Central nervous system infections in heart and heart-lung transplant recipients
W. A. Hall, A. J. Martinez, J. S. Dummer, B. P. Griffith, R. L. Hardesty, H. T. Bahnson and L. D. Lunsford
Department of Neurological Surgery, University of Pittsburgh School of Medicine.
Infections, a major cause of morbidity and mortality in immunosuppressed
heart and heart-lung transplant recipients, frequently involve the central
nervous system and can produce devastating neurologic sequelae. Between
1980 and 1987, a total of 363 heart transplant and 54 heart-lung transplant
recipients at the University of Pittsburgh sustained 13 intracranial
infections two to 143 weeks after transplantation. Computed tomography
demonstrated well-defined Nocardia and Aspergillus abscesses in four
patients. Cerebrospinal fluid was normal in all cases studied, including in
those patients in whom culture confirmed meningitis. Computed
tomography-guided stereotactic surgery was used to diagnose and aspirate
two nocardial brain abscesses. The prognosis for patients with central
nervous system infections was related to their overall condition at the
time of diagnosis. Both patients with nocardial abscesses and one patient
with Listeria leptomeningitis survived, but all ten other patients died
because of extensive multisystem infectious complications.
