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Central nervous system disorders after hematopoietic stem cell transplantation: a prospective study of the Infectious Diseases Working Party of EBMT
M. Schmidt-Hieber, D. Engelhard, A. Ullmann, P. Ljungman, J. Maertens, R. Martino, M. Rovira, PJ. Shaw, C. Robin, M. Faraci, J. Byrne, K. Schäfer-Eckart, H. Einsele, E. Faber, L. Rigacci, R. Saccardi, A. Balaguer-Rosello, C. Isaksson, M....
Language English Country Germany
Document type Journal Article
NLK
ProQuest Central
from 1997-04-01 to 1 year ago
Medline Complete (EBSCOhost)
from 2000-01-01 to 1 year ago
Health & Medicine (ProQuest)
from 1997-04-01 to 1 year ago
- MeSH
- Cerebrovascular Disorders epidemiology etiology MeSH
- Child MeSH
- Adult MeSH
- Central Nervous System Infections epidemiology etiology MeSH
- Infant MeSH
- Middle Aged MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Child, Preschool MeSH
- Prospective Studies MeSH
- Aged MeSH
- Hematopoietic Stem Cell Transplantation adverse effects statistics & numerical data MeSH
- Check Tag
- Child MeSH
- Adult MeSH
- Infant MeSH
- Middle Aged MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Male MeSH
- Child, Preschool MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
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.
Azienda Ospedaliera Universitaria Careggi Florence Italy
Clinic for Hematology and Oncology Carl Thiem Klinikum Thiemstr 111 03048 Cottbus Germany
Department of Internal Medicine 2 University Hospital Würzburg Würzburg Germany
Department of Microbiology Immunology and Transplantation KU Leuven Leuven Belgium
Department of Pediatric Hematology and Oncology Collegium Medicum UMK Bydgoszcz Poland
Department of Pediatrics Hadassah Hebrew University Medical Center Jerusalem Israel
Department of Stem Cell Transplantation University Medical Center Eppendorf Hamburg Germany
EBMT Data Office Leiden The Netherlands
Hematopoietic Stem Cell Unit Transplantation IRCCS Instituto G Gaslini Genova Italy
Hospital de la Santa Creu i Sant Pau Autonomous University of Barcelona Barcelona Spain
Hospital Universitari 1 Politècnic La Fe Valencia Spain
Karolinska University Hospital and Karolinska Institutet Stockholm Sweden
Nottingham University Hospital Nottingham UK
References provided by Crossref.org
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