Approach to Neurologic Complications in the Immunocompromised Patient

Abstract

Neurologic complications are common in immunocompromised patients, including those with advanced human immunodeficiency virus, transplant recipients, and patients on immunomodulatory medications. In addition to the standard differential diagnosis, specific pathogens and other conditions unique to the immunocompromised state should be considered in the evaluation of neurologic complaints in this patient population. A thorough understanding of these considerations is critical to the inpatient neurologist in contemporary practice, as increasing numbers of patients are exposed to immunomodulatory therapies. In this review, we provide a chief complaint-based approach to the clinical presentations and diagnosis of both infectious and noninfectious complications particular to immunocompromised patients.

Keywords

neuroinfectious diseases - immunocompromised - HIV - transplant

Publication History

Article published online:
07 October 2021

• References

• 1 Graus F, Saiz A, Sierra J. et al. Neurologic complications of autologous and allogeneic bone marrow transplantation in patients with leukemia: a comparative study. Neurology 1996; 46 (04) 1004-1009
• 2 Dowling MR, Li S, Dey BR. et al. Neurologic complications after allogeneic hematopoietic stem cell transplantation: risk factors and impact. Bone Marrow Transplant 2018; 53 (02) 199-206
• 3 Senzolo M, Ferronato C, Burra P. Neurologic complications after solid organ transplantation. Transpl Int 2009; 22 (03) 269-278
• 4 Goldstein LS, Haug III MT, Perl II J. et al. Central nervous system complications after lung transplantation. J Heart Lung Transplant 1998; 17 (02) 185-191
• 5 Lewis MB, Howdle PD. Neurologic complications of liver transplantation in adults. Neurology 2003; 61 (09) 1174-1178
• 6 Watanabe K, Arakawa Y, Oguma E. et al. Characteristics of methotrexate-induced stroke-like neurotoxicity. Int J Hematol 2018; 108 (06) 630-636
• 7 Zhang W, Egashira N, Masuda S. Recent topics on the mechanisms of immunosuppressive therapy-related neurotoxicities. Int J Mol Sci 2019; 20 (13) E3210
• 8 Pruitt AA. Neurologic complications of transplantation. Continuum (Minneap Minn) 2017; 23 (3, Neurology of Systemic Disease): 802-821
• 9 Tan IL, Smith BR, von Geldern G, Mateen FJ, McArthur JC. HIV-associated opportunistic infections of the CNS. Lancet Neurol 2012; 11 (07) 605-617
• 10 Wong MC, Suite NDA, Labar DR. Seizures in human immunodeficiency virus infection. Arch Neurol 1990; 47 (06) 640-642
• 11 Wilson MR, Sample HA, Zorn KC. et al. Clinical metagenomic sequencing for diagnosis of meningitis and encephalitis. N Engl J Med 2019; 380 (24) 2327-2340
• 12 Wilson MR, Naccache SN, Samayoa E. et al. Actionable diagnosis of neuroleptospirosis by next-generation sequencing. N Engl J Med 2014; 370 (25) 2408-2417
• 13 Sato M, Kuroda M, Kasai M. et al. Acute encephalopathy in an immunocompromised boy with astrovirus-MLB1 infection detected by next generation sequencing. J Clin Virol 2016; 78: 66-70
• 14 Hu Z, Weng X, Xu C. et al. Metagenomic next-generation sequencing as a diagnostic tool for toxoplasmic encephalitis. Ann Clin Microbiol Antimicrob 2018; 17 (01) 45
• 15 Yao M, Zhou J, Zhu Y. et al. Detection of Listeria monocytogenes in CSF from three patients with meningoencephalitis by next-generation sequencing. J Clin Neurol 2016; 12 (04) 446-451
• 16 Reddy SM, Winston DJ, Territo MC, Schiller GJ. CMV central nervous system disease in stem-cell transplant recipients: an increasing complication of drug-resistant CMV infection and protracted immunodeficiency. Bone Marrow Transplant 2010; 45 (06) 979-984
• 17 Wolf DG, Lurain NS, Zuckerman T. et al. Emergence of late cytomegalovirus central nervous system disease in hematopoietic stem cell transplant recipients. Blood 2003; 101 (02) 463-465
• 18 Anders H-J, Goebel FD. Neurological manifestations of cytomegalovirus infection in the acquired immunodeficiency syndrome. Int J STD AIDS 1999; 10 (03) 151-159 , quiz 160–161
• 19 Sarva H, Graber J, Remanan R, Rosenblum M, Omuro A. CMV encephalitis in BMT recipients. Bone Marrow Transplant 2012; 47 (02) 318-320
• 20 Maschke M, Kastrup O, Diener H-C. CNS manifestations of cytomegalovirus infections: diagnosis and treatment. CNS Drugs 2002; 16 (05) 303-315
• 21 Arribas JR, Clifford DB, Fichtenbaum CJ, Commins DL, Powderly WG, Storch GA. Level of cytomegalovirus (CMV) DNA in cerebrospinal fluid of subjects with AIDS and CMV infection of the central nervous system. J Infect Dis 1995; 172 (02) 527-531
• 22 Seeley WW, Marty FM, Holmes TM. et al. Post-transplant acute limbic encephalitis: clinical features and relationship to HHV6. Neurology 2007; 69 (02) 156-165
• 23 Zerr DM, Fann JR, Breiger D. et al. HHV-6 reactivation and its effect on delirium and cognitive functioning in hematopoietic cell transplantation recipients. Blood 2011; 117 (19) 5243-5249
• 24 Shiroshita K, Mori T, Kato J. et al. Clinical characteristics of human herpesvirus-6 myelitis after allogeneic hematopoietic stem cell transplantation and its favorable outcome by early intervention. Bone Marrow Transplant 2020; 55 (05) 939-945
• 25 Ogata M, Oshima K, Ikebe T. et al. Clinical characteristics and outcome of human herpesvirus-6 encephalitis after allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 2017; 52 (11) 1563-1570
• 26 Ogata M, Fukuda T, Teshima T. Human herpesvirus-6 encephalitis after allogeneic hematopoietic cell transplantation: what we do and do not know. Bone Marrow Transplant 2015; 50 (08) 1030-1036
• 27 Victoria NC, Phan TL, Agarwal KA. A systematic review of sodium disorders in HHV-6 encephalitis. Biol Blood Marrow Transplant 2020; 26 (05) 1034-1039
• 28 Bhanushali MJ, Kranick SM, Freeman AF. et al. Human herpes 6 virus encephalitis complicating allogeneic hematopoietic stem cell transplantation. Neurology 2013; 80 (16) 1494-1500
• 29 Ogata M, Satou T, Kadota J. et al. Human herpesvirus 6 (HHV-6) reactivation and HHV-6 encephalitis after allogeneic hematopoietic cell transplantation: a multicenter, prospective study. Clin Infect Dis 2013; 57 (05) 671-681
• 30 Vinnard C, Barton T, Jerud E, Blumberg E. A report of human herpesvirus 6-associated encephalitis in a solid organ transplant recipient and a review of previously published cases. Liver Transpl 2009; 15 (10) 1242-1246
• 31 Astriti M, Zeller V, Boutolleau D. et al. Fatal HHV-6 associated encephalitis in an HIV-1 infected patient treated with cidofovir. J Infect 2006; 52 (04) 237-242
• 32 Berzero G, Di Stefano AL, Dehais C. et al. Herpes simplex encephalitis in glioma patients: a challenging diagnosis. J Neurol Neurosurg Psychiatry 2015; 86 (04) 374-377
• 33 Schiff D, Rosenblum MK. Herpes simplex encephalitis (HSE) and the immunocompromised: a clinical and autopsy study of HSE in the settings of cancer and human immunodeficiency virus-type 1 infection. Hum Pathol 1998; 29 (03) 215-222
• 34 Saylor D, Thakur K, Venkatesan A. Acute encephalitis in the immunocompromised individual. Curr Opin Infect Dis 2015; 28 (04) 330-336
• 35 Haneche F, Demeret S, Psimaras D, Katlama C, Pourcher V. An anti-NMDA receptor encephalitis mimicking an HIV encephalitis. Clin Immunol 2018; 193: 10-11
• 36 Arboleya S, Clemente A, Deng S. et al. Anti-NMDAR antibodies in new-onset psychosis. Positive results in an HIV-infected patient. Brain Behav Immun 2016; 56: 56-60
• 37 Patarata E, Bernardino V, Martins A, Pereira R, Loureiro C, Moraes-Fontes MF. Anti-N-methyl-D-aspartate receptor encephalitis in HIV infection. Case Rep Neurol 2016; 8 (03) 251-257
• 38 Cohen DA, Lopez-Chiriboga AS, Pittock SJ. et al. Posttransplant autoimmune encephalitis. Neurol Neuroimmunol Neuroinflamm 2018; 5 (06) e497
• 39 Chittick P, Williamson JC, Ohl CA. BK virus encephalitis: case report, review of the literature, and description of a novel treatment modality. Ann Pharmacother 2013; 47 (09) 1229-1233
• 40 Hirsch HH, Steiger J. Polyomavirus BK. Lancet Infect Dis 2003; 3 (10) 611-623
• 41 Kalra SK, Sharma P, Shyam K, Tejan N, Ghoshal U. Acanthamoeba and its pathogenic role in granulomatous amebic encephalitis. Exp Parasitol 2020; 208: 107788
• 42 Gonzalez MM, Gould E, Dickinson G. et al. Acquired immunodeficiency syndrome associated with Acanthamoeba infection and other opportunistic organisms. Arch Pathol Lab Med 1986; 110 (08) 749-751
• 43 Geith S, Walochnik J, Prantl F, Sack S, Eyer F. Lethal outcome of granulomatous acanthamoebic encephalitis in a man who was human immunodeficiency virus-positive: a case report. J Med Case Reports 2018; 12 (01) 201
• 44 Vernon SE, Acar BC, Pham SM, Fertel D. Acanthamoeba infection in lung transplantation: report of a case and review of the literature. Transpl Infect Dis 2005; 7 (3-4): 154-157
• 45 Crothers JW, Hsu L, Marty FM. Fulminant Acanthamoeba castellanii encephalitis in an ibrutinib-treated patient. Open Forum Infect Dis 2020; 7 (02) a025
• 46 Schlessinger S, Kokko K, Fratkin J. et al; Centers for Disease Control and Prevention (CDC). Balamuthia mandrillaris transmitted through organ transplantation–Mississippi, 2009. MMWR Morb Mortal Wkly Rep 2010; 59 (36) 1165-1170
• 47 Itoh K, Yagita K, Nozaki T. et al. An autopsy case of Balamuthia mandrillaris amoebic encephalitis, a rare emerging infectious disease, with a brief review of the cases reported in Japan. Neuropathology 2015; 35 (01) 64-69
• 48 Deetz TR, Sawyer MH, Billman G, Schuster FL, Visvesvara GS. Successful treatment of Balamuthia amoebic encephalitis: presentation of 2 cases. Clin Infect Dis 2003; 37 (10) 1304-1312
• 49 Parija SC, Dinoop K, Venugopal H. Management of granulomatous amebic encephalitis: laboratory diagnosis and treatment. Trop Parasitol 2015; 5 (01) 23-28
• 50 Schumacher DJ, Tien RD, Lane K. Neuroimaging findings in rare amebic infections of the central nervous system. AJNR Am J Neuroradiol 1995; 16 (4, Suppl): 930-935
• 51 McArthur JC, Hoover DR, Bacellar H. et al. Dementia in AIDS patients: incidence and risk factors. Multicenter AIDS Cohort Study. Neurology 1993; 43 (11) 2245-2252
• 52 Saylor D, Dickens AM, Sacktor N. et al. HIV-associated neurocognitive disorder--pathogenesis and prospects for treatment. Nat Rev Neurol 2016; 12 (04) 234-248
• 53 Nagel MA, Cohrs RJ, Mahalingam R. et al. The varicella zoster virus vasculopathies: clinical, CSF, imaging, and virologic features. Neurology 2008; 70 (11) 853-860
• 54 Nagel MA, Bubak AN. Varicella zoster virus vasculopathy. J Infect Dis 2018; 218 (Suppl. 02) S107-S112
• 55 Nagel MA, Gilden D. Neurological complications of VZV reactivation. Curr Opin Neurol 2014; 27 (03) 356-360
• 56 Moses H, Nagel MA, Gilden DH. Acute cerebellar ataxia in a 41 year old woman. Lancet Neurol 2006; 5 (11) 984-988
• 57 Issa NP, Hentati A. VZV encephalitis that developed in an immunized patient during fingolimod therapy. Neurology 2015; 84 (01) 99-100
• 58 Tizazu EF, Chang G, Berger JR. Varicella zoster virus (VZV) oculomeningoencephalomyeloradiculitis: a previously undescribed constellation. J Neurovirol 2020; 26 (03) 433-436
• 59 Gunson RN, Aitken C, Gilden D. A woman with acute headache and sacral dermatomal numbness. J Clin Virol 2011; 50 (03) 191-193
• 60 Bhagat RK, Zieske AW, Kamble RT. Cerebrospinal leukemoid reaction secondary to VZV meninigoencephalitis in an AML patient post allogeneic bone marrow transplantation. Blood 2013; 122 (02) 300-301
• 61 Habib AA, Gilden D, Schmid DS, Safdieh JE. Varicella zoster virus meningitis with hypoglycorrhachia in the absence of rash in an immunocompetent woman. J Neurovirol 2009; 15 (02) 206-208
• 62 Ma M, Barnes G, Pulliam J, Jezek D, Baumann RJ, Berger JR. CNS angiitis in graft vs host disease. Neurology 2002; 59 (12) 1994-1997
• 63 Sostak P, Padovan CS, Eigenbrod S. et al. Cerebral angiitis in four patients with chronic GVHD. Bone Marrow Transplant 2010; 45 (07) 1181-1188
• 64 Pahari H, Nagai S, Skorupski S, Salgia R. Graft-versus-host disease of the central nervous system after liver transplantation: a rare complication. Am J Transplant 2018; 18 (10) 2591-2594
• 65 Kamble RT, Chang C-C, Sanchez S, Carrum G. Central nervous system graft-versus-host disease: report of two cases and literature review. Bone Marrow Transplant 2007; 39 (01) 49-52
• 66 Blasiak KP, Simonetta F, Vargas M-I, Chalandon Y. Central nervous system graft-versus-host disease (CNS-GvHD) after allogeneic haematopoietic stem cell transplantation. BMJ Case Rep 2018; 2018 :bcr-2017 221840
• 67 Porter SB, Sande MA. Toxoplasmosis of the central nervous system in the acquired immunodeficiency syndrome. N Engl J Med 1992; 327 (23) 1643-1648
• 68 Robert-Gangneux F, Meroni V, Dupont D. et al. Toxoplasmosis in transplant recipients, Europe, 2010-2014. Emerg Infect Dis 2018; 24 (08) 1497-1504
• 69 Hakko E, Ozkan HA, Karaman K, Gulbas Z. Analysis of cerebral toxoplasmosis in a series of 170 allogeneic hematopoietic stem cell transplant patients. Transpl Infect Dis 2013; 15 (06) 575-580
• 70 Nath A, Hobson DE, Russell A. Movement disorders with cerebral toxoplasmosis and AIDS. Mov Disord 1993; 8 (01) 107-112
• 71 Smith AB, Smirniotopoulos JG, Rushing EJ. From the archives of the AFIP: central nervous system infections associated with human immunodeficiency virus infection: radiologic-pathologic correlation. Radiographics 2008; 28 (07) 2033-2058
• 72 Marra CM. Central nervous system infection with Toxoplasma gondii . Handb Clin Neurol 2018; 152: 117-122
• 73 Benson JC, Cervantes G, Baron TR. et al. Imaging features of neurotoxoplasmosis: a multiparametric approach, with emphasis on susceptibility-weighted imaging. Eur J Radiol Open 2018; 5: 45-51
• 74 Kumar GGS, Mahadevan A, Guruprasad AS. et al. Eccentric target sign in cerebral toxoplasmosis: neuropathological correlate to the imaging feature. J Magn Reson Imaging 2010; 31 (06) 1469-1472
• 75 Bhagavati S, Choi J. Frequent hemorrhagic lesions in cerebral toxoplasmosis in AIDS patients. J Neuroimaging 2009; 19 (02) 169-173
• 76 Belaz S, Gangneux J-P, Dupretz P, Guiguen C, Robert-Gangneux F. A 10-year retrospective comparison of two target sequences, REP-529 and B1, for Toxoplasma gondii detection by quantitative PCR. J Clin Microbiol 2015; 53 (04) 1294-1300
• 77 Yu GH, Montone KT, Frias-Hidvegi D, Cajulis RS, Brody BA, Levy RM. Cytomorphology of primary CNS lymphoma: review of 23 cases and evidence for the role of EBV. Diagn Cytopathol 1996; 14 (02) 114-120
• 78 Herndier BG, Kaplan LD, McGrath MS. Pathogenesis of AIDS lymphomas. AIDS 1994; 8 (08) 1025-1049
• 79 Yang M, Sun J, Bai HX. et al. Diagnostic accuracy of SPECT, PET, and MRS for primary central nervous system lymphoma in HIV patients: a systematic review and meta-analysis. Medicine (Baltimore) 2017; 96 (19) e6676
• 80 Grimm SA, McCannel CA, Omuro AMP. et al. Primary CNS lymphoma with intraocular involvement: International PCNSL Collaborative Group Report. Neurology 2008; 71 (17) 1355-1360
• 81 Weller M. Glucocorticoid treatment of primary CNS lymphoma. J Neurooncol 1999; 43 (03) 237-239
• 82 Evens AM, Choquet S, Kroll-Desrosiers AR. et al. Primary CNS posttransplant lymphoproliferative disease (PTLD): an international report of 84 cases in the modern era. Am J Transplant 2013; 13 (06) 1512-1522
• 83 Cavaliere R, Petroni G, Lopes MB, Schiff D. International Primary Central Nervous System Lymphoma Collaborative Group. Primary central nervous system post-transplantation lymphoproliferative disorder: an International Primary Central Nervous System Lymphoma Collaborative Group Report. Cancer 2010; 116 (04) 863-870
• 84 White ML, Moore DW, Zhang Y, Mark KD, Greiner TC, Bierman PJ. Primary central nervous system post-transplant lymphoproliferative disorders: the spectrum of imaging appearances and differential. Insights Imaging 2019; 10 (01) 46
• 85 Whitehead MT, Cardenas AM, Corey AS. et al; Expert Panel on Neurologic Imaging. ACR Appropriateness Criteria® Headache. J Am Coll Radiol 2019; 16 (11S): S364-S377
• 86 Brouwer MC, Tunkel AR, McKhann II GM, van de Beek D. Brain abscess. N Engl J Med 2014; 371 (05) 447-456
• 87 Patterson TF, Kirkpatrick WR, White M. et al. Invasive aspergillosis. Disease spectrum, treatment practices, and outcomes. I3 Aspergillus Study Group. Medicine (Baltimore) 2000; 79 (04) 250-260
• 88 Ruhnke M, Kofla G, Otto K, Schwartz S. CNS aspergillosis: recognition, diagnosis and management. CNS Drugs 2007; 21 (08) 659-676
• 89 Boes B, Bashir R, Boes C, Hahn F, McConnell JR, McComb R. Central nervous system aspergillosis. Analysis of 26 patients. J Neuroimaging 1994; 4 (03) 123-129
• 90 Jantunen E, Volin L, Salonen O. et al. Central nervous system aspergillosis in allogeneic stem cell transplant recipients. Bone Marrow Transplant 2003; 31 (03) 191-196
• 91 Walsh TJ, Hier DB, Caplan LR. Aspergillosis of the central nervous system: clinicopathological analysis of 17 patients. Ann Neurol 1985; 18 (05) 574-582
• 92 Guermazi A, Gluckman E, Tabti B, Miaux Y. Invasive central nervous system aspergillosis in bone marrow transplantation recipients: an overview. Eur Radiol 2003; 13 (02) 377-388
• 93 Chong GM, Maertens JA, Lagrou K, Driessen GJ, Cornelissen JJ, Rijnders BJA. Diagnostic performance of galactomannan antigen testing in cerebrospinal fluid. J Clin Microbiol 2016; 54 (02) 428-431
• 94 Imbert S, Brossas JY, Palous M, Joly I, Meyer I, Fekkar A. Performance of Aspergillus PCR in cerebrospinal fluid for the diagnosis of cerebral aspergillosis. Clin Microbiol Infect 2017; 23 (11) 889.e1-889.e4
• 95 Sánchez-Portocarrero J, Pérez-Cecilia E, Corral O, Romero-Vivas J, Picazo JJ. The central nervous system and infection by Candida species. Diagn Microbiol Infect Dis 2000; 37 (03) 169-179
• 96 Moran CA, Terry C, Nguyen MLT, Sheth AN. Use of cerebrospinal fluid (1,3)-β-D-glucan to monitor treatment response in Candida albicans meningitis in an HIV-infected patient. Infect Dis Clin Pract 2018; 26 (06) e70
• 97 Anagnostou T, Arvanitis M, Kourkoumpetis TK, Desalermos A, Carneiro HA, Mylonakis E. Nocardiosis of the central nervous system: experience from a general hospital and review of 84 cases from the literature. Medicine (Baltimore) 2014; 93 (01) 19-32
• 98 Steinbrink J, Leavens J, Kauffman CA, Miceli MH. Manifestations and outcomes of Nocardia infections: comparison of immunocompromised and nonimmunocompromised adult patients. Medicine (Baltimore) 2018; 97 (40) e12436
• 99 Rafiei N, Peri AM, Righi E, Harris P, Paterson DL. Central nervous system nocardiosis in Queensland: a report of 20 cases and review of the literature. Medicine (Baltimore) 2016; 95 (46) e5255
• 100 Gertz K, Siebert E, Halle E. et al. Multiple supratentorial brain abscesses due to Listeria monocytogenes in a patient with myasthenia gravis. Clin Neurol Neurosurg 2013; 115 (09) 1923-1924
• 101 Berry AC, Nguyen L, Yarbrough T, Iqbal F, Green WK. Ring-enhancing brain lesions: Listeria monocytogenes abscesses. Intern Emerg Med 2016; 11 (05) 763-765
• 102 Mathisen GE, Johnson JP. Brain abscess. Clin Infect Dis 1997; 25 (04) 763-779 , quiz 780–781
• 103 Limmahakhun S, Chayakulkeeree M. Listeria monocytogenes brain abscess: two cases and review of the literature. Southeast Asian J Trop Med Public Health 2013; 44 (03) 468-478
• 104 Tiri B, Priante G, Saraca LM, Martella LA, Cappanera S, Francisci D. Listeria monocytogenes brain abscess: controversial issues for the treatment-two cases and literature review. Case Rep Infect Dis 2018; 2018: 6549496
• 105 Rai S, Marak RSK, Jain S, Dhole TN. Posterior fossa midline cryptococcoma in a patient with idiopathic CD4 lymphocytopenia. Indian J Med Microbiol 2012; 30 (03) 367-370
• 106 Williamson PR, Jarvis JN, Panackal AA. et al. Cryptococcal meningitis: epidemiology, immunology, diagnosis and therapy. Nat Rev Neurol 2017; 13 (01) 13-24
• 107 Shih CC, Chen YC, Chang SC, Luh KT, Hsieh WC. Cryptococcal meningitis in non-HIV-infected patients. QJM 2000; 93 (04) 245-251
• 108 Fang W, Chen M, Liu J. et al. Cryptococcal meningitis in systemic lupus erythematosus patients: pooled analysis and systematic review. Emerg Microbes Infect 2016; 5 (09) e95
• 109 Meyohas M-C, Roux P, Bollens D. et al. Pulmonary cryptococcosis: localized and disseminated infections in 27 patients with AIDS. Clin Infect Dis 1995; 21 (03) 628-633
• 110 Dimino-Emme L, Gurevitch AW. Cutaneous manifestations of disseminated cryptococcosis. J Am Acad Dermatol 1995; 32 (5, Pt 2): 844-850
• 111 Graybill JR, Sobel J, Saag M. et al; The NIAID Mycoses Study Group and AIDS Cooperative Treatment Groups. Diagnosis and management of increased intracranial pressure in patients with AIDS and cryptococcal meningitis. Clin Infect Dis 2000; 30 (01) 47-54
• 112 Feldmesser M, Harris C, Reichberg S, Khan S, Casadevall A. Serum cryptococcal antigen in patients with AIDS. Clin Infect Dis 1996; 23 (04) 827-830
• 113 Boulware DR, Rolfes MA, Rajasingham R. et al. Multisite validation of cryptococcal antigen lateral flow assay and quantification by laser thermal contrast. Emerg Infect Dis 2014; 20 (01) 45-53
• 114 Charlier C, Dromer F, Lévêque C. et al; French Cryptococcosis Study Group. Cryptococcal neuroradiological lesions correlate with severity during cryptococcal meningoencephalitis in HIV-positive patients in the HAART era. PLoS One 2008; 3 (04) e1950
• 115 Sarkis RA, Mays M, Isada C, Ahmed M. MRI findings in cryptococcal meningitis of the non-HIV population. Neurologist 2015; 19 (02) 40-45
• 116 Tien RD, Chu PK, Hesselink JR, Duberg A, Wiley C. Intracranial cryptococcosis in immunocompromised patients: CT and MR findings in 29 cases. AJNR Am J Neuroradiol 1991; 12 (02) 283-289
• 117 Starkey J, Moritani T, Kirby P. MRI of CNS fungal infections: review of aspergillosis to histoplasmosis and everything in between. Clin Neuroradiol 2014; 24 (03) 217-230
• 118 Subramanian A, Dorman S. AST Infectious Diseases Community of Practice. Mycobacterium tuberculosis in solid organ transplant recipients. Am J Transplant 2009; 9 (Suppl. 04) S57-S62
• 119 Keane J, Gershon S, Wise RP. et al. Tuberculosis associated with infliximab, a tumor necrosis factor α-neutralizing agent. N Engl J Med 2001; 345 (15) 1098-1104
• 120 Marais S, Pepper DJ, Schutz C, Wilkinson RJ, Meintjes G. Presentation and outcome of tuberculous meningitis in a high HIV prevalence setting. PLoS One 2011; 6 (05) e20077
• 121 Kent SJ, Crowe SM, Yung A, Lucas CR, Mijch AM. Tuberculous meningitis: a 30-year review. Clin Infect Dis 1993; 17 (06) 987-994
• 122 Davis LE, Rastogi KR, Lambert LC, Skipper BJ. Tuberculous meningitis in the southwest United States: a community-based study. Neurology 1993; 43 (09) 1775-1778
• 123 Verdon R, Chevret S, Laissy JP, Wolff M. Tuberculous meningitis in adults: review of 48 cases. Clin Infect Dis 1996; 22 (06) 982-988
• 124 Farinha NJ, Razali KA, Holzel H, Morgan G, Novelli VM. Tuberculosis of the central nervous system in children: a 20-year survey. J Infect 2000; 41 (01) 61-68
• 125 Girgis NI, Sultan Y, Farid Z. et al. Tuberculosis meningitis, Abbassia Fever Hospital-Naval Medical Research Unit No. 3-Cairo, Egypt, from 1976 to 1996. Am J Trop Med Hyg 1998; 58 (01) 28-34
• 126 Misra UK, Kumar M, Kalita J. Seizures in tuberculous meningitis. Epilepsy Res 2018; 148: 90-95
• 127 Thwaites GE, Tran TH. Tuberculous meningitis: many questions, too few answers. Lancet Neurol 2005; 4 (03) 160-170
• 128 Hosoğlu S, Ayaz C, Geyik MF, Kökoğlu OF, Ceviz A. Tuberculous meningitis in adults: an eleven-year review. Int J Tuberc Lung Dis 1998; 2 (07) 553-557
• 129 Misra UK, Kalita J, Bhoi SK, Singh RK. A study of hyponatremia in tuberculous meningitis. J Neurol Sci 2016; 367: 152-157
• 130 Kalita J, Misra UK, Nair PP. Predictors of stroke and its significance in the outcome of tuberculous meningitis. J Stroke Cerebrovasc Dis 2009; 18 (04) 251-258
• 131 Wasay M, Khan M, Farooq S. et al. Frequency and impact of cerebral infarctions in patients with tuberculous meningitis. Stroke 2018; 49 (10) 2288-2293
• 132 Alarcón F, Dueñas G, Cevallos N, Lees AJ. Movement disorders in 30 patients with tuberculous meningitis. Mov Disord 2000; 15 (03) 561-569
• 133 Nhu NTQ, Heemskerk D, Thu DA. et al. Evaluation of GeneXpert MTB/RIF for diagnosis of tuberculous meningitis. J Clin Microbiol 2014; 52 (01) 226-233
• 134 Garg RK, Malhotra HS, Jain A. Neuroimaging in tuberculous meningitis. Neurol India 2016; 64 (02) 219-227
• 135 Wasay M, Arif H, Khealani B, Ahsan H. Neuroimaging of tuberculous myelitis: analysis of ten cases and review of literature. J Neuroimaging 2006; 16 (03) 197-205
• 136 Mylonakis E, Hohmann EL, Calderwood SB. Central nervous system infection with Listeria monocytogenes. 33 years' experience at a general hospital and review of 776 episodes from the literature. Medicine (Baltimore) 1998; 77 (05) 313-336
• 137 Dzupova O, Rozsypal H, Smiskova D, Benes J. Listeria monocytogenes meningitis in adults: the Czech Republic experience. BioMed Res Int 2013; 2013: 846186
• 138 Dee RR, Lorber B. Brain abscess due to Listeria monocytogenes: case report and literature review. Rev Infect Dis 1986; 8 (06) 968-977
• 139 Carmo RLD, Alves Simão AK, Amaral LLFD. et al. Neuroimaging of emergent and reemergent infections. Radiographics 2019; 39 (06) 1649-1671
• 140 Chong J, Di Rocco A, Tagliati M, Danisi F, Simpson DM, Atlas SW. MR findings in AIDS-associated myelopathy. AJNR Am J Neuroradiol 1999; 20 (08) 1412-1416
• 141 Wang Y, Yu CY, Huang L, Han YY, Liu YM, Zhu J. Acute longitudinal and hemorrhagic myelitis caused by varicella-zoster virus in an immunocompetent adolescent. Neurologist 2015; 19 (04) 93-95
• 142 Bourre B, Lefaucheur R, Ahtoy P, Travers F, Fetter D. Varicella-zoster virus acute myelitis in a patient with MS treated with natalizumab. Neurology 2013; 81 (22) 1966-1967
• 143 Cuello JP, Romero J, de Ory F, de Andrés C. Longitudinally extensive varicella-zoster virus myelitis in a patient with multiple sclerosis. Spine 2013; 38 (20) E1282-E1284
• 144 Hernández-Albújar S, Arribas JR, Royo A, González-García JJ, Peña JM, Vázquez JJ. Tuberculous radiculomyelitis complicating tuberculous meningitis: case report and review. Clin Infect Dis 2000; 30 (06) 915-921
• 145 Marais S, Roos I, Mitha A, Mabusha SJ, Patel V, Bhigjee AI. Spinal tuberculosis: clinicoradiological findings in 274 patients. Clin Infect Dis 2018; 67 (01) 89-98
• 146 Goldstein J, Dangayach N, Riley D. An almost crypto(genic) cause of radiculopathy. Neurology 2012;78(1 Suppl):P01.253
• 147 So YT, Olney RK. Acute lumbosacral polyradiculopathy in acquired immunodeficiency syndrome: experience in 23 patients. Ann Neurol 1994; 35 (01) 53-58
• 148 Corral I, Quereda C, Casado JL. et al. Acute polyradiculopathies in HIV-infected patients. J Neurol 1997; 244 (08) 499-504
• 149 Talpos D, Tien RD, Hesselink JR. Magnetic resonance imaging of AIDS-related polyradiculopathy. Neurology 1991; 41 (12) 1995-1997
• 150 Wallis E, Al-Hakim B, Holmes P, Douthwaite S, Kulasegaram R. Avoiding a lumbar puncture may be a rash decision: a case report of varicella-zoster virus-associated radiculopathy in advanced HIV infection. Int J STD AIDS 2019; 30 (10) 1031-1033
• 151 Skripuletz T, Pars K, Schulte A. et al. Varicella zoster virus infections in neurological patients: a clinical study. BMC Infect Dis 2018; 18 (01) 238
• 152 Zubair AS, Hunt C, Watson J, Nelson A, Jones Jr LK. Imaging findings in patients with zoster-associated plexopathy. AJNR Am J Neuroradiol 2017; 38 (06) 1248-1251
• 153 Nelson A, Watson J, Reda H, Jones L. Zoster associated limb paresis (ZALP) is associated with prolonged weakness and pain: a natural history study. Neurology 2014; 82 (10) P6.107
• 154 Lipson BK, Freeman WR, Beniz J. et al. Optic neuropathy associated with cryptococcal arachnoiditis in AIDS patients. Am J Ophthalmol 1989; 107 (05) 523-527
• 155 Garg RK, Malhotra HS, Kumar N, Uniyal R. Vision loss in tuberculous meningitis. J Neurol Sci 2017; 375: 27-34
• 156 Munro M, Yadavalli T, Fonteh C, Arfeen S, Lobo-Chan A-M. Cytomegalovirus retinitis in HIV and non-HIV individuals. Microorganisms 2019; 8 (01) 55
• 157 Biswas J, Choudhry S, Priya K, Gopal L. Detection of cytomegalovirus from vitreous humor in a patient with progressive outer retinal necrosis. Indian J Ophthalmol 2002; 50 (04) 319-321
• 158 Cochrane TF, Silvestri G, McDowell C, Foot B, McAvoy CE. Acute retinal necrosis in the United Kingdom: results of a prospective surveillance study. Eye (Lond) 2012; 26 (03) 370-377 , quiz 378
• 159 Goldberg RA, Reichel E, Oshry LJ. Bilateral toxoplasmosis retinitis associated with ruxolitinib. N Engl J Med 2013; 369 (07) 681-683
• 160 Wu XN, Lightman S, Tomkins-Netzer O. Viral retinitis: diagnosis and management in the era of biologic immunosuppression: a review. Clin Exp Ophthalmol 2019; 47 (03) 381-395
• 161 Park KH, Bang JH, Park WB. et al. Retrobulbar optic neuritis and meningoencephalitis following progressive outer retinal necrosis due to CMV in a patient with AIDS. Infection 2008; 36 (05) 475-479
• 162 Long HM, Dick A. Presumed CMV associated necrotizing retinopathy in a non-HIV immunocompromised host. Clin Exp Ophthalmol 2005; 33 (03) 330-332
• 163 Engstrom Jr RE, Holland GN, Margolis TP. et al. The progressive outer retinal necrosis syndrome. A variant of necrotizing herpetic retinopathy in patients with AIDS. Ophthalmology 1994; 101 (09) 1488-1502
• 164 Brinkman K, Debast S, Sauerwein R, Ooyman F, Hiel J, Raemaekers J. Toxoplasma retinitis/encephalitis 9 months after allogeneic bone marrow transplantation. Bone Marrow Transplant 1998; 21 (06) 635-636
• 165 Nussenblatt RB, Belfort Jr R. Ocular toxoplasmosis. An old disease revisited. JAMA 1994; 271 (04) 304-307
• 166 Gagliuso DJ, Teich SA, Friedman AH, Orellana J. Ocular toxoplasmosis in AIDS patients. Trans Am Ophthalmol Soc 1990; 88: 63-86 , discussion 86–88
• 167 Nagel MA, Bennett JL, Khmeleva N. et al. Multifocal VZV vasculopathy with temporal artery infection mimics giant cell arteritis. Neurology 2013; 80 (22) 2017-2021
• 168 Berger JR, Kaszovitz B, Post MJD, Dickinson G. Progressive multifocal leukoencephalopathy associated with human immunodeficiency virus infection. A review of the literature with a report of sixteen cases. Ann Intern Med 1987; 107 (01) 78-87
• 169 Yousry TA, Pelletier D, Cadavid D. et al. Magnetic resonance imaging pattern in natalizumab-associated progressive multifocal leukoencephalopathy. Ann Neurol 2012; 72 (05) 779-787
• 170 Carson KR, Evens AM, Richey EA. et al. Progressive multifocal leukoencephalopathy after rituximab therapy in HIV-negative patients: a report of 57 cases from the Research on Adverse Drug Events and Reports project. Blood 2009; 113 (20) 4834-4840
• 171 Carson KR, Focosi D, Major EO. et al. Monoclonal antibody-associated progressive multifocal leucoencephalopathy in patients treated with rituximab, natalizumab, and efalizumab: a review from the Research on Adverse Drug Events and Reports (RADAR) Project. Lancet Oncol 2009; 10 (08) 816-824
• 172 Sudhakar P, Bachman DM, Mark AS, Berger JR, Kedar S. Progressive multifocal leukoencephalopathy: recent advances and a neuro-ophthalmological review. J Neuroophthalmol 2015; 35 (03) 296-305
• 173 Tan CS, Koralnik IJ. Progressive multifocal leukoencephalopathy and other disorders caused by JC virus: clinical features and pathogenesis. Lancet Neurol 2010; 9 (04) 425-437
• 174 Horger M, Beschorner R, Beck R. et al. Common and uncommon imaging findings in progressive multifocal leukoencephalopathy (PML) with differential diagnostic considerations. Clin Neurol Neurosurg 2012; 114 (08) 1123-1130
• 175 Liman TG, Bohner G, Heuschmann PU, Endres M, Siebert E. The clinical and radiological spectrum of posterior reversible encephalopathy syndrome: the retrospective Berlin PRES study. J Neurol 2012; 259 (01) 155-164
• 176 Fugate JE, Rabinstein AA. Posterior reversible encephalopathy syndrome: clinical and radiological manifestations, pathophysiology, and outstanding questions. Lancet Neurol 2015; 14 (09) 914-925
• 177 Feske SK. Posterior reversible encephalopathy syndrome: a review. Semin Neurol 2011; 31 (02) 202-215
• 178 Nightingale S, Wood C, Ainsworth J. The posterior reversible encephalopathy syndrome in HIV infection. BMJ Case Rep 2012; 2012: bcr0120125647
• 179 Bestetti A, Pierotti C, Terreni M. et al. Comparison of three nucleic acid amplification assays of cerebrospinal fluid for diagnosis of cytomegalovirus encephalitis. J Clin Microbiol 2001; 39 (03) 1148-1151
• 180 Zhang F, Tetali S, Wang XP, Kaplan MH, Cromme FV, Ginocchio CC. Detection of human cytomegalovirus pp67 late gene transcripts in cerebrospinal fluid of human immunodeficiency virus type 1-infected patients by nucleic acid sequence-based amplification. J Clin Microbiol 2000; 38 (05) 1920-1925
• 181 Lakeman FD, Whitley RJ. National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group. Diagnosis of herpes simplex encephalitis: application of polymerase chain reaction to cerebrospinal fluid from brain-biopsied patients and correlation with disease. J Infect Dis 1995; 171 (04) 857-863
• 182 Whitley RJ. Herpes simplex virus infections of the central nervous system. Continuum (Minneap Minn) 2015; 21 (6 Neuroinfectious Disease): 1704-1713
• 183 Cinque P, Vago L, Ceresa D. et al. Cerebrospinal fluid HIV-1 RNA levels: correlation with HIV encephalitis. AIDS 1998; 12 (04) 389-394
• 184 Plavina T, Subramanyam M, Bloomgren G. et al. Anti-JC virus antibody levels in serum or plasma further define risk of natalizumab-associated progressive multifocal leukoencephalopathy. Ann Neurol 2014; 76 (06) 802-812
• 185 Koralnik IJ, Boden D, Mai VX, Lord CI, Letvin NL. JC virus DNA load in patients with and without progressive multifocal leukoencephalopathy. Neurology 1999; 52 (02) 253-260
• 186 Borges AS, Figueiredo JF. Detection of anti-Toxoplasma gondii IgG, IgM and IgA immunoglobulins in the serum, cerebrospinal fluid and saliva of patients with acquired immunodeficiency syndrome and neurotoxoplasmosis. Arq Neuropsiquiatr 2004; 62 (04) 1033-1037
• 187 Foy PC, van Burik J-AH, Weisdorf DJ. Galactomannan antigen enzyme-linked immunosorbent assay for diagnosis of invasive aspergillosis after hematopoietic stem cell transplantation. Biol Blood Marrow Transplant 2007; 13 (04) 440-443
• 188 Onishi A, Sugiyama D, Kogata Y. et al. Diagnostic accuracy of serum 1,3-β-D-glucan for pneumocystis jiroveci pneumonia, invasive candidiasis, and invasive aspergillosis: systematic review and meta-analysis. J Clin Microbiol 2012; 50 (01) 7-15
• 189 Clifford DB, Arribas JR, Storch GA, Tourtellote W, Wippold FJ. Magnetic resonance brain imaging lacks sensitivity for AIDS associated cytomegalovirus encephalitis. J Neurovirol 1996; 2 (06) 397-403
• 190 Holland NRM, Power C, Mathews VP, Glass JD, Forman M, McArthur JCM. Cytomegalovirus encephalitis in acquired immunodeficiency syndrome (AIDS). Neurology 1994; 44 (3, Pt 1): 507-514
• 191 Sili U, Kaya A, Mert A. HSV Encephalitis Study Group. Herpes simplex virus encephalitis: clinical manifestations, diagnosis and outcome in 106 adult patients. J Clin Virol 2014; 60 (02) 112-118
• 192 Friedman DP, Flanders AE. MR imaging of BK virus encephalitis. AJNR Am J Neuroradiol 2006; 27 (05) 1016-1018
• 193 Shah R, Bag AK, Chapman PR, Curé JK. Imaging manifestations of progressive multifocal leukoencephalopathy. Clin Radiol 2010; 65 (06) 431-439
• 194 Ashdown BC, Tien RD, Felsberg GJ. Aspergillosis of the brain and paranasal sinuses in immunocompromised patients: CT and MR imaging findings. AJR Am J Roentgenol 1994; 162 (01) 155-159
• 195 Levy RM, Mills CM, Posin JP, Moore SG, Rosenblum ML, Bredesen DE. The efficacy and clinical impact of brain imaging in neurologically symptomatic AIDS patients: a prospective CT/MRI study. J Acquir Immune Defic Syndr (1988) 1990; 3 (05) 461-471
• 196 Cinque P, Scarpellini P, Vago L, Linde A, Lazzarin A. Diagnosis of central nervous system complications in HIV-infected patients: cerebrospinal fluid analysis by the polymerase chain reaction. AIDS 1997; 11 (01) 1-17
• 197 Datar S, Singh T, Rabinstein AA, Fugate JE, Hocker S. Long-term risk of seizures and epilepsy in patients with posterior reversible encephalopathy syndrome. Epilepsia 2015; 56 (04) 564-568