Angstwurm K, Neumann B
Neurologische Universitätsklinik Regensburg, medbo Bezirksklinikum, Universitätsstraße 84, 93042, Regensburg, Deutschland.
Internist (Berl). 2019 Jul;60(7):690-700. doi: 10.1007/s00108-019-0614-7.
Treatments in oncology, transplantation medicine and immunology frequently lead to immunodeficiency. This review presents the most important opportunistic neurologic infections, mostly of the central nervous system (CNS). Signs and symptoms, diagnostic procedures and therapeutic options are presented. The most frequent infections are due to varicella zoster virus (VZV), Cryptococcus neoformans and Toxoplasma gondii; JC virus (JCV) and cytomegalovirus (CMV) are rare causes of encephalitis. Differential diagnoses include infection by non-opportunistic causatives, therapy associated neurotoxicity, Epstein-Barr virus (EBV) associated CNS lymphoma, recurrence of the malignancy, as well as non-infectious diseases like intracranial bleeding, ischemic stroke, autoimmune diseases and posterior reversible leukencephalopathy syndrome. Treatment of these patients, moreover, needs to consider all previous therapies and to involve a neurologist.
肿瘤学、移植医学和免疫学中的治疗常常会导致免疫缺陷。本综述介绍了最重要的机会性神经系统感染,主要是中枢神经系统(CNS)感染。文中呈现了其体征和症状、诊断程序及治疗选择。最常见的感染是由水痘带状疱疹病毒(VZV)、新型隐球菌和弓形虫引起;JC病毒(JCV)和巨细胞病毒(CMV)是脑炎的罕见病因。鉴别诊断包括非机会性病原体感染、治疗相关神经毒性、爱泼斯坦-巴尔病毒(EBV)相关的中枢神经系统淋巴瘤、恶性肿瘤复发,以及诸如颅内出血、缺血性中风、自身免疫性疾病和后部可逆性白质脑病综合征等非感染性疾病。此外,这些患者的治疗需要考虑之前的所有治疗方法,并需要有神经科医生参与。