Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania 10104, USA.
Semin Neurol. 2010 Jul;30(3):296-310. doi: 10.1055/s-0030-1255216. Epub 2010 Jun 24.
With improved treatments, patients with many types of cancer survive longer. However, both the acute adverse effects of more intensive therapies and the risks of chronic immunosuppression have led to a diverse and evolving spectrum of central nervous system (CNS) infections. The presentation and course of CNS infections in cancer patients may be different from those in patients without cancer, complicating and delaying accurate diagnosis. New syndromes related both to the underlying malignancies and to their treatment continue to emerge. Noninfectious disorders such as adverse drug effects, vascular lesions, and radiation effects can mimic CNS infections. The two major clinical presentations of CNS infections are meningoencephalitic syndromes and focal deficits due to mass lesions. The range of pathogens can be narrowed by considering the type of immune deficit present, local nosocomial trends, and the specific vulnerabilities created by the underlying disease and treatment regimen. Patients undergoing neurosurgical procedures and those receiving hematopoietic cell transplants (HCT) account for the majority of cancer patients with CNS infections. Significant recent changes reviewed here include evolving patterns of bacterial meningitis, current treatment recommendations for fungal infections, special infectious risks associated with immunomodulatory therapies, and neuroimaging techniques to distinguish infection from other intracranial processes.
随着治疗方法的改进，许多类型的癌症患者的存活时间更长。然而，高强度治疗的急性不良反应和慢性免疫抑制的风险导致了中枢神经系统 (CNS) 感染的多样性和不断发展的谱。癌症患者的 CNS 感染的表现和病程可能与无癌症患者不同，这使得准确诊断变得复杂和延迟。与基础恶性肿瘤及其治疗相关的新综合征不断出现。非传染性疾病，如药物不良反应、血管病变和辐射效应，可模拟 CNS 感染。CNS 感染的两种主要临床表现是脑膜脑炎综合征和由于肿块病变引起的局灶性缺陷。通过考虑存在的免疫缺陷类型、局部院内趋势以及基础疾病和治疗方案所产生的特定脆弱性，可以缩小病原体的范围。接受神经外科手术和造血细胞移植 (HCT) 的患者占 CNS 感染癌症患者的大多数。这里审查的重大近期变化包括细菌性脑膜炎的演变模式、真菌感染的当前治疗建议、免疫调节治疗相关的特殊感染风险以及用于区分感染与其他颅内过程的神经影像学技术。
