Conti D J, Rubin R H
Massachusetts General Hospital, Boston.
Neurol Clin. 1988 May;6(2):241-60.
Infections of the central nervous system are an important cause of morbidity and mortality in recipients of organ transplants. Three organisms--Listeria monocytogenes, Aspergillus fumigatus, and Cryptococcus neoformans--account for the great majority of such infections. The incidence of these infections is directly related to the patient's net state of immunosuppression and to the epidemiologic exposures he encounters. There is an expected timetable of when particular infections are likely to occur post-transplant. The most important factor in effecting patient survival is the rapidity with which diagnosis is made. Because of the nature of the infecting organisms and the impaired inflammatory response, the clinical presentation of CNS infection is often insidious, making early diagnosis difficult. However, an aggressive approach based upon lumbar puncture and CT scanning for patients with headache and fever or altered states of consciousness can be very rewarding. In addition, the use of such ancillary clues as the results of skin and lung biopsies can be an important clue to disseminated infection, particularly involving the CNS. The recent deployment of the MRI scan in immunosuppressed patients with unexplained CNS symptoms holds particular promise for early diagnosis.
中枢神经系统感染是器官移植受者发病和死亡的重要原因。三种病原体——单核细胞增生李斯特菌、烟曲霉和新型隐球菌——是此类感染的主要病因。这些感染的发生率与患者的免疫抑制净状态以及所接触的流行病学暴露直接相关。移植后特定感染可能发生的时间有一个预期的时间表。影响患者生存的最重要因素是诊断的速度。由于感染病原体的性质以及炎症反应受损，中枢神经系统感染的临床表现往往隐匿，早期诊断困难。然而，对于头痛、发热或意识状态改变的患者，基于腰椎穿刺和CT扫描采取积极的方法可能会非常有成效。此外，利用皮肤和肺活检结果等辅助线索可能是播散性感染的重要线索，特别是涉及中枢神经系统的感染。最近，MRI扫描应用于有不明原因中枢神经系统症状的免疫抑制患者，对早期诊断具有特别的前景。
