title: Central nervous system infections in heart transplant recipients.
abstract: OBJECTIVE
  To study central nervous system infections after heart transplantations.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  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), varicella-zoster 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.
authors.affiliation: Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
authors.forename: Diederik
authors.initials: D
authors.lastname: van de Beek
authors.forename: Robin
authors.initials: R
authors.lastname: Patel
authors.forename: Richard C
authors.initials: RC
authors.lastname: Daly
authors.forename: Christopher G A
authors.initials: CG
authors.lastname: McGregor
authors.forename: Eelco F M
authors.initials: EF
authors.lastname: Wijdicks
mesh_terms: D000328:Adult; D002494:Central Nervous System Infections / Q000209:etiology* / Q000401:mortality; D015331:Cohort Studies; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents