TY - JOUR
T1 - Central nervous system infections in heart transplant recipients
AU - Van De Beek, Diederik
AU - Patel, Robin
AU - Daly, Richard C.
AU - McGregor, Christopher G.A.
AU - Wijdicks, Eelco F.M.
PY - 2007/12
Y1 - 2007/12
N2 - Objective: To study central nervous system infections after heart transplantations. Design: Retrospective cohort study. Setting: Cardiac Transplant Program at Mayo Clinic, Rochester, Minnesota. Patients: Three hundred fifteen consecutive patients who underwent heart transplantation from January 1988 through June 2006. Results: Central nervous system infections developed in 8 patients (3%), all of whom presented within the first 4 years after transplantation. The most common presentations were acute or subacute confusion or headache (88%), often without the classic symptoms of fever and neck stiffness. Direct cerebrospinal fluid examination was unrevealing in most cases, though cerebrospinal fluid protein levels were elevated in all patients with infections. Diagnoses included cryptococcal meningitis (n=3), progressive multifocal leukoencephalopathy (n=2), varicellazoster virus encephalitis (n=2), and Aspergillus fumigatus infection (n=1). Three of 8 patients died (38%) and 2 (25%) survived with mild sequelae. Central nervous system infection was a significant predictor of mortality (hazard ratio, 4.39; 95% confidence interval, 1.72-11.18; P=.002). Conclusions: Central nervous system infections are rare but devastating complications of heart transplantations. Recognition of these infections is difficult owing to a paucity of clinical manifestations. We report here, for the first time, varicella-zoster virus central nervous system infection in heart transplantations.
AB - Objective: To study central nervous system infections after heart transplantations. Design: Retrospective cohort study. Setting: Cardiac Transplant Program at Mayo Clinic, Rochester, Minnesota. Patients: Three hundred fifteen consecutive patients who underwent heart transplantation from January 1988 through June 2006. Results: Central nervous system infections developed in 8 patients (3%), all of whom presented within the first 4 years after transplantation. The most common presentations were acute or subacute confusion or headache (88%), often without the classic symptoms of fever and neck stiffness. Direct cerebrospinal fluid examination was unrevealing in most cases, though cerebrospinal fluid protein levels were elevated in all patients with infections. Diagnoses included cryptococcal meningitis (n=3), progressive multifocal leukoencephalopathy (n=2), varicellazoster virus encephalitis (n=2), and Aspergillus fumigatus infection (n=1). Three of 8 patients died (38%) and 2 (25%) survived with mild sequelae. Central nervous system infection was a significant predictor of mortality (hazard ratio, 4.39; 95% confidence interval, 1.72-11.18; P=.002). Conclusions: Central nervous system infections are rare but devastating complications of heart transplantations. Recognition of these infections is difficult owing to a paucity of clinical manifestations. We report here, for the first time, varicella-zoster virus central nervous system infection in heart transplantations.
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U2 - 10.1001/archneur.64.12.noc70065
DO - 10.1001/archneur.64.12.noc70065
M3 - Article
C2 - 17923621
AN - SCOPUS:37148998907
SN - 0003-9942
VL - 64
SP - 1715
EP - 1720
JO - Archives of neurology
JF - Archives of neurology
IS - 12
ER -