Fungal encephalitis following bone marrow transplantation: clinical findings and prognosis.
BACKGROUND
Central nervous system fungal infections (FI) are important complications and a cause of mortality in patients who receive hematopoietic stem cell transplantation (HSCT).


OBJECTIVE
To study the clinical aspects of fungal encephalitis (FE).


METHODS
The study was carried out at the HSCT Center of the Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil.


METHODS
Clinical records and autopsy reports from patients submitted to HSCT with a diagnosis of FE.


RESULTS
Twelve patients were diagnosed with FE presenting with lowered level of consciousness, hemiparesis and seizures. We were able to identify two subgroups regarding susceptibility to FE: (1) patients with early onset FI and severe leucopenia, and (2) patients with later onset FI with graft-versus-host disease using immunosuppressive drugs. Eleven of the patients died directly due to the neurological complication, all had post-mortem confirmation of the diagnosis of FI.


CONCLUSIONS
These clinical, paraclinical and temporal patterns may provide the opportunity for earlier diagnosis and interventions.
Teive
Hag
H
Neurology Service, Department of Internal Medicine, Hospital de Clínicas, Federal University of Paraná, Curitiba, Pr, Brazil. hagteive@mps.com.br
Carsten
A L M
AL
Iwamoto
F M
FM
Almeida
S M
SM
Munhoz
R P
RP
Werneck
L C
LC
Medeiros
C R
CR
Pasquini
R
R
D000293:Adolescent; D000328:Adult; D001938:Brazil; D020314:Central Nervous System Fungal Infections / Q000150:complications / Q000209:etiology* / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D004660:Encephalitis / Q000150:complications* / Q000276:immunology; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology* / Q000276:immunology / Q000401:mortality; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D019172:Transplantation Conditioning / Q000009:adverse effects*; D055815:Young Adult