OT:Central nervous system infections rare but devastating following heart transp

[Guest guest]

The reason for this article was one sentance/paragraph that caught

my eye.

" Examining the cerebrospinal fluid did not necessarily help

determine the cause of central nervous system infections, though

protein levels were usually elevated in infected patients. "

Both of Sharon's spinal taps showed elevated protein levels.

KC

Central nervous system infections rare but devastating following

heart transplantation

Public release date: 8-Oct-2007

EurekAlert (press release) - Washington,DC

Contact: Carol Lammers

507-284-5037

JAMA and Archives Journals

http://www.eurekalert.org/pub_releases/2007-10/jaaj-cns100407.php

Central nervous system infections rare but devastating following

heart transplantation

Central nervous system infections develop infrequently following

heart transplants but are a significant predictor of death,

according to an article posted online today that will appear in the

December 2007 print issue of Archives of Neurology, one of the

JAMA/Archives journals.

In the past 10 years, approximately 24,000 Americans have undergone

heart transplantation, according to background information in the

article. Improvements in surgical techniques and immunosuppressive

medications have resulted in increased survival rates for transplant

recipients.

Diederik van de Beek, M.D., Ph.D., and colleagues at the Mayo Clinic

College of Medicine, Rochester, studied 315 consecutive patients who

underwent heart transplants there from January 1988 through June

2006. Data were gathered from the clinic databases, electronic and

paper medical records, laboratory records and cranial imaging tests.

Eight patients (3 percent) developed central nervous system

infections, all within four years after transplantation. The most

common symptoms were confusion or headache (88 percent), often

without the classic signs of fever and neck stiffness. Three of the

eight patients died (38 percent), and two (25 percent) survived with

mild complications.

Three patients developed cryptococcal meningitis, two had

progressive multifocal leukoencephalopathy, two had varicella-zoster

virus encephalitis, and 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, " the authors

write. " Whether varicella-zoster virus encephalitis is emerging in

other transplant populations should be a subject of further

research. "

Examining the cerebrospinal fluid did not necessarily help determine

the cause of central nervous system infections, though protein

levels were usually elevated in infected patients. " Nevertheless,

appropriate management and rapid diagnosis can be achieved by taking

a careful history and with physical examination, neuroimaging and

diagnostic microbiological techniques, " the authors write. " Because

the mortality and morbidity rates are high, aggressive diagnosis and

intervention are warranted in heart transplant recipients with

suspected central nervous system infection. "

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(Arch Neurol. 2007;64(12):(doi:10.1001/archneur.64.12.noc70065)).

Available pre-embargo to the media at www.jamamedia.org.)

Editor's Note: Dr. van de Beek is supported by the Meerwaldt

Foundation, the Netherlands Organization for Health Research and

Development (ZonMw) and a grant from NWO-Rubicon. Please see the

article for additional information, including other authors, author

contributions and affiliations, financial disclosures, funding and

support, etc.