ABSTRACT

Central nervous system (CNS) infections represent an important complication in cancer patients undergoing therapy. These infections are often difficult to diagnose, a high level of suspicion, prompt investigation and institution of appropriate and early therapy remains critical for improved outcomes. A wide variety of viruses, bacteria, mycobacteria, fungi and parasitic meningeal and brain disease makes empiric selection of antimicrobial therapy a daunting task. The factors that assist in the selection of initial therapy includes predisposing factors such as a) presence of prosthetic devices, b) surgical manipulation, c) host’s immune defects either related to underlying malignancy, antineoplastic chemotherapy, or d) complications arising from stem cell transplantation to name a few. For instance, patients with severe neutropenia have an increased risk for bacterial meningitis due to Gram negative organisms, and fungal brain abscesses, where as patients with profound cellular immune defects are susceptible to Listeria monocytogenes infection, Cryptococcal meningitis and recrudescent herpes viruses and toxoplasmosis. In evaluation of patients with CNS infections a knowledge of non-infectious causes that are clinically difficult to distinguish from an infection also need to be considered. In this regard, neoplastic meningitis, paraneoplastic syndrome and recently described chemotherapy-induced reversible posterior leukoencephalopathy syndrome, are to name a few. Mental confusion and fever related to a drug is a important consideration in this population