title: CNS infections in patients with hematological disorders (including allogeneic stem-cell transplantation)-Guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO).
abstract: Infections of the central nervous system (CNS) are infrequently diagnosed in immunocompetent patients, but they do occur in a significant proportion of patients with hematological disorders. In particular, patients undergoing allogeneic hematopoietic stem-cell transplantation carry a high risk for CNS infections of up to 15%. Fungi and Toxoplasma gondii are the predominant causative agents. The diagnosis of CNS infections is based on neuroimaging, cerebrospinal fluid examination and biopsy of suspicious lesions in selected patients. However, identification of CNS infections in immunocompromised patients could represent a major challenge since metabolic disturbances, side-effects of antineoplastic or immunosuppressive drugs and CNS involvement of the underlying hematological disorder may mimic symptoms of a CNS infection. The prognosis of CNS infections is generally poor in these patients, albeit the introduction of novel substances (e.g. voriconazole) has improved the outcome in distinct patient subgroups. This guideline has been developed by the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO) with the contribution of a panel of 14 experts certified in internal medicine, hematology/oncology, infectious diseases, intensive care, neurology and neuroradiology. Grades of recommendation and levels of evidence were categorized by using novel criteria, as recently published by the European Society of Clinical Microbiology and Infectious Diseases.
authors.affiliation: Department of Hematology, Oncology and Tumor Immunology, HELIOS Clinic Berlin-Buch, Berlin martin.schmidt-hieber@helios-kliniken.de.
authors.forename: M
authors.initials: M
authors.lastname: Schmidt-Hieber
authors.affiliation: Department of Hematology, Oncology and Stem Cell Transplantation, University Hospital, Aachen, Medical Faculty, RWTH Aachen, Aachen.
authors.forename: G
authors.initials: G
authors.lastname: Silling
authors.affiliation: Department of Hematology and Oncology, Otto-von-Guericke University Hospital Magdeburg, Magdeburg.
authors.forename: E
authors.initials: E
authors.lastname: Schalk
authors.affiliation: Department of Internal Medicine II, University Hospital Würzburg, Center of Internal Medicine, Würzburg.
authors.forename: W
authors.initials: W
authors.lastname: Heinz
authors.affiliation: Department of Hematology, Oncology and Stem Cell Transplantation, University Hospital, Aachen, Medical Faculty, RWTH Aachen, Aachen.
authors.forename: J
authors.initials: J
authors.lastname: Panse
authors.affiliation: Department of Hematology, Oncology and Tumor Immunology, Charité University Medicine, Campus Virchow Clinic, Berlin.
authors.forename: O
authors.initials: O
authors.lastname: Penack
authors.affiliation: Department of Stem Cell Transplantation, University Medical Center Hamburg Eppendorf, Hamburg.
authors.forename: M
authors.initials: M
authors.lastname: Christopeit
authors.affiliation: Department of Hematology and Oncology, Mannheim University Hospital, University of Heidelberg, Mannheim.
authors.forename: D
authors.initials: D
authors.lastname: Buchheidt
authors.affiliation: Department of Neurology, Hospital Nordwest Frankfurt, Frankfurt/M., Germany Brunei Neuroscience Stroke and Rehabilitation Centre, Jerudong, Brunei Darussalam Department of Neuroinfectiology, Otto-Meyerhof-Centre, University of Heidelberg, Heidelberg.
authors.forename: U
authors.initials: U
authors.lastname: Meyding-Lamadé
authors.affiliation: Department of Neuroradiology, University Hospital Heidelberg, Heidelberg.
authors.forename: S
authors.initials: S
authors.lastname: Hähnel
authors.affiliation: Department of Hematology and Oncology, University Hospital Halle, Halle.
authors.forename: H H
authors.initials: HH
authors.lastname: Wolf
authors.affiliation: Paracelsus Clinic Osnabrück, Osnabrück.
authors.forename: M
authors.initials: M
authors.lastname: Ruhnke
authors.affiliation: Department of Hematology and Oncology, Charité University Medicine, Campus Benjamin Franklin, Berlin.
authors.forename: S
authors.initials: S
authors.lastname: Schwartz
authors.affiliation: Department of Hematology, Oncology and Palliative Care, Ernst von Bergmann Clinic, Potsdam, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Maschmeyer
mesh_terms: D002490:Central Nervous System / Q000382:microbiology / Q000503:physiopathology*; D003141:Communicable Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology / Q000503:physiopathology*; D005858:Germany / Q000453:epidemiology; D017408:Guidelines as Topic; D006402:Hematologic Diseases / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology* / Q000503:physiopathology; D006405:Hematology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D008495:Medical Oncology; D014122:Toxoplasma / Q000472:pathogenicity; D065819:Voriconazole / Q000627:therapeutic use
chemical_list: D065819:Voriconazole
keywords: central nervous system infection; diagnosis; guideline; immunocompromised patient; treatment