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.

Assistance Publique Hopitaux de Paris Henri Mondor University Hospital Hematology Department and UPEC Créteil France Hôspital Henri Mondor Créteil France

Azienda Ospedaliera Universitaria Careggi Florence Italy

Clinic for Hematology and Oncology Carl Thiem Klinikum Thiemstr 111 03048 Cottbus Germany

Clinic for Hematology and Oncology Klinikum Nürnberg Paracelsus Medizinische Privatuniversität Nürnberg Germany

Department of Hemato Oncology Faculty Hospital Olomouc Faculty of Medicine and Dentistry Palacky University Olomouc Czech Republic

Department of Hematology Institute of Hematology and Oncology IDIBAPS Hospital Clinic University of Barcelona Josep Carreras Leukemia Research Institute Barcelona Spain

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

Division of Infectious Diseases University of Genova DISSAL Genoa Italy

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

IRCCS Ospedale Policlinico San Martino Genoa Italy

Karolinska University Hospital and Karolinska Institutet Stockholm Sweden

Nottingham University Hospital Nottingham UK

Ospedale S Camillo Rome Italy

Pediatric Hematology Oncology Mother and Child Hospital Azienda Ospedaliera Universitaria Integrata Verona Italy

The Children's Hospital at Westmead Sydney Australia

Umea University Hospital Umeå Sweden

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