Czartoski Todd
Department of Medicine (Infectious Diseases) and Neurology, Box 358070, University of Washington, Seattle, WA 98195, USA.
Curr Treat Options Neurol. 2006 May;8(3):193-201. doi: 10.1007/s11940-006-0010-1.
Central nervous system (CNS) infections are a rare but serious complication of transplantation. An appropriate diagnostic workup should be streamlined with stratification of infection risk by length and degree of immune suppression, lesion localization, and timing. Polymerase chain reaction has high sensitivity and specificity for rapid identification of viral infections and should be used when available. Early diagnosis is imperative, and biopsy should be pursued if a diagnosis is not readily obtained with noninvasive testing. Treatment is pathogen specific. Combination antifungal therapy should be considered for cerebral aspergillosis. Zygomycetes and related invasive fungi require surgical resection and high-dose antifungal therapy. Viral meningoencephalitis therapy should be continued until resolution of clinical signs and symptoms, and viral clearance is verified with repeat cerebrospinal fluid analysis. Cytomegalovirus encephalitis requires ongoing maintenance therapy until clearance of viremia or antigenemia. Bacterial meningitis is uncommon in transplantation and should be treated with 21 days of antibiotics. CNS bacterial abscesses, including nocardiosis, should be surgically drained if feasible and treated until resolution of clinical and radiographic evidence of infection.
中枢神经系统（CNS）感染是移植手术中一种罕见但严重的并发症。应根据免疫抑制的时长和程度、病变定位及时间对感染风险进行分层，从而简化适当的诊断检查流程。聚合酶链反应对快速识别病毒感染具有高敏感性和特异性，如有条件应予以使用。早期诊断至关重要，若通过非侵入性检测无法轻易确诊，则应进行活检。治疗应针对病原体。对于脑曲霉病，应考虑联合抗真菌治疗。接合菌及相关侵袭性真菌需要手术切除并进行高剂量抗真菌治疗。病毒性脑膜脑炎的治疗应持续至临床症状和体征消退，并通过重复脑脊液分析证实病毒清除。巨细胞病毒性脑炎需要持续进行维持治疗，直至病毒血症或抗原血症清除。细菌性脑膜炎在移植患者中并不常见，应使用抗生素治疗21天。中枢神经系统细菌性脓肿，包括诺卡菌病，若可行应进行手术引流，并持续治疗直至感染的临床和影像学证据消退。
