRefGoogle Scholar
  14. 14.
    Saito M, Kiyozaki H, Obitsu T, Imoto H, Taniyama Y, Takata O, et al. Herpes simplex virus-1 encephalitis induced by chemoradiotherapy and steroids in an esophageal cancer patient: a case report. BMC Cancer. 2016;16:233.PubMedPubMedCentralCrossRefGoogle Scholar
  15. 15.
    Kleinschmidt-DeMasters BK, Gilden DH. Varicella-Zoster virus infections of the nervous system: clinical and pathologic correlates. Arch Pathol Lab Med. 2001;125(6):770–80.PubMedGoogle Scholar
  16. 16.
    Rafailidis PI, Mourtzoukou EG, Varbobitis IC, Falagas ME. Severe cytomegalovirus infection in apparently immunocompetent patients: a systematic review. Virol J. 2008;5:47.PubMedPubMedCentralCrossRefGoogle Scholar
  17. 17.
    Ongradi J, Ablashi DV, Yoshikawa T, Stercz B, Ogata M. Roseolovirus-associated encephalitis in immunocompetent and immunocompromised individuals. J Neurovirol. 2017;23(1):1–19.PubMedCrossRefGoogle Scholar
  18. 18.
    Frey JW, Cherabie JN, Assi MA. Human herpesvirus-6 encephalitis following chemotherapy induction for acute myelogenous leukemia. Transpl Infect Dis. 2017;19(6):e12756.CrossRefGoogle Scholar
  19. 19.
    Garcia-Suarez J, de Miguel D, Krsnik I, Banas H, Arribas I, Burgaleta C. Changes in the natural history of progressive multifocal leukoencephalopathy in HIV-negative lymphoproliferative disorders: impact of novel therapies. Am J Hematol. 2005;80(4):271–81.PubMedCrossRefGoogle Scholar
  20. 20.
    Pelosini M, Focosi D, Rita F, Galimberti S, Caracciolo F, Benedetti E, et al. Progressive multifocal leukoencephalopathy: report of three cases in HIV-negative hematological patients and review of literature. Ann Hematol. 2008;87(5):405–12.PubMedCrossRefGoogle Scholar
  21. 21.
    Yokoyama H, Watanabe T, Maruyama D, Kim SW, Kobayashi Y, Tobinai K. Progressive multifocal leukoencephalopathy in a patient with B-cell lymphoma during rituximab-containing chemotherapy: case report and review of the literature. Int J Hematol. 2008;88(4):443–7.PubMedCrossRefGoogle Scholar
  22. 22.
    McCullers JA, Vargas SL, Flynn PM, Razzouk BI, Shenep JL. Candidal meningitis in children with cancer. Clin Infect Dis. 2000;31(2):451–7.PubMedCrossRefGoogle Scholar
  23. 23.
    Antinori S, Corbellino M, Meroni L, Resta F, Sollima S, Tonolini M, et al. Aspergillus meningitis: a rare clinical manifestation of central nervous system aspergillosis. Case report and review of 92 cases. J Infect. 2013;66(3):218–38.PubMedCrossRefGoogle Scholar
  24. 24.
    Schmalzle SA, Buchwald UK, Gilliam BL, Riedel DJ. Cryptococcus neoformans infection in malignancy. Mycoses. 2016;59(9):542–52.PubMedCrossRefGoogle Scholar
  25. 25.
    Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM, et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis. 2004;39(9):1267–84.PubMedCrossRefGoogle Scholar
  26. 26.
    Dougan C, Ormerod I. A neurologist’s approach to the immunosuppressed patient. J Neurol Neurosurg Psychiatry. 2004;75(Suppl 1):i43–9.PubMedPubMedCentralCrossRefGoogle Scholar
  27. 27.
    Liesman RM, Strasburg AP, Heitman AK, Theel ES, Patel R, Binnicker MJ. Evaluation of a commercial multiplex molecular panel for diagnosis of infectious meningitis and encephalitis. J Clin Microbiol. 2018;56(4):e01927–17.PubMedPubMedCentralCrossRefGoogle Scholar
  28. 28.
    Leber AL, Everhart K, Balada-Llasat JM, Cullison J, Daly J, Holt S, et al. Multicenter evaluation of BioFire FilmArray Meningitis/Encephalitis panel for detection of bacteria, viruses, and yeast in cerebrospinal fluid specimens. J Clin Microbiol. 2016;54(9):2251–61.PubMedPubMedCentralCrossRefGoogle Scholar
  29. 29.
    Bodilsen J, Dalager-Pedersen M, Schonheyder HC, Nielsen H. Time to antibiotic therapy and outcome in bacterial meningitis: a Danish population-based cohort study. BMC Infect Dis. 2016;16:392.PubMedPubMedCentralCrossRefGoogle Scholar
  30. 30.
    Miner JR, Heegaard W, Mapes A, Biros M. Presentation, time to antibiotics, and mortality of patients with bacterial meningitis at an urban county medical center. J Emerg Med. 2001;21(4):387–92.PubMedCrossRefGoogle Scholar
  31. 31.
    Tunkel AR, Hasbun R, Bhimraj A, Byers K, Kaplan SL, Michael Scheld W, et al. 2017 Infectious Diseases Society of America’s clinical practice guidelines for healthcare-associated Ventriculitis and meningitis. Clin Infect Dis. 2017;64:701–6 (15 March).CrossRefGoogle Scholar
  32. 32.
    Givens P, Velez A, Sandin L, Quilitz R, Greene J. Development of enteroviral aseptic meningitis after rituximab treatment of non-hodgkin lymphoma. Infect Dis Clin Pract. 2012;20:291–3.CrossRefGoogle Scholar
  33. 33.
    Brouwer MC, Tunkel AR, McKhann GM 2nd, van de Beek D. Brain abscess. N Engl J Med. 2014;371(5):447–56.PubMedCrossRefGoogle Scholar
  34. 34.
    Economides MP, Ballester LY, Kumar VA, Jiang Y, Tarrand J, Prieto V, et al. Invasive mold infections of the central nervous system in patients with hematologic cancer or stem cell transplantation (2000–2016): uncommon, with improved survival but still deadly often. J Infect. 2017;75(6):572–80.PubMedCrossRefGoogle Scholar
  35. 35.
    Brook I. Microbiology and treatment of brain abscess. J Clin Neurosci. 2017;38:8–12.PubMedCrossRefGoogle Scholar
  36. 36.
    Pagano L, Caira M, Falcucci P, Fianchi L. Fungal CNS infections in patients with hematologic malignancy. Expert Rev Anti-Infect Ther. 2005;3(5):775–85.PubMedCrossRefGoogle Scholar
  37. 37.
    Garcia RR, Min Z, Narasimhan S, Bhanot N. Fusarium brain abscess: case report and literature review. Mycoses. 2015;58(1):22–6.PubMedCrossRefGoogle Scholar
  38. 38.
    Shih RY, Koeller KK. Bacterial, fungal, and parasitic infections of the central nervous system: radiologic-pathologic correlation and historical perspectives. Radiographics. 2015;35(4):1141–69.PubMedCrossRefGoogle Scholar
  39. 39.
    Kim S, Lee KL, Lee DM, Jeong JH, Moon SM, Seo YH, et al. Nocardia brain abscess in an immunocompetent patient. Infect Chemother. 2014;46(1):45–9.PubMedPubMedCentralCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Shylah M. Moore-Pardo
    • 1
  • Olga Klinkova
    • 2
  1. 1.Division of Infectious Diseases, Department of Internal MedicineUniversity of South FloridaTampaUSA
  2. 2.Moffitt Cancer CenterTampaUSA

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