Infections of the CNS (central nervous system) are rare after heart transplants – but when they do happen they are significant predictors of death (raise the risk of death significantly), says a report in Archives of Neurology (JAMA/Archives).
During the past decade about 24,000 patients in the USA have had a heart transplant, explain the authors. Survival rates for these patients have improved thanks to better immunosuppressive drugs and superior surgical techniques.
Diederik van de Beek, M.D., Ph.D., Mayo Clinic College of Medicine, Rochester, USA, and team looked at 315 consecutive patients who had a heart transplant during the period 1988-2000. They collected information from the clinic databases, paper and electronic medical records, lab records and cranial imaging tests.
3% of the patients (total 8) developed CNS infections within four years of transplantation. The most common symptoms included headache/confusion 88%, frequently without the classic signs of fever and neck stiffness. 25% of those 8 survived with mild complications, while three of them (38%) died. Three of them developed cryptococcal meningitis, two developed progressive multifocal leukoencephalopathy, two had varicella-zoster virus encephalitis, while one had Aspergillus fumigatus infection.
“Varicella-zoster virus encephalitis has not been previously reported in heart transplant recipients, to our knowledge, but has been described in patients after bone marrow transplantation or in patients with HIV infection. Whether varicella-zoster virus encephalitis is emerging in other transplant populations should be a subject of further research,” the authors explained.
Although an examination of the cerebrospinal fluid did not always help determine the cause of the CNS infections, infected patients tended to have high protein levels, said the researchers.
“Nevertheless, appropriate management and rapid diagnosis can be achieved by taking a careful history and with physical examination, neuroimaging and diagnostic microbiological techniques. Because the mortality and morbidity rates are high, aggressive diagnosis and intervention are warranted in heart transplant recipients with suspected central nervous system infection,” the authors concluded.
“Central Nervous System Infections in Heart Transplant Recipients”
Diederik van de Beek, MD, PhD; Robin Patel, MD; Richard C. Daly, MD; Christopher G. A. McGregor, MB, FRCS, MD; Eelco F. M. Wijdicks, MD, PhD
Arch Neurol. 2007;64:(doi:10.1001/archneur.64.12.noc70065).
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Written by: Christian Nordqvist