Central nervous system infections in solid organ transplant recipients: Results from the Swiss Transplant Cohort Study. Issue 1 (July 2022)

• Record Type: Journal Article
• Authors: van den Bogaart, Lorena; Lang, Brian M.; Rossi, Simona; Neofytos, Dionysios; Walti, Laura N.; Khanna, Nina; Mueller, Nicolas J.; Boggian, Katia; Garzoni, Christian; Mombelli, Matteo; Manuel, Oriol
• Is Part Of: Journal of infection. Volume 85:Issue 1(2022)
• Page Start: 1
• Page End: 7
• Publication Date: 2022-07
• Subjects: Bacterial infections -- Central nervous system infections -- Epidemiology -- Fungal infections -- Solid organ transplant recipients -- Viral infections; CI Confidence interval -- CMV Cytomegalovirus -- CNS Central nervous system -- CSF Cerebrospinal fluid -- EBV Epstein-Barr virus -- eCRF Electronic case report -- HSV Herpes-simplex virus -- ICU Intensive care unit -- IQR Interquartile range -- JCV JC polyomavirus -- PML Progressive multifocal leukoencephalopathy -- PTLD Post-transplant lymphoproliferative disorders -- SOT Solid organ transplant -- STCS Swiss Transplant Cohort Study -- TBE Tick-borne encephalitis -- TMP/SMX Trimethoprim/sulfamethoxazole -- VZV Varicella-zoster virus; Infection -- Periodicals; Bacterial Infections -- Periodicals; Communicable Diseases -- Periodicals; Electronic journals; 616.905
• DOI: 10.1016/j.jinf.2022.05.019
• Languages: English
• ISSNs: 0163-4453

Abstract

Highlights: The incidence of CNS infections is low in the current era of transplantation. Viral meningitis/encephalitis are the most frequent CNS infections. Time to CNS infection onset after transplantation varies according to the etiology. Diagnosis of CNS infections in SOT recipients remains challenging. Fungal infections are associated with a high mortality rate. ABSTRACT: Objectives: To describe the epidemiology and clinical presentation of central nervous system (CNS) infections in solid organ transplant (SOT) recipients in the current era of transplantation. Methods: Patients from the Swiss Transplant Cohort Study (STCS) transplanted between 2008 and 2018 were included with a median follow-up of 3.8 years. Epidemiological, microbiological, and clinical data were extracted from the STCS database and patients' medical records. We calculated incidence rates and 90-day survival of transplant recipients with CNS infection. Results: Among 4762 patients, 42 episodes of CNS infection in 41 (0.8%) SOT recipients were identified, with an overall incidence rate of 2.06 per 1000 patient-years. Incidence of CNS infections was similar across all types of transplantations. Time to CNS infection onset ranged from 0.6 to 97 months after transplant. There were 22/42 (52.4%) cases of viral infections, 11/42 (26.2%) of fungal infections, 5/42 (11.9%) of bacterial infections and 4/42 (9.5%) of probable viral/bacterial etiology. Clinical presentation was meningitis/encephalitis in 25 cases (59.5%) and brain-space occupying lesions in 17 cases (40.5%). Twenty-three cases (60.5%) were considered opportunistic infections. Diagnosis were achieved mainly by brain biopsy/necropsy (15/42, 36%) or by cerebrospinal fluid analysis (20/42, 48%). Up to 40% of cases (17/42) had concurrent extra-neurological disease localizations. Overall, 90-day mortality rate was 29.0% (73.0% for fungal, 14.0% for viral and 11.0% for bacterial and probable infections, p <0.0001). Conclusions: CNS infections were rare in the STCS, with viral meningoencephalitis being the most common disease. Fungal infections were associated with a high mortality.