Hall W A
Department of Neurosurgery, University of Minnesota Hospital and Clinic, Minneapolis.
Neurosurg Clin N Am. 1992 Apr;3(2):435-42.
Granulocytopenia, cellular and humoral mediated immune dysfunction are predisposing factors to the development of CNS infections in immunosuppressed patients. Brain abscess formation in the compromised host is most commonly caused by enteric bacilli, the bacterium N. asteroides, the fungus Aspergillus fumigatus, or the parasite T. gondii. Mucor and the JC virus cause invasive encephalitis in this patient population. CT and MR imaging have greatly aided in the diagnosis of intracranial lesions because of these agents. Stereotactic biopsy-aspiration for diagnosis and to relieve mass effect combined with systemic antimicrobial therapy is the treatment of choice for intracerebral abscess in the compromised host. Organ rejection and chronic immunosuppressive therapy can complicate surgical intervention in these patients. Only with a high index of suspicion, an aggressive approach to diagnosis, and rapid vigorous therapy may we hope to alter the clinical course in this difficult group of patients.
粒细胞减少、细胞介导和体液介导的免疫功能障碍是免疫抑制患者发生中枢神经系统感染的易感因素。免疫功能受损宿主发生脑脓肿最常见的病因是肠道杆菌、星型诺卡菌、烟曲霉菌或弓形虫。毛霉菌和JC病毒可在这类患者中引起侵袭性脑炎。由于这些病原体的存在，CT和磁共振成像在颅内病变的诊断中发挥了很大作用。立体定向活检抽吸术用于诊断和减轻占位效应，联合全身抗菌治疗是免疫功能受损宿主脑内脓肿的首选治疗方法。器官排斥反应和长期免疫抑制治疗会使这些患者的手术干预复杂化。只有保持高度的怀疑指数、积极的诊断方法和迅速有力的治疗，我们才有希望改变这群难治患者的临床病程。
